Journal of Interdisciplinary Cycle Research ISSN NO: 0022-1945 Spatial Distribution and Service Area of Primary Health Centres in District,

K. Sumesh Assistant Professor, Department of Geography Government Arts College Coimbatore (Autonomous) Tamil Nadu, . [email protected]

Abstract—Fundamentally,the type and quality of services available in the local area serves as a pivotal factor for determining the health care decisions of an area.Added to this, distance, time, and cost acquired as part of the mode of traveling resorted to in reaching health care centres alsoacts a decisive factor in the selection of healthcare service providers. In the case of Kerala,the public health system service provided by Primary Health Centres (PHC)are free of cost and offer better treatment with maximum standard to local people. This paper analyses the spatial distribution of PHC in of Kerala chiefly by measuring its geographical accessibility with available road network using Network Analysis in a Geographical Information System environment.

Keywords—Spatial, Service area, Network Analysis, Theissen Polygon, Location Quotient.

I. INTRODUCTION Primary Health Centre (PHC) is the cornerstone of rural health services- a first port of call to a qualified doctor of the public sector in rural areas for the sick and those who directly report or are referred from Sub-Centres for curative, preventive and promotive health care (IPHS, 2012). The spatial arrangement of the health care delivery system depends on the location and distribution of the population within a region, and the characteristics of the transportation infrastructure (Delamater P L, et.al. 2012). The access framework was useful in uncovering the disparity between supply- and demand-side dimensions and pinpointing areas which could benefit from further attention and thereby providing a closure of the equity gap for vulnerable populations in accessing PHC services that correspond to their needs (Lauralie R et.al. 2016). Mandal R B and Sinha, V N, (1980), opined that healthcare in India is handicapped because it has to face serious crises in cost, quality of care and equitable distribution of modes and standards of service to the population as a whole. On the other side, spatial distribution of health facilities, unequal distribution of population and lack of proper transport facilities leads to the disparity in access to Primary Health Centres.

Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance (Mark F Guagliardo 2004). Many researches on accessibility in healthcare system suggest that the deprived society or population isfacing problems such as inadequate quality of services, more travel time and high transportation cost (Hyndman J C, Holman C A, 2001; Tayyab Ikram Shah & et.al, 2016;Hosgson M J and Valadereas, 1983). Deepak Wankhede (2008), in his study conducted in Nagpur District, points out that the location of most primary health centres is decided by political influence and very less significance was given to optimum location or central location by government. Primary healthcare, similarly defined, is healthcare provided to all, especially the most marginalised, with their participation and for their needs. If the primary healthcare system of a country is not functioning well, it is symptomatic of problems in its democracy itself. Consider access to primary healthcare in India and the health status of the poor populations (Pavitra Mohan, 2018). In this context the Geographical Information System as a tool can be utilised in a better way to solve these problems to some extent. In developing countries, however, constraining factors such as initial prohibitive costs and inadequate expertise have limited the widespread application of Geographic Information Systems for Transportation (Ernest Agyemang, 2009). The lack of

Volume XII, Issue VII, July/2020 Page No:308 Journal of Interdisciplinary Cycle Research ISSN NO: 0022-1945 appropriate data for GIS remains a chronic problem.The major requirements and issues surrounding GIS management technology are building and maintaining a database, selecting and upgrading hardware and software, using the technology to solve problems, funding, networking, providing access, and others. (Pankaj Gupta. et.al, 2009). Kerala and West Bengal are the two Indian states where primary health care services and functions are co-managed by Grama Panchayaths. The Hospital Management committee (HMC) as per Sec.173A of KPRA (Kerala Panchayath Raj Act) is the popular arrangement in the Primary Health Centre in Kerala. The objective of the Management Committee is to ensure people's participation in health-related activities and institutional activities. This study has been conducted to analyse the spatial distribution and accessibility toPHCs based on road connectivity by applying network analysis in GIS.

II. METHODOLOGY The list of allopathic PHCsof Kasaragod district is assimilated from Directorate of Health Services, Kerala and spatial distribution of PHCs are identified with the help of Google Earth map. The present available road network of Kasaragod district is compiled from various sources like Open Street Map, Google Earth, and Toposheet andhas been used for network analysis.Innetwork analysis, the road network of the district has been converted into network dataset and transportation network analysis operation in ArcGIS 10 is used for generating service areas of each PHC of the District. Time taken for travel is calculated by dividing the length of the roads by the speed of the roads and then it is multiplied by 60 (Minutes). The service area of each PHC has been categorized according to the time taken by ease in mode of transportation which is available in the locality to reach the nearest PHC. The speed of any vehicle is calculated depending upon the hierarchy of the road. In the case of study area,Kasaragod District,people usually depend on autorickshaws to travel short distances. In some instances, people may also use their own vehiclesor public transportation system for conveyance,the speed of these modes may vary according hierarchy of roads. For this study, an average speed of 30 km per hour in village roads and 40 km per hour in National Highways, State Highways and District Road isbeen selected,because people use auto rickshaws as a common mode of conveyance for short distance. The primary survey conducted in two PHC shows that nearly 50 percent of people are using autorickshaws to reach PHC. In additionto theservice area analysis, the health block wise Location Quotient (LQ) is used to calculate relative concentration of PHCs in Kasaragod District. The availability of service based on population by Government of India norms has been analysed. The Thiessen polygon analysis is used to analyse the service of each PHCs and panchayath wise comparison is made in connection with theconcentration of population.

III. OBJECTIVES 1. To identify the service area of PHCs of Kasaragod District of Kerala. 2. To identify least service areas and suggest ideal locations for new PHCs in Kasaragod District.

IV. STUDY AREA Kasaragod district is located at the northern end of Kerala. The District is bound to the north by district of state, on the west by Arabian Sea, on the south by District and on the east by Kodagu and Dakshina Kannada districts of Karnataka state. The District lies between 12° 02' 33’’ and 12° 47'41’‘North latitudes and 74° 51' 47'' and 75° 26' 09'' East longitudes. At present, there are 3 municipalitiesand 38 panchayaths in Kasaragod district.As per 2011 census population in the District were 13, 07,375 and it constitutesabout 3.9 percentage of the total population of the State.

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V. SERVICE AREA ANALYSIS

Relative Distribution of PHCs - (Location Quotient) The Kasaragod district has 9 health blocks encompasses 55 allopathic public health care centres, which include 1 District hospital, 1 General hospital, 5 Taluk hospitals, 6 Community Health Centres and 42 Primary Health Centres. Among the PHCs, two are located in Kasaragod and Municipalities which shows urban character (Urban PHCs). Highest concentrations of PHCs are found in Block and lowest is found in Mangalpady and Bedadka blocks. According to 2011 census, total population of Kasaragod district was 13, 07,375. There are three municipalities in Kasaragod district, in which municipality is a part of Nileshwaram Health Block. Figure 2 shows the distribution of health care centres and health blocks of Kasaragod district.

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Location Quotients is a simple tool used to determine the spatial distribution of a phenomenon in an area, compared to an entire region. Here the spatial distributions of PHCs by block wise are compared to entire district.

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Location Quotient (LQ) is calculated using the following equation.

(PHCs in a Block / Health Block Population) (PHCs in the district / District population)

Table - 1 Health block wise Relative Distribution of PHCs, Kasaragod District

Location Population Available Sl. No. Health Block Quotient Description (Year -2011) PHCs (LQ)

1 Mangalpady 1,73,304 3 0.51 Low Spatial Concentration

2 Muliyar 1,50,699 4 0.78 Low Spatial Concentration

3 Bedadka 1,45,075 4 0.81 Low Spatial Concentration

4 Periye 1,22,050 4 0.97 Equal Spatial Concentration

5 Kumbala 1,09,977 4 1.07 Equal Spatial Concentration

6 Nileshwar 1,27,354 5 1.16 High Spatial Concentration

7 Panathady 1,11,605 5 1.32 High Spatial Concentration

8 Cheruvathur 1,53,753 7 1.34 High Spatial Concentration

9 Badiyadka 86,044 4 1.37 High Spatial Concentration

11,79,861 40

The table no.1 shows the details of block wise relative distribution of PHCs. LQ value with more than 1.10 is considered as high spatial concentration category. Badiyadka,Cheruvathur, Panathdy and Nileshwar health blocks have high concentration of PHCs compared to district as a whole. LQ value between 0.90 to 1.10 is considered as equal spatial concentration category. Spatial distribution equal to that of the district is found in Priye and health block.LQ value less than 0.90 is classified as low spatial concentration category. Magalpady, Muliyar and Bedadka are the health blocks in Kasaragod district with low spatial concentration of PHCs.Among them Mangalpady has exceptionally low concentration of PHCs compared to Kasaragod district. More PHCs should be started in these health blocks to attain equal relative distribution.

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PHCs service based on population size

As per Govt. of India norms, typical Primary Health Centre covers a population of 20,000 in hilly, tribal, or difficult areas and 30,000 populations in plain areas with 6 indoor /observation beds. It acts as a referral unit for 6 Sub-Centres and refer out cases to CHC (30 bedded hospital) and higher order public hospitals located at sub-district and district level.

Table - 2 Health Block Wise Distribution of Population and PHCs, Kasaragod District Block PHCs need Sl. Population Available Number of Health Block Population per 30000 Status No. (Year – 2011) PHCs panchayath /30,000 population

1 Mangalpady 1,73,304 3 5 5.78 6 -3

2 Muliyar 1,50,699 4 5 5.02 5 -1

3 Bedadka 1,45,075 4 4 4.84 5 -1

4 Periye 1,22,050 4 3 4.07 4 0

5 Kumbala 1,09,977 4 3 3.67 4 0

6 Nileshwar 1,27,354 5 3+1(m) 4.25 4 1

7 Panathady 1,11,605 5 5 3.72 4 1

8 Cheruvathur 1,53,753 7 6 5.13 5 2

9 Badiyadka 86,044 4 4 2.87 3 1

The table number 2 shows the distribution of PHCs as per size of the population (Govt. of India norms) in Kasaragod district (IPHS, 2012). In five health blocks according to size of population the number of PHCs are found in excess, among them in Cheruvathur health block two PHCs are in excess as per PHC – Population ratio.Two health blocks need more PHCs as per norms on population size. Mangalpady blocks need 3 more PHCs because of the concentration of high population compared to other blocks. Muliyarand Bedadkahealth block are also highly populated health blocks which need one more PHC to each block to satisfy the needs of the available population. Mogralputhur panchayath is far away from Muliyar health block, it may cause managerial problems for health workers to coordinate the regular activities.In the case of municipalities, Nileswaram municipality is found in Nileshram health block so the numbers for PHCs are available sufficient according to the population. Kasaragod and Kanhangad municipalities need one more UPHCs for each municipality according to the population size. Service area and Distribution of Population (Theissen Polygon Analysis)

Thiessen polygons or Voronoi polygons are an important method for the analysis of proximity and neighbourhood analysis. Thiessen polygons are used to distribute space to the nearby point feature. The polygons are formed by the perpendicular bisectors of the lines joining nearby stations (Schumann A.H. 1998). The figure number 3 shows the theissen polygon analysis of PHCs of Kasaragod district and distribution of population by panchayath. As per this proximity analysis, the service area of Ennappara, Bandadka, KaricheryVellarikkundu, Mulleria, , and MeenjaPHCs are large when compared to service area of other PHCs. Service area of these PHCs is mostly found in medium populated panchayath.

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Network Analysis Kasaragod district has good road network connectivity, but in remote area major constrain is the timely availability of public transportation facility. So, the people mostly depend on taxi services especially autorickshaws. They chargeRs. 20 per kilometre which is expensive. Usually road length alone taken for network service analysis may cause inaccurate results, because of the variation in the carrying capacity of different roads. To avoid this, drive time is taken to determine service area which provides better result for analysis.The figure number 4 shows the road network and location of PHCs in Kasaragod district. Service areas of each PHCs are demarcated based on drive time and classified into 2- minuteinterval. The service area above 10 minutes’ drive time is considered as least service areas. Lack of public transportation system is a major problem in these areas and if they are depending on taxis which

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becameexpensive for deprived population of least service areas to attain medical facility in proper time. The figure number 5 shows the service area of PHCs in Kasaragod district based on network analysis.

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Based on network analysis, Karoda in Manjeshwaram panchayath, Bekur in Mangalapdy panchayath, Chevar in Paivalike Panchayath, Iriyanni of Muliyar panchayath, Munnad of Bedadka panchayath, Kalliyot in Pullurperiya panchayath, Entire Kallar Panchayath, Thayanni area of East Eleri panchayath and Chaeemeni of KayyurCheemeni panchayath seems to beleast service area of PHCs in Kasaragode district. To overcome least service area of PHCs in Kasaragod district 9 new PHCs should be established in ideal locations. The optimum locations for new PHCs are Karoda, Bekur, Chevar, Munnad, Kalliyot, Kallar, Iriyanni, Thayanni and Cheemeni. The figure number 6 shows the ideal location and service areas of new PHCs in Kasaragod district.

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VI. CONCLUSION Geographical Information System is the only proficient database management system to analyse spatial distributed data. Nowadays, GIS programs are widely used with analytical tools for mapping service areas. Based on Location Quotient analysis Magalpady, Muliyar and Bedadka are the health blocks which need more PHCs to satisfy the service to available population.Analysis on service of PHCson the basis of population size reveals that MagalpadyMuliyar and Bedadka health block need more PHCs. Ideal location for new PHCs in Magalapady health blocks isKarodaChevar and Bekur.In Muliyar health block ideal spot for PHC is Iriyanni and for Bedadka health block Munnad is ideal location identified by using network analysis. Theissen polygon analysis depicted areas of largest serving PHCs and by applying network analysis ideal location is identified to reduce the present service areas, they are Iriyanni, Munnad,

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Kalliyot and Kallar. Two ideal locationsare also identified in less service areas in the south of district;they are Thayanni in Nileshwar health blockand Cheemeni in Cheruvathur Health Block.Mogralputhur panchayath should merge with Kumbala health block for better coordination of services. The present study reveals that the useof network analysisin GIS is very supportive in demarcating service areas of PHCs in Kasaragode district. The research also servesa source for identifying new optimum location for new PHCs in less service areas. REFERENCES

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