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Locational analysis of public and private health services in Rohtak and Bhiwani districts, (India), 1981 to 1996
Naresh Kumar
Centre
for the Study of Regional Development
Jawaharlal Nehru University, New
Delhi-110067,
Fax: +91 11 616 5886, 619 8234
Email: n_kumar17@yahoo.com, naresh@jnuniv.ernet.in
Abstract:
India has a vast network of public and
private health services manned by a large number of medical and paramedical
personnel, but poor locational decisions constrain geographical access to health
services in rural and less developed areas. In this paper, an attempt is made to
examine availability, geographical accessibility and efficiency levels of
Primary Health Centres (PHCs) and private Registered Medical Practitioners
(RMPs) in 920 villages and 14 towns of two districts (Rohtak and Bhiwani,
located in northern west part of India) for three points of time 1981, 1991 and
1996. Rohtak, a part of the National Capital Region, is one of the developed
districts in terms of economic infrastructure and located to the west of Delhi
Union Territory; and Bhiwani, located further to the west of Rohtak district, is
relatively less developed.
The number of PHCs has increased and average
weighted distance to access them also declined from 1981 to 1996, showing an
improvement in the availability of and geographical accessibility to PHCs.
However, there is no sign of improvement in the availability and geographical
access of RMPs, rather their number has declined from 1981 to 1991. The
geographically efficiency level of both public and private health services has
declined from 1981 to 1996. Lack of criterion is one of the important reasons
for poor geographical efficiency of the existing health services locations.
Simulation analysis clearly reveals that the use of location-allocation models
for the planning additional locations of not only health services but also of
other infrastructure services can help improving their geographical
accessibility and efficiency levels.
Introduction:
Health
was/is considered as a crucial component of well being and economic development
(Phillips, 1990). Therefore, with development planning in the Third World
Countries efforts have been made consistently to improve people's health since
the Second World War. Consequently, life expectancy in the Developing Countries
has increased from 40 in 1950 to 62 years in 1990 (1990).
At present,
India has a vast network of public and private health services manned by a large
number of medical and paramedical personnel (Government of India, 1997), but
'health for all' still remains a distant reality, because of poor geographical
access to health services and explosive cost of utilisation. Non-availability
and/or distorted geographical-distribution are some of the important reasons for
poor geographical accessibility not only in India, but also through out the
Developing Countries (Freund, 1986; McEvers, 1980; Stock, 1985; World Bank,
1993). Therefore, better spatial organisation is needed to improve geographical
access to health services.
In India, both public and private sectors are
involved in health care provision. It is important to note that the locational
decisions of both types of these services do not correspond effectively to the
needs of rural population; and locational patterns and functioning of both are
also different. It is observed that most of the time administrative, political
and economic factors supersede locational-suitability of new services.
Therefore, certain areas and sections of the society (especially women and
children in rural areas) do not have adequate access to basic health services
(Oppong and Hodgson, 1994), which result in inter-section and inter-regional
disparities.
Re-location of any service may not be feasible economically,
but location-allocation models can be used to identify new potential locations.
In this paper, location-allocation models are used extensively to fulfil two
main objectives. First, an attempt is made to examine availability, spatial
accessibility and efficiency levels to both public and private health services
in two districts of Haryana State, India for three points of time 1981, 1991 and
1996. Second, to simulate new potential locations and evaluate the feasibility
of location-allocation models for planning additional infrastructure services in
rural areas.
This work is divided into four sections. The first section
is on the introduction of the study area, database and models used. The
availability, spatial accessibility and efficiency level of existing public and
private health services in the area under study are examined in the second
section, which is followed by a simulation analysis of new potential locations.
The results of this work are summarised in the final section along with a brief
discussion on the feasibility of location-allocation models for planning
infrastructure services in rural India.
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