Priyanka Hazarika
Research Scholar, Gauhati University, Guwahati, Assam, India

Women empowerment in recent times has acquired great significance in social, economic and political arena. Empowering women is considered as an effective strategy to bring an end to their subordinated position in society. Better health care facilities provided to women is considered as an important way to empower women in several ways. For example,  a healthy woman can actively participate in economic activities, a healthy woman can perform all the domestic services in a good way, a healthy mother can take utmost care of her children; she can help her children in their schooling etc. Thus there is a positive correlation between health care and women empowerment. In this paper an attempt is made to observe the existing health care system in rural Assam and its role in empowering women.
Keywords: Women, Empowerment, Health care, Rural Assam

1.   Introduction
Empowerment of women generally implies the process of upliftment of economic, social and political status of women. Better health care is one of the ways to achieve economic empowerment for the families and especially for the women of the families. Health is an indicator of well-being that has immediate implications for the quality of life as well as for productive capacities and capabilities (Sahoo, 2008). According to WHO, “Health is a state of complete physical, mental and social well- being not only in the absence of disease or infirmity which allow the person to lead a socially and economically productive life.” Better health care helps the women in several ways. It helps the women to contribute to the families economically. A healthy woman can actively participate in economic activities due to which she is able to get higher wage and thus the economic and social positions of her family get improved. Besides this, a healthy woman can perform all the domestic services in a good way. A healthy mother can take utmost care of her children; she can help her children in their schooling etc. In this way, better health care facilities play an important role in empowering women. The present paper is an analysis of the role of health care system of Assam among the women population, especially in rural areas.

2. Objectives

  • To analyse the existing health care system of rural Assam,
  • To observe the effectiveness of the system among the households specially for rural women population,
  • To suggest better health care policy measures for economic empowerment of women.

3. Methodology
The present paper is entirely based on secondary data collected from Government publications, articles published in journals, news paper, books etc. The paper has been organized in two sections. In first section, discussion about relationship between health care system and empowerment of women is taken place. The second section deals with an analysis of the existing health care system in rural Assam in fulfilling the objectives of present paper. The paper was concluded with suitable policy measures realizing the prevailing situation observed from our study.

4. Results and Discussion
4.1 The Existing Health Care System in Rural Assam
Health services in Assam have been mainly provided by three sectors: The Government, the private (for profit) and the voluntary organizations over the years.

The department of Health and Family Welfare is responsible for health services, family planning programmes, medical education and training. The Ministry of Health and Family Welfare has a commissioner and a secretary. Directorate of Health Services (DHS), DHS of Family Welfare (FW) and Directorate of Medical Education (DME) are come under the purview of the secretary. Each of these Directorates has its own area/ provision to provide health care services among population from state to district level. The major training institutions like the medical colleges, apart from training and creating workers for health services, provide specialist care for patients. There is a wide network of institutes, both in public and private sector, which provide health care services in Assam.

In April 2005, Assam launched the National Rural Health Mission (NRHM) in order to support the DHS and DHS (FW) by providing effective health care in all the areas of health, especially in the rural areas. NRHM has emerged as a major financing and health sector reform strategy to strengthen State Health Systems. The rural health care services in Assam have been largely dependent on the NRHM and the state government’s expenditure on public health. The health services provided by NRHM have been effective among rural population in Assam through Sub- Centres (SCs), Primary Health Care centres (PHCs), Community Health Care centres (CHCs) etc. The main objective of the mission was to provide accessible, affordable and quality health care to the rural people especially to rural women and children.

   The SCs and PHCs are the principal sources of providing health care services especially to the needy and vulnerable groups of rural Assam. The PHCs are established and maintained by the State Government under the Minimum Needs Programme (MNP)/ Basic Minimum Service (BNS) Programme. The PHCs are envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. A PHC is expected to have a medical officer and 14 Paramedical and other staffs. It should have 4 to 6 beds for patients. PHC plays an important role in empowering women by a number of ways- 

  • By improving women’s health and health of their families,
  • By training women both as care givers and health educators,
  • By placing them in positions of responsibility etc.

The CHC is another effective health care institution which is being established and maintained by State Government under MNP/ BNS programme. The SC is the most peripheral outpost for delivering health care services in rural areas. It is the first contact point between the Primary Health Care system and the Community. The SCs are established in order to provide services relating to maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable diseases.

There is a norm of one SC among 5000 population, one PHC among 30000 population and a CHC among population of 125000. However there are shortfalls in health care centres in the state. The health care facilities in the state include a total number of 4604 SC, 975 PHC, 109 CHC, 13 Sub divisional Hospitals and 25 District Hospitals. This indicates that a sizeable proportion of rural population still remains beyond the ambit of health care facilities due to mere availability of SCs and CHCs in the state. Again, most of the facilities are available to the people in urban areas due to which people of rural areas are still neglected in this respect.

Table1: Health Care Infrastructure in Assam (2013)
Health Care Centre
In Position
Sub Centre
Primary Health Centre
Community Health Centre
Source: NRHM survey, 2013

Besides this, the number of doctors and specialists are not adequate in rural health care centres in Assam. The following table depicts a clear picture of this.

Table2: Health Care personnel for maternal and child health in rural Assam (2013)
In Position
Obstetricians & Gynecologists at CHCs
Pediatricians at CHCs
Total specialists at CHCs
Radiographers at CHCs
Source: NRHM survey, 2013

4.2 Effectiveness of the existing Health Care System among rural households in Assam

To study the effectiveness of existing health care services among rural population especially among rural women in Assam, we need to take help of various health indicators.

At the time of launching of NRHM, the health indicators for Assam viz. IMR and MMR were 68 and 480 respectively in 2005- 06. One of the major aims of NRHM was to reduce IMR to 28 per 1000 live births, reduce MMR to 100 per 100000 live births by 2012, reduce TFR to 2.1 by 2012 and reduce the mortality due to communicable diseases. But in 2012, the IMR and MMR in Assam have decreased to 55 and 328 respectively. At this current rate of decline, it seems to be difficult for Assam to reach the target. The TFR for rural areas also decreased from 3 to 2.7. The notable thing is that among all states, Assam has the highest MMR in the country. The Under 5 Mortality Rate (75) and the female Under 5 Mortality Rate in Assam are also highest in the country. The main causes responsible for neo- natal deaths can be viewed as prematurity, birth asphyxia and sepsis whether in post- natal period, the major killers are pneumonia, diarrhea and under nutrition ( UNICEF, 2014). The IMR in the state is high in the minority concentrated districts of Nagaon, Darrang, Karimganj, Dhubri, Morigaon and in the tribal concentrated districts of Sonitpur and Kokrajhar. The non- availability of required specialized doctors for maternal and child health in the CHCs, the non- availability of beds per health center as well as per lakh population have been responsible high MMR and IMR in the state.

The post natal care received by rural women in the state was less than that by urban women. The nutritional support to lactating mothers is also not adequate due to which the health status of mother and child mainly belong to BPL families is not satisfactory.

However, after launching NRHM in Assam, the institutional delivery in the state increased to 478503 in 2013 from 149003 in 2005-06, registering a threefold increase. The proportion of safe deliveries in the state has also shown improvement. Another important outcome of NRHM intervention in the health care is the improvement in immunization coverage among children which was increased from 46.6% in 2005-06 to 80.3% in 2013.

Thus from above discussion it is clear that in rural Assam, public health care system is still lagging behind satisfactory. Although after launching NRHM, the performance of the Public health sectors among the rural population has improved to a certain extent, but it is not adequate. While the poor rural people wants to rely more heavily on the services provided by the government, the government on their part is ignoring their problems. In most of rural public health care centres, the patients generally have to confront various problems like poor care and attention, amount of time taken to visit a doctor, absence of medicines, lack of testing machineries and other modern facilities, and sometimes absence of doctors. Although the present government is taking steps to appoint in rural health care centres, but process is still slow and needed to be continued. Moreover the doctors in these government hospitals only prescribe medicines which the patients have to buy from pharmacies spending their own money. Therefore, the people in rural Assam begin to give more preference to private hospitals. Studies made by Berman and Khan (1993) show that majority of people seek care during illness from private rather than public providers for outpatient care. The poor people are even ready to pay huge amount of money in private medical treatment for getting attention and better treatment.

5.Policy Implication
Since health is an important factor for well-being of any individual, thus the government should take much care for improving the health status of people. Now-a-days, a higher proportion of health services are provided by the private sectors. But this sector is perceived to be financially exploitative. Thus the private health care sector should be regulated by the government so that it can deliver health care facilities at a reasonable cost. In his study, Duggal (2013) said that the healthcare system, both public and private, should be organized under a common framework which provides access to all without any barriers.

The public health facilities should be extended to cover various health related problems of rural households of Assam. In rural areas of Assam, the ratio of doctors, nursing personnel etc. is very low according to professionally accepted norms. There is also an acute shortage of nurses trained in super- specialty disciplines for deployment in tertiary care facilities. Therefore, necessary steps should be taken by the government in order to appoint sufficient number of doctors and trained nurses in public health care centres. The SCs, PHCs and CHCs should also be provided with adequate number of beds, testing machineries, drugs and vaccines.

The government of Assam has launched several schemes particularly for improving the health status of mothers and girl child. These include schemes like MAMONI, MAJONI, MOROM etc. Under such schemes, pregnant women, mothers and girl children are getting benefited financially. But in some rural areas of Assam, such schemes are not equally distributed. Therefore proper implementation and equitable distribution of such schemes are needed. Besides this, nutritional and health education should be imparted among working, lactating and pregnant women (Gogoi, 2008.). Healthy nutrition through use of local produce and local recipes should be encouraged. The women and girls of rural areas may be imparted basic nursing for empowering them not only economically but also socially. In order to ensure good health of pregnant women and to enable their safe motherhood, the state has posted 352 Rural Health Practitioners (RHP) who besides providing the necessary ante- natal checkups for pregnant women also conduct normal delivery cases in the Sub Centres (NRHM, 2013). The process needed to be continued.

Thus in conclusion we can say that economic empowerment is a powerful route for women to realize their rights and well- being. As many researchers stated that the working women have to perform dual roles. In performing dual roles, they face problems in the household works, physical strain in the work spot and various health problems. Therefore better health care facilities should be provided to them. The Government intervention is needed through public and private health care sectors so that the people especially the women will be greatly benefited by these services.

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1 comment:

  1. What we call health care is a bad deal for the consumer. The name alone is a lie. It should be called "sickness care" or even "sickness facilitation " because, for those who are covered, it tricks them into placing the responsibility for their health on their doctor. This is a big mistake. CocoSlimmer


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