Health System in Himachal Pradesh
Himachal Pradesh is a hilly state located in the north- west of the country. There are wide physical variations ranging from low hills to high mountains with lakes and flowing rivers in the state. The state has an area of 55, 673 sq. km, and it accounts for 1.75 percent of India’s total geographical area. The state is having 12 districts with a population of 68, 64,602. The density of population is 123 persons per sq.km. Himachal Pradesh with an urban population of only10.03 percent of the total population has 56 cities and towns. The majority (89.9) of the population is in rural settlements varying in size from isolated hamlets to conglomerated settlements. About the half of the area is covered under the tribal belt with a population of just 5.71lakh (Census of India, 2011).
The health services in the state are being provided by the Department of Health and Family Welfare through the network of 52 civil hospitals, 77 community health centres, 453 primary health centres, 23 civil dispensaries and 2,067 sub-centres. To support these services, various provisions have been made for secondary level health care facilities through specialised hospitals and those attached to state medical colleges.
1. Infrastructure System :
Education/ Research institutes :
Tanda Medical College : Dr. Rajendra Prasad Government Medical College Kangra is medical college and hospital located in Tanda, Kangra, Himachal Pradesh.[1] Originally, being a TB sanitorium, inaugurated by the then President of India, Dr. Rajendra Prasad, the State Government decided to set up a new medical college here in 1996.
IGMC, Shimla : Himachal Pradesh Medical College at Shimla (HPMC) was established in the year 1966 with admissions of 50 students in the first batch. Indira Gandhi Medical College is affiliated to Himachal Pradesh University, Shimla. With the establishment of Medical College in the State, the hopes and aspirations of the people of the state were met with the standards of health services going on and students benefiting with the advantage of staying home and getting better educational avenues. Himachal Pradesh Medical College was renamed Indira Gandhi Medical College (now popularly known as IGMC in abbreviated form) in 1984.
AIIMS, Bilaspur :Union govt. approved setting up of an AIIMS in Bilaspur in Himachal Pradesh with an outlay of Rs 1,350 crore under the Pradhan Mantri Swasthya Surakhsa Yojna (PMSSY).
According to an official statement, the 750-bed AIIMS will have a medical college with an intake capacity of 100 seats and a nursing college with 60 seats.
It will also have an AYUSH department with 30 beds for treatment in traditional system of medicine. "The new AIIMS will also help create a large pool of doctors and other health workers in the region, who would be available for primary and secondary level institution facilities being created under National Health Mission,"
Hospitals :
In Himachal Pradesh hospital-population ratio is 0.79 hospital per lakh persons which is much less than other hilly states of India where there are 2.20 hospitals per lakh persons (National Health Profile, 2011). In as many as five districts including Kinnaur, Lahaul & Spiti, Shimla, Sirmaur and Solan, the number of hospitals per one lakh persons was higher than the state average of 0.79 hospitals per 1 lakh persons. In the districts of Hamirpur, Bilaspur, Una, Kangra, Mandi, Kullu and Chamba the number of hospitals per 1 lakh persons was much less than the state . The districts of Lahaul & Spiti, Kinnaur and Shimla had more than 1 hospital per lakh persons in the state. In all the remaining districts, except Hamirpur, hospital-population ratio ranged between 0.50 and 1.00 hospital per lakh persons. The district of Hamirpur revealed a pathetic situation, with regard to availability of hospitals as there was not even 1 hospital for 2 lakh persons in the district (Fig.-1(A). The spatial distribution of hospitals thus shows that tribal areas are far better in terms of availability of hospitals.
Community Health Centres (CHCs) :
The state had 0.91 community health centre per 80,000 persons as compared to other hilly states of India which had 0.45 community health centre per 80,000 persons (NHP, 2011). The districts of Kullu, Bilaspur, Chamba, Mandi, Kinnaur and Lahaul& Spiti possessed higher number of community health centre per 80,000 persons. The remaining districts had less number of community health centres per 80,000 persons than the state average.
Primary Health Centres (PHCs) :
There were 1.39 primary health centres per 20,000 persons in Himachal Pradesh in 2011. This ratio is comparatively lower International Journal of Advanced Research and Development 235 than in other hill states in India.
Health Sub-Centres (HSCs) :
In Himachal pradesh health sub-centre-population ratio was 0.90 health sub-centre per 3000 persons, which was higher than other hill states in India where this ratio was 0.48 health sub-centre per 3000 persons in 2011 (NHP, 2011) [14]. In Bilaspur, Shimla, Solan, Mandi, Hamirpur, Chamba, Kinnaur and Lahaul&Spiti the number of health sub-centre per 3000 persons was higher than the state average (Table-2). In Kangra, Kullu, Sirmaur and Una the number of health subcentre was however less than the state average of health subcentre per 3000 persons.
2. Human Resources :
Human and physical resources are the key components of health system. These resources may include human health resources such as doctors, nurses, techinal staff etc. and physical health resources such as beds, machines, equipments etc.
Doctors
Doctors include physicians, surgeons and specialists of different branches. To present the availability of doctors in the study area under study doctor-population ratio (number of doctors per 10,000 persons) has been calculated. There are wide variations in number of doctors across the districts; the number ranges from 7.3 doctors per 10,000 persons in district Lahaul & Spiti to 1.2 doctors per 10,000 persons in district Kangra. In terms of availability of doctors per 10,000 persons, districts of Lahaul & Spiti, Kinnaur and Shimla had more than 2.5 doctors per 10,000 persons in the state. The number of doctors was the lowest in the disticts of Chamba, Kangra, Mandi, Sirmaur and Una and it was less than 1.5 doctors per 10,000 persons.
Nurses
The availability of nurses across the districts of Kangra, Una, Mandi, Solan and Sirmaur is less than 3 nurses per 10,000 persons (Fig.- 2 B). In the districts of Chamba, Kinnaur, Hamirpur, Bilaspur and Shimla the availability of nurses had ranged between 3 and 5 nurses per 10,000 persons. There were only 3 districts including Lahaul&Spiti, Kullu and Bilaspur where the number of nurses was more than 5 nurses per 10,000 persons.
3. Availability of Health services :
The level of availability of health services in any region manifests the level of health and human well- being in that region. There are wide regional imbalances in the availability of different components of health care infrastructure, physical and human. The districts thus, found with high availablity of health services are Lahaul & Spiti, Kinnaur and Shimla with composite index value of above 0.18. Bilaspur, Chamba, Solan, Kullu and Hamirpur districts displayed a moderate level (index value of between 0.09 and 0.18) of availbility of health services. Kangra, Sirmaur, Mandi and Una registered a low level of availability of health services with the composite index value of less than 0.09 . The high level of availability of health services in district Shimla can be attributed to the fact that Shimla is the state capital and has a large proportion of urban population (Census of India, 2011). Districts Kangra, Sirmaur, Mandi and Una on the other hand, had low level of health services. Such a pattern of availability of health services may be due to peculiar geographical conditions, unequal distribution of population, political issues, specific policies and economic conditions of the state. So, there is an urgent need for planned development of health services.
4. Steps taken to enhance health services :
Universal Healthcare :
The Himachal Pradesh government is planning to set up a healthcare model which will run like a trust, fully funded by the money that patients would otherwise pay as out of pocket (OOP) expenses — money spent on purchase of medical care that is not reimbursed. Logic is that people have to spend that money anyway on OOP expenditures on drugs, consultation fess etc. If we can persuade the paying community to pay even half of the annual amount spent as OOP, can pool that money and be able to universalise healthcare,”
According to the World Health Organisation (WHO), Indians spend a whopping 85.9 per cent on purchasing healthcare, considered as among the highest in the world. The HP government maintains that a patient in the State spends approximately Rs. 2,600/per capita as OOP expenses. In the proposed scheme, beneficiaries will pre-pay the same amount spent annually as OOP for free access to care through the year. Further, people who are not the below poverty line (BPL) may contribute a nominal amount for healthcare services.
Telemedicine :
The use of telecommunication and information technology to provide clinical health care from a distance. It has been used to overcome distance barriers and to improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.
Scope of Project To improve the health services of the State by providing access to medical specialists/ experts from PGI/ IGMC to common man even at PHC/CHC level. 20 remote locations connected to IGMC Shimla which is further connected to PGI Chandigarh
Emergency Response Services in Himachal Pradesh :
Aims to provide comprehensive Emergency Response Service in the State of Himachal Pradesh. The government of Himachal Pradesh has selected a private provider to provide emergency response services. The private provider, EMRI, is responsible for design, procurement, operation and maintenance of the emergency response services, including procurement of ambulances, set up of IT Infrastructure, operations and maintenance.
Capital expense of 120 Million is provided by the government. A fixed operational expense of 50,000 per ambulance per month is provided by the government.Operates ambulances with 24 x 7 availability 365 days a year.
Health in Tourism :
Himachal Pradesh Tourism Development Corporation Ltd. has taken an initiative to start Ayurvedic Rejuvenation Therapy at Hotel Holiday Home, Shimla and The Palace, Chail and Ayurvedic Treatments at Hotel Tea-Bud Palampur which includes different Indian Medical Therapy System. The Corporation has initiated this on trial basis and is planning to invite outside parties for establishing health resorts in Himachal Pradesh with an objective to boost health tourism in the state.
Conclusion :
Though the overall availability of existing health services in Himachal Pradesh is adequate as compared with the standard norms of hill states of India, yet the distribution of these Keeping in view the existing low level of availability of health services in many districts of the state, it seems important to mention here that intensive efforts are required towards making health services accessible and available to the people of state through rationalization of health services and minimizing their inter and intra-regional differences.