Health Sector in Uttarakhand
INTRODUCTION
Uttarakhand is the 27th state of republic India which was carved out of Uttar Pradesh on 9th Nov, 2000. Uttarakhand is having 53, 483 sq. km area which has been divided in 13 districts divided in two divisions‟ Kumaun and Garhwal. Almora, Bageshwar, Champawat, Nainital, Pithoragarh and Udhamsinghnagar districts are in Kumaun division while Dehradun, Haridwar, Tehri Garhwal, Uttarkashi, Chamoli, Pauri Garhwal and Rudraprayag districts are in Garhwal division. Out of these 13 districts, 3 districts are plain and remaining 10 are hill districts. Geographically the state can broadly be divided into 3 zones. Upper Hills – Uttarkashi, Chamoli, Rudraprayag, Pithoragarh and Bageshwar. Middle Hills – Tehri Garhwal, Pauri Garhwal, Almora, Champawat, the hill regions of Nainital and Chakrata tehsil of Dehradun. Foot Hills – The remaining are of Dehradun, Haridwar, Udham Singh Nagar and the remaining area of Nainital. According 2011 Census of India, Uttarakhand population has reached approximately 1.01 Crore with an increase of 19.17 percent from the past decade. Uttarakhand feeds approximately 0.84% of India‟s total population. As per census report of Uttarakhand, the total population of the State is 10,116,752; of which male and female are 5,154,178 and 4,962,574, respectively which has increased from 84,89,349, the total population of the state as per Census 2001 where 43,25,924 were males and 41,63,425 were females. With regards to Sex Ratio, the state has demonstrated that it has the better indicators than the national averages. As per Census 2011, Uttarakhand‟s Sex Ratio stands out at 963 which was at 962 in 2001 census and fares better as compared to average sex ratio of India (940) but the child sex ratio (886) of Uttarakhand remains a matter of concern and needs immediate enforcement of PC&PNDT Act in full force along with behaviour change communications to stop female foeticide.
State Health Infrastructure:
| S.No | Health Facility | Number of Institutions |
| 1 | District Hospitals | 12 |
| 2 | Female Hospitals | 06 |
| 3 | Base Hospitals | 03 |
| 4 | Combined Hospitals | 15 |
| 5 | CHC including Identified FRUs | 55 |
| 6 | PHC’s | 239 |
| 7 | Sub Centre | 1765 |
| 8 | State Allopathic Dispensaries | 322 |
| 9 | Ayurvedic Hospitals & Dispensaries | 543 |
| 10 | Homeopathic Dispensaries | 107 |
| 11 | Unani Hospitals | 03 |
| 12 | Blood Banks | 23 |
| 13 | T.B.Clinic | 13 |
Uttarakhand is a predominantly rural state with 16,826 rural settlements, of which 12,699 or 81% have a population of less than 500. In most of the districts, more than 75-85 % of rural settlements have a population of less than 500. Only 17 % of the rural settlements have a population ranging between 500-1999 and the villages with population of 2000 or more are very rare (2.7 %). The small size of settlements and their widespread distribution is a formidable challenge for service delivery in the state of Uttarakhand with such a high percentage of small and scattered hamlets mainly in the tough geographic conditions.
CURRENT HEALTH PROJECTS IN UTTARAKHAND
- A) U Health Card : This is the initiative and the innovative step taken first time by any State Govt. to provide cashless scheme to its employees & pensioners.
- B) Health Management Information System (HMIS):
1) Ministry of Health and Family Welfare launched the National Rural Health Mission (NRHM) to ensure necessary architectural corrections in the basic health care delivery system. The plan of action includes: increasing public expenditure on health, reducing regional imbalance in health infrastructure, pooling resources, integration of organizational structures, optimization of health manpower, decentralization and District management of health programmes, community participation and ownership of assets, induction of management and financial personnel into District health systems, and operationalizing Community Health Centres into functional hospitals in each Block across the country that meet Indian Public Health Standards.
2) It is a tool which helps in gathering, aggregating, analysing and then using the information generated for taking actions to improve performance of health systems.
- C) Janani-Shishu Suraksha Karyakram (JSSK):
1) Janani –Shishu Suraksha Karyakram is a step further in ensuring better facilities for women and child health services. State ensures that benefits under JSSK would reach every needy pregnant woman coming to government institutional facility.The new initiative of JSSK would provide completely free and cashless services to pregnant women.
2) Mother and Child Tracking System (MCTS) The most common reason why this potential could not be realized is that the health care delivery system is not able to deliver even the low cost appropriate medical technology to all pregnant women and children. It is argued that if the efficiency of the health care delivery system is improved in terms of ensuring universal access to all pregnant women and children to maternal and child health services, reduction in maternal, infant and child mortality can be accelerated significantly.
- D) State ASHA Resource Centres (SARC)
Accredited social health activist (ASHA) is a key link to public health services in villages in India. We conducted a cross-sectional study to determine the proportion of women utilizing services of the ASHA for pregnancy-related conditions. We assessed the knowledge, attitude, practices, hindrances and motivation factors among ASHAs regarding pregnancy-related conditions. We also sought to determine the factors associated with the utilization of ASHAs for pregnancy-related services. Presently 11086 ASHAs are working in Uttarakhand State.
- E) Urban Health Centres
To improve health status of the urban poor through increased coverage of key reproductive child health services and adoption of healthy behaviours.
- F) Adolescent Reproductive and Sexual Health (ARSH)
Adolescents Reproductive & Sexual Health (ARSH) has been identified as one of the four strategies under RCH-II and implementing context – sensitive ARSH intervention in the state is now over three years old. In the year 2008, the ARSH intervention was initiated through a pilot project in the state of state of Uttarakhand with the external support of USAID under Innovations in Family Planning Services (IFPS) grant. The branding of the ARSH program in the state was done as “UDAAN – Understanding, Delivering and Addressing Adolescent Needs”.
- G) School Health Programme (SHP):
School Health Programme is being implemented in the State from the financial year 2010-11. This programme is being run in the state in convergence with education department. There are 38 school health teams functional in the state for health examination of the school children.
- H) Pre-Conception Pre-Natal Diagnostic Techniques:
Communities in Uttarakhand follow a patriarchal system and Female foeticide is the result of high preference for son and patriotic societies. Education is helpful in the development o
f each area but on the issue of increasing female foeticide no impact of education can be seen. Female foeticide is a more prevalent in the cities than in the villages and educated people are involved in this heinous crime.
These are the health initiatives taken by government of Uttarakhand but these are not enough and satisfactory as per National Egovernance Plan (NeGP), 2006 and its implementation in other states. Uttarakhand is also facing so many problems because of its hilly geography and diversified locations on the hills. One of the main problem is to create infrastructure for health. As technology is getting so advanced, Cloud computing based e-health projects can surely help to empower the health sector in Uttarakhand.