The National Health Policy (NHP, 2017) emphasizes universal health care with a comprehensive primary health care approach to ensure ‘health for all’. The policy envisages attaining the highest possible level of health and well-being for all through preventive and promotive health care and universal access to good quality health care services.
Over the years, progress has been made in providing better healthcare services. The National Health Mission program has brought tangible changes in the health sector, particularly for those living in rural areas. However, despite the promises made in the NHP and numerous government initiatives, the desired health outcomes remain elusive.
Rural healthcare faces multiple challenges that could be addressed by making it accountable to people through Panchayats, the local self-government institutions. By empowering these grassroots bodies, a more transparent, responsive, and effective rural healthcare system is foreseeable.
The Jharkhand government’s 2015 decision to bring rural health services under the purview of Panchayati Raj Institutions (PRI) and Zila Parishads was a welcome move towards making the health system more accountable to the people, community, and local bodies. The idea was to empower gram panchayats to strengthen the health system and ensure the presence of doctors and health workers at the health posts and sub-centers. It also provisioned that the reports related to the attendance of doctors would be sent to the civil surgeon by the Mukhiya after verification by the gram panchayat.
Under this system, assistant nurses and midwives (ANM) were required to apply to the Mukhiya for leave, and they would receive their salary only after the gram panchayat’s approval. Even at the district level, it was provisioned that the civil surgeons would get approval from the chairman and district council to avail a casual leave. It was opposed by the doctors in the state and their association, the Jharkhand State Health Services Association (JSHSA), with a threat of mass resignation, forcing the government not to implement it.
The presence of doctors in their respective health posts is a serious issue and must be ensured for effective and timely health care for people. Although no recent data is available, a multi-state study by IMS Health in 2013 showed that doctor absenteeism in Jharkhand was 57 percent.
Such cases of doctor absenteeism can be addressed by making them accountable to Panchayats. Many such issues can be addressed by making it mandatory for doctors and health personnel to be present at their assigned health posts and serve the people. The Jharkhand government did not implement their decision due to threats from the doctors’ association. The Jharkhand government should have stuck to their decision as people’s health must not be compromised.
Panchayats must focus on health and oversee healthcare services in their jurisdictions. Clear guidelines and frameworks need to be established with detailed roles and responsibilities.
Panchayats often lack the technical expertise needed to manage healthcare services effectively. Therefore, capacity-building initiatives are crucial. Panchayats must be provided financial autonomy to exercise their healthcare responsibilities effectively. This will enable Panchayats to undertake health-related projects, maintain healthcare infrastructure, and ensure the availability of essential medicines and supplies. One of the strengths of Panchayats is their ability to mobilize community participation. Engaging the local community in health programs can lead to better health outcomes.
Making Panchayats accountable to rural healthcare is not a solution for all the issues plaguing the system. Nevertheless, it is a significant step towards empowering their administrative authority, financial resources, and technical expertise to make the rural healthcare system more responsive and accountable.
The author is a Professor at Xavier Institute of Social Service, Ranch. The views expressed are personal.
Email: pandeyanant@hotmail.com
