Locational analysis of public and private health services in Rohtak and Bhiwani districts, (India), 1981 to 1996
Study area:
Haryana is
selected for the present study (Figure - 1 and 2a). This state is selected for
two reasons. First, there has been a rapid economic growth in Haryana since the
introduction of the Green Revolution in the 1960s. In 1981, out of the total:
99.6 per cent and 55 per cent of villages of Haryana have electricity and
transport services, respectively; unlike other states Haryana is considered one
of the most economically developed states of the country (Bhalla et al, 1999;
Kumar, 1993). Male and female life expectancy rates in this state are 65.2 and
64.2 respectively against 60.6 and 61.7 years for the country (RGI, 1998).
Second, despite improvement in life expectancy and economic growth, a large
section of the population (a majority of them rural poor and women) does not
have adequate access to basic infrastructure services, especially education and
health. The position of women in Haryana also compares poorly with the other
socially developed states of the country, such as Kerala (Kumar, 1993; Sen,
1996). Out of 16, two districts (namely Rohtak and Bhiwani, which encompass
different geographical, social and economic characteristics, Figure-2b, Table-1)
are selected for the present study. Distance from Delhi UT, which has an inverse
relationship with the concentration of infrastructure services, is the main
criterion for the selection of these two districts. Rohtak is immediately to the
west of Delhi Union Territory and Bhiwani is further to the west of Rohtak
District (see Kumar, 1999 for a detailed discussion on the study area).
Figure 1
Figure 2a
Health statistics in Haryana: Since the
inception of Haryana State in 1966 there has been a significant increase in the
number of health services over a period of three decades (Table-2): per capita
expenditure on health increased from Rs. 1.2 in 1966-67 to Rs. 84.48 in 1995-96
. Expenditure on medical, family welfare, public health, sanitation and water
supply increased from Rs. 385 millions in 1980-81 to Rs. 3367 millions in
1995-96. At 1980-81 prices increase was Rs. 1059 millions, more than 10 per cent
annual growth; and about 10 per cent of the total development and revenue
expenditures were on health services in 1995-96 (Government of Haryana, 1997b).
Annual growth in health expenditure was more than 15 per cent per annum from
1980-81 to 1985-86, falling to less than 5 per cent during the 1985-86 to
1990-91 and less than 10 per cent from 1990-91 to 1995-96.
The number of
CHCs, PHCs and Sub-Centres and trained doctors, and paramedical personnel
increased substantially over the last three decades. Along with Government, the
number of private doctors also increased. An increase in the number of health
services alone could not ensure improvement in geographical access and
efficiency level of health services in less developed areas in general and in
rural areas in particular. The Government of India (1997) places on record that
there are marked disparities in the provision of health services at state and
district levels; and attempts are being made to correct these imbalances by
additional provision of health services in less developed
districts.
Database and Methodology: Data sources,
collection and type: This work is based on primary and secondary sources
of data. Secondary data were collected at village and district level from the
Census, the Economic and Statistical Organisation (ESO), the Finance Department
and the Chief Medical Office (CMO). Data on population size and public and
private health services were collected from District Census Handbooks (DCHB) of
Bhiwani and Rohtak Districts for the years 1981 and 1991. Information collected
for the selected health services were: (1) whether the service is available or
not; (2) if available, then the type of service; and (3) if not available, at
what distance it is located.
The latest data for health services were
not available from any published source. Therefore, 1996 data on the provision
of public health services were collected from Chief Medical Offices (CMO) of
Bhiwani and Rohtak Districts, but CMO office does not maintain records for
private health services. Therefore, analysis for private health services is
restricted to 1981 and 1991.
Methodology: Generally, the
geographical accessibility is worked out by calculating average weighted
distances people have to travel to reach a service. However, geographical
efficiency is estimated by comparing the actual with the optimal average
weighted distances. But an important issue here is: what is 'optimal' and how
can it be identified? An answer to this question may lie in the analysis of
'location-allocation models' if optimality is defined in terms of geographical
distance and demand (Ghosh and Rushton, 1987; Rushton, 1984 and 1988; Killen,
1983). The main objective of location-allocation models is to find out the
'optimal locations'. These models can be used with various constraints, such as
minimum distance, maximum attendance, maximum coverage and minimum total powered
distance etc.