Rural Healthcare Services in India: Challenges and Remedies

: Health is of paramount importance in an individual's life, and it has far-reaching implications for personal well-being, societal development, and overall quality of life. Good health is essential for enjoying a high quality of life. Healthy individuals are more productive in their personal and professional lives. Health is not merely the absence of illness but a state of physical, mental, and social well-being. It affects every aspect of an individual's life and has implications for communities and societies at large. Prioritizing health through preventive measures, healthcare access, and lifestyle choices is fundamental to personal and societal development. So that, present study focus on Rural and urban healthcare services, availability, infrastructure, technology, and affordability. Addressing the disparities between rural and urban healthcare is a significant challenge, and policymakers often focus on initiatives to improve rural healthcare access, such as telemedicine, mobile clinics, and incentives for healthcare professionals to work in rural areas.


I. Introduction
Majority of the peoples' top priority of life is 'to be healthy'.One of the most frequently used saying is 'Health is Wealth'.Its popularity may be due to its good fit to everyone's life.Health measured in terms of longevity of life is one of the three components of Human Development Index, a standard indicator of development.Health care has also been considered as a merit good.It is because health care not only benefit the person who practiced it but also has positive externality on his neighbors.Hence, health care has become a domain of public interest.United Nations in its Millennium Summit conducted in 2000 has developed eight international development goals.All the 189 UN member counties and about 22 international organization were committed to help in achieving these goals.Out of the eight international development goals three are related to health namely; a) to reduce child mortality, b) to improve maternal health and c) to combat HIV/AIDS, malaria and other diseases.In India, Governments at different levels have taken several initiatives to ensure health care services to its people.Rural Urban disparity in the health indicators is given in the third section.The poor health outcomes especially in the rural areas may be due to problems in the health care system.In this backdrop, an attempt has been made to analyze challenges in the rural health care system.The WHO (1948) in its constitution defined the 'health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity' It was considered as a very broad definition and lacks operational value due to use of the word 'complete'.Subsequently WHO has dropped the term 'complete' in its definition.Over the years there was a shift from viewing health 'as a state' to 'a dynamic term of resilience 'Hence, WHO (1984) revised its definition of health as 'the extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment.Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities'.The concept of 'Health care' refers to the act of taking preventive measures or necessary medical treatment to improve a person's well-being.The concept of health care services includes all the services dealing with the diagnosis and treatment for a disease.Further, it may also include the promotion, maintenance and restoration of health.Restoration of health may be done with surgery, by administering the medicine or by bringing alterations in a person's life style.Health care services are normally offered through a health care system which is made up of hospitals and physicians.The concept of Health promotion not only includes 'disease curative' services but it also includes disease preventive measures like sanitation, hygiene, food security, nutrition.It may be at personal level or community level.

3.2: Rural and Urban Disparities in the Health Indicators
Health care service delivery system is much favorable to urban people compared to the people living in rural areas.The health care service delivery to the rural people has more problems compared to the health care service delivery to the urban patient which is reflected in the poor health outcomes in the rural area compared to urban area.Comparison of following health indicators reveals the disadvantageous status of rural areas compared to urban areas of India.Life expectancy at birth (during 2008) is lower in rural area (64.9 Year) compared to the urban area (69.6%).Crude Death Rate (during 2009) was relatively more in rural area (7.8%) compared to urban area (5.8%).Infant Mortality Rate (during 2009) was considerably more in rural area (55%) compared to urban area (34%) The percentage of women in reproductive age group facing the problem of anemia (NFHS-3) was more in rural area (57.4%) compared to the rural area (50.9%).Mothers who had at least 3 Antenatal Care (ANC) visit (NFHS-3) was considerably low in rural areas (43.7%) compared to the urban areas (74.7%).The percentage of deliveries attended by the skilled medical professional (during 2008-12) was also considerably low in rural areas compared to rural areas.The percentage of children who were reported to be underweight (2008-12) was more in rural areas (45.6%) compared to urban areas (32.7%).

Rural Healthcare Services:
1. Limited Access to Healthcare Facilities: Rural areas often have a shortage of healthcare facilities, including hospitals, clinics, and specialized care centers.This scarcity can lead to longer travel times and reduced access to medical services.

Healthcare Workforce Shortages:
Rural regions typically face a shortage of healthcare professionals, including doctors, nurses, and specialists.This scarcity can result in delayed or inadequate healthcare services.3. Lack of Specialized Care: Rural areas often lack access to specialized medical care and advanced diagnostic equipment, necessitating referrals to urban centers for complex medical conditions.4. Transportation Challenges: Poor Road infrastructure and limited public transportation options in rural areas can impede patients' ability to reach healthcare facilities, especially during emergencies.5. Economic Barriers: Rural populations tend to have lower incomes, making it difficult for them to afford healthcare services, even when they are available.

Preventive Care and Health Education:
There may be limited awareness of preventive healthcare measures, and health education programs may be less accessible in rural areas, leading to a higher burden of preventable diseases.
Urban Healthcare Services: 1. Better Access to Facilities: Urban areas generally have a higher concentration of healthcare facilities, including tertiary care hospitals, specialized clinics, and diagnostic centers, offering a wider range of services.2. Healthcare Workforce Availability: Urban centers typically have a larger pool of healthcare professionals, including specialists and sub-specialists, which can lead to more comprehensive care.

Advanced Technology and Equipment:
Urban healthcare facilities often have access to advanced medical technology and equipment, enabling quicker diagnoses and treatments.4. Greater Healthcare Choices: Patients in urban areas have more healthcare provider choices and can seek second opinions more easily, leading to increased competition among providers and potentially better quality of care. 5. Health Insurance and Affordability: Urban populations are more likely to have access to health insurance and employer-sponsored healthcare, which can ease the financial burden of medical expenses.6. Educational Resources: Health education and awareness programs are often more accessible in urban areas, promoting preventive healthcare practices.7. Research and Innovation: Urban healthcare centers are more likely to be involved in medical research, clinical trials, and innovation in healthcare practices and technologies.
Rural and urban healthcare services differ in terms of accessibility, healthcare workforce availability, infrastructure, technology, and affordability.Addressing the disparities between rural and urban healthcare is a significant challenge, and policymakers often focus on initiatives to improve rural healthcare access, such as telemedicine, mobile clinics, and incentives for healthcare professionals to work in rural areas.

3.3: Challenges of Rural Health Care Services
The Indian healthcare system is a complex ecosystem characterized by a diverse population, a broad spectrum of healthcare providers, and a mix of public and private healthcare delivery.This abstract provides an overview of the Indian healthcare landscape, highlighting its unique challenges and promising opportunities.There are several challenges in the rural health care service delivery system which are responsible for poor health care system in the rural area.Major challenges of rural health care system are as follows.
1. Access Disparities: India faces significant challenges in providing equitable access to healthcare services.Rural-urban divides, socioeconomic disparities, and inadequate healthcare infrastructure hinder access to quality care for a substantial portion of the population.2. Resource Constraints: Limited financial resources and workforce shortages strain the healthcare system's capacity to meet the demands of a rapidly growing population.The country's low public health expenditure as a percentage of GDP contributes to resource limitations.3. Disease Burden: India grapples with a dual burden of infectious diseases and non-communicable diseases (NCDs).NCDs, such as diabetes and cardiovascular diseases, are on the rise, further stressing healthcare resources.4. Quality Concerns: Quality of care remains a concern, particularly in public healthcare facilities.
Variability in service quality and suboptimal healthcare practices are issues that need to be addressed.

Opportunities:
1. Digital Health: India is experiencing a digital health revolution with the widespread adoption of telemedicine and health startups.This trend has the potential to improve healthcare access, especially in rural areas.2. Public-Private Partnership: Collaboration between the public and private sectors can help address resource constraints.Initiatives like Ayushman Bharat aim to provide health insurance coverage to millions, reducing the financial burden on individuals.3.Primary Healthcare Strengthening: Focusing on strengthening primary healthcare facilities can enhance preventive care and early disease management, ultimately reducing the burden on secondary and tertiary care facilities.4. Research and Innovation: India has a strong pool of medical professionals and researchers.
Encouraging research and innovation in healthcare can lead to the development of cost-effective treatments and therapies.5. Health Education: Promoting health literacy and education can empower individuals to make informed decisions about their health, contributing to improved healthcare outcomes.

3.4: Healthcare Infrastructure and Access
The Indian healthcare system is at a critical point in time, facing numerous challenges but also presenting opportunities for transformative change.Addressing disparities in access, resource allocation, and quality of care while leveraging digital health and fostering collaboration are key steps toward achieving a more inclusive and effective healthcare system in India.
• Rural-Urban Divide: Several studies highlight the stark divide in healthcare infrastructure and access between rural and urban areas.Rural regions often suffer from a lack of healthcare facilities and healthcare professionals, leading to significant disparities in health outcomes.• Public and Private Healthcare: India's healthcare system consists of both public and private providers.Research indicates that the private sector plays a substantial role in delivering healthcare services, but affordability and quality can be concerns in the private healthcare sector.• Healthcare Financing and Insurance: Ayushman Bharat: Launched in 2018, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme aimed to provide health insurance coverage to millions of vulnerable families.Research has examined the impact of this program on healthcare utilization and financial protection for beneficiaries.

Disease Burden and Health Challenges:
• Non-Communicable Diseases (NCDs): The rising prevalence of NCDs, such as diabetes and cardiovascular diseases, has been a focus of research.Factors contributing to this trend include changing lifestyles, dietary habits, and urbanization.• Infectious Diseases: India has faced challenges related to infectious diseases, such as tuberculosis and vector-borne illnesses.Research has examined issues like drug-resistant TB and the effectiveness of vaccination programs.

Quality of Healthcare:
• Variability in Quality: Literature highlights significant variability in the quality of healthcare services across different regions and healthcare providers.Quality concerns in public healthcare facilities have been a subject of investigation.• Patient Satisfaction: Studies have explored patient satisfaction with healthcare services, shedding light on factors that influence patient experiences, including communication, waiting times, and staff behavior.

Healthcare Policy and Governance:
• Healthcare Policy Reforms: Researchers have assessed various policy initiatives and reforms aimed at improving healthcare in India.These include efforts to increase healthcare spending, regulate the private healthcare sector, and strengthen primary healthcare.• Regulatory Challenges: Challenges related to healthcare regulation, such as issues with drug pricing and the need for transparent governance, have been discussed in the literature.

Digital Health and Telemedicine:
• Emergence of Telemedicine: The literature reflects the growing role of digital health and telemedicine, especially in the context of increasing access to healthcare services, particularly in rural and underserved areas.• Challenges in Implementation: Researchers have also examined challenges related to the adoption and effective implementation of digital health technologies.• Health Inequalities and Socioeconomic Disparities: The literature underscores the role of socioeconomic factors in health inequalities, with lower-income populations facing greater barriers to healthcare access and quality.Majority of Indian people are living in rural area (68.8 percent in 2011).Though only 31.2 percent of our people are living in urban area, urban places are densely populated centers and they are the market places catering to the goods and services needs of the people living in the nearby rural places.Thus, market forces encourage private health care service providers to concentrate in densely populated urban area.Public sector has shouldered the responsibility of ensuring the health care services to the rural people at their nearest places.Hence, public sector has created different kinds of health institutions to serve the rural people and assigned different health care responsibilities.At the gross root level Sub-Centre and in the next higher rung Primary Health Centers are serving in the rural areas providing primary health care services.Community Health Centers located in the semi-urban and urban places are providing primary as well as secondary health care services.District hospitals located in urban places are equipped to provide tertiary health care services besides providing primary as well as secondary health care services.Though Sub-Centers are at the bottom of rural health care system their focus is more on maternal and child health care services.

IV. Conclusion
The Indian healthcare system is a complex and multifaceted system facing many challenges while also presenting promising opportunities.This system, characterized by a vast and diverse population, a mix of public and private providers, and disparities in access and quality, has been a subject of intense scrutiny and research.While India's healthcare system faces substantial challenges, it is important to acknowledge the ongoing efforts to address these issues.Government policies, regulatory reforms, and investments in healthcare infrastructure are gradually reshaping the landscape.However, achieving universal and equitable healthcare access, improving healthcare quality, and effectively addressing the diverse health needs of a vast population will continue to be key priorities for India's healthcare journey in coming years.

➢ 2 ➢ 1 :
To study the concept of Health and Health Care Services.• Email: editor@ijfmr.comIJFMR23056388 Volume 5, Issue 5, September-October 2023 To analyze health disparities in Rural and Urban areas.➢ To examine challenges of Rural Health Care Services in India.III. Discussion of the Study 3.Concept of Health and Health Care Services