What Do The People Say About Health Care Facilities? 1

CMDR Monograph Series No. - 46

WHAT DO THE PEOPLE SAY ABOUT HEALTH CARE FACILITIES?

Analysis of Focus Group Discussions in Orissa, and states and selected villages in Dharwad district of Karnataka

Gopal K. Kadekodi Mallesh N.S Seema S. Hegde

CENTRE FOR MULTI-DISCIPLINARY DEVELOPMENT RESEARCH Jubilee Circle, DHARWAD-580001, Karnataka, Ph : 091-0836-2447639, Fax : 2447627 E-mail : [email protected] 2 CMDR Monograph Series No. - 46 WHAT DO THE PEOPLE SAY ABOUT HEALTH CARE FACILITIES?

Analysis of Focus Group Discussions in Orissa, Karnataka and Maharashtra states and selected villages in Dharwad district of Karnataka

Introduction . How are the public health facilities People are the ultimate beneficiaries functioning ( e.g., availability of doctors, any development process, including that of medicines, health education etc.); to health care development. Understanding what extent they serve the people; what such a development process requires a two are their views about private facilities; sided analyses, namely a supply side and a . What are the different water outlets; demand side. When it comes to the demand are they adequate; is the water side analysis, it is very important to analyse drinkable; are they within reachable the voices of the people regarding the access distance; How do the people view and utilization to health care facilities in the about the sanitary facilities in the public and private domain, views regarding village. Are they aware about the health other dimensions of development including effects of bad sanitary situation? effects from economic reforms process. . What are the different morbidity status to which the people are normally With this objective of assessing and exposed to; analyzing the demand side situation, two . Their views about different nutritional different approaches were adopted in this supports for children; study. They are: . What can be said about consumerism,  Conducting primary surveys in the including alcoholism selected states with household as a unit . Views on agriculture related health of measurement. problems; effects of use of pesticides,  Conducting Focus Group fungicides and chemical fertilizers Discussions in selected villages in the . Status about function of Public three states. Distribution Systems in the village

This monograph deals with the second Research Methodology aspect of this demand side story. The basic Focus Group Discussions are questions posed to the villagers in the village carried out in three states, at the levels of group meetings are1 : villages. The three states are Orissa, a low 1 See Annexure for the details of these and other questions taken up in the FGD. What Do The People Say About Health Care Facilities? 3 developed state; Karnataka, a medium level A schedule of detailed issues to be developed state; and Maharashtra, a highly discussed was used to raise them one by developed state. one in each of the group discussions. Annexure 1 shows the list of such questions. Since the states under the study are Focus Group Discussions (FGD) were highly diversified in terms of geographical conducted in the selected villages using the coverage and climatic conditions, it was felt schedule of issues at the background. Series necessary to design the FGDs in a large of questions are posed to the village groups, number of villages covering various agro- one at a time, which can be viewed as climatic sub-regions in each state2 . After pertaining to the seven major categories/ having reviewed the agro-climatic sub- groups of questions mentioned in the regions, one district in each of them have Introduction above. A large number of sub- been selected for the FGD studies. On questions and issues are placed before the average four villages in each district have people under each of these seven categories. been then selected on the basis of a simple On each of these clearly identifiable issue or random sampling (without replacement). question, the people are asked to discuss Focus Group Discussions are organised by them freely and come up with their consensus the CMDR teams in each of those villages. view or observation. On all these questions Enough care is taken to inform all the the village communities are asked to provide households about the exact day of the their group views for the situation before the meeting, the place and timings of meeting. current reforms period, namely prior to Prior to the meetings, the assembled villagers 1990s and in the current reforms period. The are explained about the purpose of the responses are then classified or ranked in a discussion, with a plea to air their views and hierarchical manner with numerical (as 1, 2, experience very frankly, and without any fear 3 4 etc.) or qualitative rankings (such as and apprehensions of any rewards. excellent, good, ok, bad and so on) at the village level. Thus a series of responses at The sampled districts are shown in each village level on a large number of the table below: questions and issues form the basic State Level of Names of the Districts information set for further analysis. Development Orissa Low , Gajapati and Using a Multi-Criterion Analysis Karnataka Medium Dharwad, Bidar, (MCA), the village level responses are first Chikkamagalore, aggregated at the district level. For this, Chitradurga, and Mysore responses on all the cluster of questions Maharashtra High Thane, Gadchiroli, Nasik, Amravati and Dhule under one category are aggregated and a

2 Details regarding the climatic variations, and hence the use of agro-climatic delineations to select the districts, and the villages are discussed in another monograph exclusively devoted to the analysis of primary data. 4 CMDR Monograph Series No. - 46

Composite Ranking3 is obtained for each A Comparative Analysis of Health of the seven categories of health related Related Issues and Facilities issues for each district in each of the selected in Different States states. Subsequently, these rankings are aggregated from the district level to arrive at When it comes to health related issues, the state level for each of the seven water and sanitation are most important. categories of issues4 . Finally, the Composite As far as the situation is concerned, this Rankings over all the seven categories are seems to have improved in all the three states further aggregated to arrive at the state level between the two time periods. However, it Over-all Rankings. While doing this, the can be noted that it was already quite high in rankings of the negative effects are treated Orissa during the pre-reforms period (0.56), as ill-effects, and those of positive effects which further improved marginally during the as benefits. Outcomes of the MCA are reforms period (0.65). Both in Maharashtra analyses and interpreted. Such ranking and Karnataka, the status was at par (also procedures are separately followed for the with Orissa) during the pre-reforms period. two sets of data, namely for the ‘pre-reforms But, as compared to Orissa, they seem to period’ and ‘during the current reforms have improved much more in Maharashtra period’. (0.72) and Karnataka (0.79). It is worth noting that in Karnataka, the improvement Status of Health as seen from the Multi- is quite significant from a score of 0.51 during criterion Analysis the pre-reforms period to 0.79 subsequently. The MCA is a robust method, which . On the whole, it can be said that water provides relative scores or ranking about the and sanitation situation has various health related attributes such as those improved in all the three states, listed earlier. The relative scores are now marginally in Orissa; better in interpreted to reflect upon the situations in Maharashtra and Karnataka, almost respect of the seven categories of health equally; related issues in the three states. Some of the major findings are summarised below for With respect to morbidity status, the Before and During Reforms Periods it was worst in Orissa during the pre-reforms first, followed by the same at the district period (with a score of 0.82), which has levels: improved during the reforms period (with a

3 In the language of MCA, they are often referred as Scores. 4 Also deduced are the aggregate scores at the district level over the seven categories of issues, to be called as District Level Aggregate Rankings. What Do The People Say About Health Care Facilities? 5 score of 0.67). Like wise it has shown In respect of Nutritional support improvements in Karnataka (with a drop in to children, it was said to be fairly good in the score from 0.74 during the pre-reforms Karnataka during the pre-reforms period,, period to 0.57 during the subsequent whereas very low in both Orissa and period). But the situation has worsened in Maharashtra. It seem to have improved very Maharashtra (as depicted with an increase much in Maharashtra (from 0.31 to 0.67), in scores from 0.45 to 0.63). Therefore, it as against very little in Orissa (from 0.33 to can be safely said that as against a good 0.40). In Karnataka also it has shown quite improvement in Orissa and Karnataka, it a bit of improvement (from a score of 0.0.55 has really deteriorated in Maharashtra. to 0.70) over the two periods.

. On the whole, morbidity status seems . Thus, Nutritional support improved to have improved in both Orissa and in all the three states, much better Karnataka during current reforms in Maharashtra than in Karnataka with period, whereas it has worsened in very low improvement in Orissa. Maharashtra. Another major health related The availability of health care problem is due to the use of pesticides, facilities are also analysed, taking note of fungicides and inorganic chemical fertilizers the responses in respect of public facilities. in agriculture. Its effects during the pre- This is said to be very bad in Maharashtra reforms period was stated to be very low in during the pre-reforms period (with a score all the three states. But during the current of 0.38), whereas it was rated very high in reforms period, they seem to have gone up Orissa (score of 0. 64), and moderate in substantially in all the three states, relatively Karnataka (0.46). In the current reforms more in Karnataka, then in Orissa, followed period, all the three states have shown by Maharashtra. This is a matter of serious improvements in the availability of health concern. facilities, with very high ranking in Orissa (0.91), with Karnataka and Maharashtra . Agricultural related health ranking improvements at moderate levels. problems seem to have gone up uniformly in all the three states; . In brief, Availability of health care facilities has improved Alcoholism is another major issue substantially in Orissa and analysed based on the information provided Maharashtra, moderately in by the villagers. Initially it was already very Karnataka. high in Maharashtra (0.89), followed 6 CMDR Monograph Series No. - 46

equally but lower levels in Orissa (0.47) and Finally, the access to PDS is also Karnataka (0.43). But during the current analysed. This facility seems to have reforms period, the same has revered, with improved substantially in Maharashtra (from Orissa registering the highest rate of a score of 0.38 during pre-reforms period alcoholism (0.91), followed by Maharashtra to 0.72 during the current reforms period), (0.88) and Karnataka (0.73). In other remained the same in Karnataka (around a words, the reforms process seem to have score of 0.68), but deteriorated in Orissa opened up access to this health related (from 0.80 to 0.69). adverse effects. . In brief, functioning of PDS has . On the whole, alcoholism has improved much more in Maharashtra, increased substantially in Orissa, remained the same but high in moderately in Karnataka, bust stayed Karnataka, but has deteriorated in almost at the same high level in Orissa. Maharashtra.

Composite Indices (Ranking) of Health Related Issues for Karnataka State (based on Dharwad, Bidar, Chitradurga, Chikkamagalur and Mysore Districts) A Comparative Picture of Before & During Reforms Period

Source, distance, nature etc, garbage, 0.79 drainage and toilet Water & Sanitation 0.51

Suffering from diseases like diarrhea, 0.74 0.57 typhoid, cold & cough etc. Morbidity Pattern

PHC,pvt. doctor, awareness, satisfaction, 0.68 drug shops, transportation Availability of Health care facility 0.46

No.of Anganwadi center 0.70 Nutritional Support f or Children 0.55

Use of fertilizers, pesticides and related 0.74 diseases Agriculture related Health problem 0.23

No. of alcohol shops 0.73 Use of Alcohol 0.43

Service and quality 0.69 0.67 Function of PDS Services & its quality

During Before Reforms Reforms What Do The People Say About Health Care Facilities? 7 Composite Indices (Ranking) of Health Related Issues for Karnataka State (based on Dharwad, Bidar, Chitradurga, Chikkamagalur and Mysore Districts) A Comparative Picture of Before & During Reforms Period

Source, distance, nature etc, garbage, 0.72 Water & Sanitation 0.57 drainage and toilet

Suffering from diseases like diarrhea, 0.63 Morbidity Pattern 0.45 typhoid, cold & cough etc.

PHC, pvt. Doctor, awareness, Availability of Health care facility 0.62 satisfaction, drug shops, 0.38 transportation

0.67 No. Of Anganwadi center Nutritional Support for Children 0.31

Use of fertilizers, pesticides and Agriculture related Health problem 0.60 related diseases 0.24

Degree of Alcoholism 0.88 0.89 Degree of Alcoholism

Service and quality 0.72 Function of PDS Services & its quality 0.38

Durin g Before Reforms Reforms Composite Indices (Ranking) of Health Related Issues for Orissa State (based on Gajapati, Balasore and Malkanagiri Districts) A Comparative picture of Before & During Reforms period

0.65 Source, distance, nature etc, garbage, Water and Sanitation 0.56 drainage and toilet

0.82 0.67 Suffering from diseases like diarrhea, Morbidity pattern typhoid, cold & cough etc. 0.91 PHC,pvt. doctor, awareness, Availability of Health care facility 0.64 satisfaction, drug shops, transportation

Nutritional support for children Quality and regularity and health 0.40 0.33 status like malnutrition

0.68 Use of fertilizers, pesticides and Agriculture related health problem related diseases 0.10

0.91 No. of alcohol shops and health Use of Alcohol & its effects 0.47 problems

0.80 Service and quality 0.69 Function of PDS services and its quality

During Before Reforms Reforms 8 CMDR Monograph Series No. - 46

Analysis at the Over-all State Levels pre-reforms period. During the Reforms period, the relative rankings are: On the basis of the individual issue Karnataka(0.40), Maharashtra(0.34) and based information, the aggregate view at the Orissa(0.34). These indicate that the overall state level is made . Once again an MCA is status of health is still quite low in all the applied here. These aggregates take in to states, with Karnataka fairing bit better than account of both the negative and positive the other two states. effects on the status of health. Composite Indices of Health Delivery Status in Three States During Before Before reforms period, the relative State scores in decreasing order were: Reforms Reforms Maharashtra (0.26), Karnataka(0.23), and Karnataka 0.3969 0.2316 Orissa(0.21). Hence it can safely said that Orissa 0.3379 0.2081 they are low but almost the same during the Maharashtra 0.3374 0.2601

Composite Indices of Health Delivery Status in Three States: A Comparative Picture of Before and During Reforms Period

0.45

0.4

0.35

0.3

0.25 0.2

0.15

0.1

0.05

0 Karnataka Orissa Maharashtra

During Ref orms Before Reforms What Do The People Say About Health Care Facilities? 9

Annexure 1

Guideline listing the major Health Related Questions Issues For Focused Group Discussion Regarding Health Status

I. Water and Sanitation Facilities. Before Now 1.Water - No. and type of public wells/ponds etc. - Nature of water- potable/salinity - Water availability throughout the year - If not in the village, distance of water source - Time taken to walk down to the source - Water Cess- amount paid, effectiveness of the service - Adequacy of water- to drink (human beings and animals): for day to day routine activities (bathing, washing clothes, animal rearing, others)

2. Sanitation facilities - Drains and sewerage- open or underground - Maintenance of drainage - Garbage cleaning - Public Toilets and their status-Sulabh, Panchayat’s, any other - Morbidity related to maintenance of sanitation facilities - Sanitation cess

II. Morbidity Pattern in the Village: - Presence of communicable diseases - Presence of non-communicable diseases (Record the morbidity pattern for children, adults and aged separately)

III. Availability of Health Facilities Kind of facilities available in the village or nearly village Public- PHU, PHC, CHC, any other Private-Visit by the doctor at regular intervals, Presence of a clinic, hospital Number of private doctors present in the village NGO- Rotary Club, Lions’ Club, Rural Development Society, Religious institution, any other Comparison between public, private and NGO facilities with regard to - Costliness of services - Effectiveness of services- usability and relevance - Prompt availability of services 10 CMDR Monograph Series No. - 46

- The kind of satisfaction that the community derives from these different facilities - Withdrawal of services by the government health sector such as supply of medicines Medicine - Presence of pharmaceutical/drug store - Type of medicine - Service provided - Any other alternative to a full-fledged drug store in the village for basic medicines - Prices (variations——)

Health Education Programmes - Experience with the family welfare programme - Types of awareness Programmes (Information on the usefulness, relevance, adaptability for people)

Annex to the availability of Health Facility - Connectivity by Road- Pucca road (all weather road), Kutcha road - Public transport- Bus, auto, private vehicles - Any other

Preference for the type of service - Preference of the community for the type of medical facility or doctor: - Public - Private - NGO

IV. Nutritional support for the children PHC Anganwadi NGO

V. Agriculture and related health problems - Effects of using fertilizers and pesticides on the health of individuals and domestic animals

VI. Use of Alcohol in the village - Alcoholism and vices - Increase in the number of alcohol shops- arrack shops and/or wine shops in the village

VII. PDS functioning - Availability of rice, sugar, kerosene, etc – regularity in the service provided What Do The People Say About Health Care Facilities? 11

Annexure 2 system has been well in all the selected villages. Now under ‘Nirmal Gram Yojan’ some households in the selected villages have Detailed Write-ups on FGD constructed toilet facility, but there are no Outcomes from each of the districts public toilets. Households collected the garbage on there own lands for composting. District wise FGD Report Dharwad district Morbidity pattern:

Availability of drinking water facility in Earlier, villagers were suffering from the the selected villages: diseases like choler, skin diseases, malaria, diorrhea/dysentery, cough&cold. And Households in the selected villages children were suffering from malaria, skin use to get water for drinking and other diseases, cholera, cough&cold, scabies, purposes from wells and ponds. It is polio and diorrhea/dysentery. This is mainly observed from the group discussion that the because of untreated water used for drinking water quality was not good. So, waterborne purpose. But now polio and scabies are diseases like gastro entries, cholera, skin controlled and other diseases declined in diseases, diorrhea / dysentery were children and at the same time in adults also prevalent. Now under National Rural Water the diseases, which are seen earlier, are Supply Scheme (NRWS) all villages have controlled due to implementation of NRWS got tap water supply, this system has been Scheme and other controlling measures maintained well in all selected villages. As a taken by Government. But blood pressure result of this waterborne diseases have and joint pain are coming up due to change declined. ‘Water cess’ is collected from the in life style. private tap holders at the rate of Rs-15-20 per month. Availability of health care facility:  Selected villages have not good health Sanitation facility in the selected care facility. Only one village i.e., villages: Ganjigatti has PHC within the village. The primary health service by the government Earlier, villages had no sanitation is not good. There are no qualified facility. Now out of four villages two villages doctors in the villages, therefore have under ground drainage (UGD) system households of these villages have to visit under the Netherlands’ ‘Water Supply and Hubli/Dharwad for getting medical facility, Sanitation Project’. The other two villages even for getting primary health care and have open drainage system. The sanitation they have to travel about 15-30 km. 12 CMDR Monograph Series No. - 46

 The allopathic medicines are not available consuming alcohol, because of poverty and in the villages. Villagers have to get unemployment. medicines from either taluka head quarter Functioning of PDS: or district head quarter, but basic All villages have Public Distribution medicines are available in general stores. System (PDS) and they are functioning well  Some health camps like eye check up, and they are providing items like rice, wheat, antenatal check up, child check up and sugar, kerosene. Earlier one village had bad malaria awareness camps have been functioning of PDS. conducted in the recent years in the Dharwad district.  Earlier, one village was connected by District wise FGD Report kutcha road, but now the condition has Thane District of Maharashtra State improved, the frequency of buses are increased and private tempo also Four villages were selected for FGD operating. in the Thane district - Aghai, Adoshi, Khaire and Chas. Nutritional support for children: Aghai village is situated in Shahapur Anganwadi centers are functioning taluk; this village comes under the reserve well in the selected villages and providing forest area called “Tansa Reserve Forest”. Nutritional support to the children. The no. As the village comes near the dam called of Anganwadi centers are increased 40% Tanasa dam, it gets water throughout the year over the period of time. and it 20km away from the taluk.

Agricultural related health problems: Khaire is 25-30 km away from the taluk Shahapur. The village is 4 km away from Farmers are using pesticides, the shenave, where PHC is located. fungicides and chemical fertilizers in their fields. It has caused for problems like skin Adoshi is situated in Mokhada taluk, itching, eye irritation, omitting, headache, which is nearly 25-30 km away from the since last 10 years. village. Nearest health care facility to this village is Khodala where PHC, sub-center Consumption of alcohol: is there in the village.

There is increase in the no. of alcohol Chas is 7-8 km away from the taluk shops, people are consuming more alcohol. Mokhada, adiwasi stays in the village are It is observed that youngsters also started takur, katkari, varli. What Do The People Say About Health Care Facilities? 13

1) Water and Sanitation: facility is available in the selected villages. Regarding public toilets since beginning there Water: Water is basic amenity for is no such facility, people defecates outside. human beings, it includes quality & availability In Aghai village some villagers have built of water, etc., Compare to the before private toilets on their own. Five years reforms period the water facility is improved before Gram Panchayat has given Rs-2500 in Thane district. Earlier 23 water sources for building the toilets some people have built were working in the selected 4 villages of them, but some villagers haven’t, during that Thane district (wells, hand pumps, river, etc,) time villagers have to pay Rs-300 as now total 27 are there, because of increase sanitation cess per year. But now it is not in the wells, habitants have to walk some functional. distance to fetch the water, at least they have to spend 20-30 minutes to get water. Due to lack of maintenance of drainage Adoshi and Chas villagers were face the and sewerage water spread on and around water shortage in summer season; even now the houses. Therefore, unhygienic they are not getting adequate water in surrounding was seen around the houses, it summer. But the situation in Aghai and leads to diseases like skin disease, typhoid, Khaire villages is different. It has been Diarrhoea, vomiting, fever, cough&cold. reported that water is available throughout These are frequently occurred in the villages the year in these villages, to get ride of this at present, but the condition has changed problem ‘Nal Yojan’ has been sanctioned slightly because of improved education for all villages, but villagers are getting water facility. some time only through the taps particularly in summer season. Earlier villagers were not 2) Morbidity pattern: paying any ‘water cess’ to the Gram Panchayat, now also they are not paying During Reforms period the morbidity except Aghai village (Rs-40 per month). pattern is increased, adult and children are Now the Gram Panchayat is using TCL as suffering form both communicable and non- purifier of water, but earlier only 2 villages communicable diseases. Earlier days- adults have been adopted this facility. were suffer from diseases like malaria, diarrhoea, measles, vomiting, skin infection, Sanitation: Sanitation is one of the waterborne diseases, typhoid, leprosy, key indicators for good health and scabies, jaundice, cold&cough, dysentery. environment in any community. It is pertinent Children were suffering from diseases like to note that earlier there were no sanitation malaria, diarrhoea, measles, vomiting, skin facilities such as drainage, garbage cleaning infection, cold&cough, waterborne diseases, and toilet, but now at least garbage-cleaning jaundice, fever, gastro. Now, along with 14 CMDR Monograph Series No. - 46 these diseases some more are occurred given all types of Health Education Adult- T.B, cancer, diabetes, whopping Lectures. cough and eye problem. Children-  Road and transport facilities are malnutrition and mumps. improved, all villages have getting bus and private vehicles, Adoshi and Chas have 3) Availability of health care facilities: pucca road facility, but earlier only bus facility was in less frequent and except Availability of health care facility is Adoshi other villages having Kutch road increased in the selected villages of Thane facility. Now also Padas connected with district. Earlier 1Primary Health Center Kutch road, in rainy season the mud (PHC), 3 private doctors and 1 NGO were comes out of the road; people are facing working in the villages and they were lot of problem. providing good service, villagers were satisfied with the PHC. Now 1 PHC, 2 4) Nutritional support for children: private doctors, 3 ANM and 2 NGOs are providing health care facilities to villagers. Anganwadi centers are providing PHC is charging Rs-5 as case paper fee, nutritional support for children, earlier only earlier it was 3 rupees and private doctor 4 Anganwadi center were working in two charge 20-40 rupees per patient. Where as, villages (Aghai, Chas). Now 6 Anganwadi ANM centers are not providing regular and centers are working in all 4 villages, children good service. Tata Institute of Social are getting ‘Usal, Khichadi’ as diet to eat. Sciences (TISS) is working in Aghai village But malnutrition is seen among the children, since 11 years, under the Integrated Rural earlier also malnutrition was seen. Health & Development project. It is providing Anganwadi & Health Education 5) Agricultural related health problems: Programmes to the villagers. Now one more NGO is working in Chas village (BAIF). Specifically there are no agricultural related health problems seen among the  There is no Medical shops in the villagers, skin diseases, cold&cough are selected villages, only basic medicine is commonly seen, but 10 years before one available in general shops, the situation death case has been reported due to has not been changed, but in Adoshi poisoning in Aghai village village even basic medicine is also not available. 6) Alcoholism:  Health education programmes were not conducted till now; it has been reported Alcohol shops are not seen in the that only in Aghai village the ‘TISS’ had selected villages of Thane district, alcohol is What Do The People Say About Health Care Facilities? 15 prepared by villagers in their house only, they increase in the wells and bore wells, villagers sell a bottle Rs-10. The consumption of of Krishnapur are getting water within the alcoholism is high among the villagers, village, whereas other villagers have to walk however, villagers have not been reported some distance to fetch the water, at least about the extent of alcoholism, earlier also it they have to spend 30-45 minutes to get was there, but in Aghai village consumption water. Except Kottaa village other villages’ of alcoholism is decreased, only people who water is potable in nature. Nagaram and stay in padas are taking more alcohol and Kottaal villagers were facing the water within 1-5 years the percentage is decreased shortage in summer season; even now they i.e., 5-10% are not getting adequate water in summer. But the situation in Krishnapur and Basapur 7) Functioning of PDS: villages is different. It has been reported that water is available throughout the year in these 4 Public Distribution Shops (PDS) villages. Now the Gram Panchayat is using are giving regular service to the villagers, and TCL as purifier of water in selected villages rice, wheat, sugar, and kerosene are being of Gadchiroli, but earlier Kottamal village provided at govt rates. But 10 years before has been adopted this facility. Villagers have only 1 PDS was working in Khaire village. to pay ‘water cess’ , but it vary from village People were satisfied with service. to village, for example- Nagaram Rs-100, Krishnapur-Rs20. District wise FGD Report of Maharashtra Sanitation: Sanitation is one of the key State indicators for good health and environment in any community. It is pertinent to note that Four villages were selected for FGD in earlier Nagarm village had drainage and the Gadchiroli district – Nagram, Kottamal, garbage facility in the village, other villages Krishnapur, Basapur. hadn’t any such facility, but now things are changed drainage and garbage facility is 1) Water and Sanitation: available in all selected villages, particularly Nagaram village having all sanitation facility, Water: Water is basic amenity for but 20-25% of villagers are getting (enjoying) human beings; it includes quality & availability these facilities in the village. of water, etc., water facility in Gadachiroli district. Earlier 36 water sources were Due to lack of maintenance of drainage working in the selected 4 villages of and sewerage, unhygienic surrounding was Gadchiroli district (wells, hand pumps, river, seen around the houses, it leads to diseases etc,) now total 44 are there, because of like malaria, cholera, dysentery gastro, 16 CMDR Monograph Series No. - 46

Diarrhoea, but the condition has changed and mainly the charge depends on severity only malaria & cholera are appearing among of diseases. In PHC Rs-5 is being charged, the villagers. earlier it was Rs-2, somehow villagers are satisfied with private treatment. 2) Morbidity pattern: One Religious institution runs a Mission Hospital at taluka place of During Reforms period the morbidity Nagaram, which has the most facilities as pattern is increased, adult and children are compare to other two, 10 years before also suffering form both communicable and non- it was working. communicable diseases. Earlier days- adults  There is no Medical shops in the selected were suffering from diseases like malaria, villages, earlier also the situation was T.B, mouth cancer, gastro, diarrhoea, similar, if at all the villagers have to get cholera, back pain and dysentery. Children medicine, they have to go at taluk place, were suffering from diseases like polio, cold even basic medicine is not available in the & cough. But now, along with these diseases villages. Only the traditional healer keeps some more are occurred Adult- skin disease, some ayurvedic medicine without body pain and headache. Children- knowing its ingredients and the relevance. dysentery & diarrhoea, but there is a little  Earlier days the family welfare control over the diseases and compare to programme and Health education other 4 districts Gadchroli is less affected to programmes were not conducted in the morbidities. villages, such programme conducted at taluk place. But now health education 3) Availability of health care facilities: programme are conducted except Kottamal village, like eye camp, polio Availability of health care facility is camp, polio camps are being conducted increased in the selected villages of thrice in a year. Gadchiroli district. Earlier 1 RMP doctor  Road and transport facilities are was working in the Krishnapur village, no improved, the private and public health other village had any health care facility in facilities are well connected by pucca the district. If at all they want to get Medical roads, only internal roads of villages are treatment they had to go taluk places, where kutcha and bus and private vehicles are PHC, private doctors working. But now providing service. In Nagarm village the except Kottamal village other villages are interior tribal area is connected by tar having 6 RMP doctors, they made regular road. Except Basapur village others were visits to villages and providing prompt connected with pucca road and s.t.bus service, sometime villagers prefer private was the only mode of conveyance doctor, where they have to pay Rs-15-20 What Do The People Say About Health Care Facilities? 17

4) Nutritional support for children: 7) Functioning of PDS:

Under Integrated Child Development 4 Public Distribution Shops (PDS) Scheme (ICDS) Anganwadi centers are were giving regular service to the villagers providing nutritional support for children, of Gadchiroli district. The items like rice, earlier 4 Anganwadi center were working in sugar, and kerosene were being provided at villages of Gadchiroli district, ‘khichadi’ was government rates. But now a day irregularity being given to children once in a day, now found in the PDS. also the situation is similar. District wise FGD Report 5) Agricultural related health Nasik District of Maharashtra State problems: Four villages were selected for FGD Using of chemical fertilizers and pesticide in the Nasik district – Adharwad, Borli, are being increased in recent days in Galne, Hatane. Nagaram and Kottamal villages, while Adharwad village is situated in spraying pesticides the farmers gets the felling Igatpuri taluk; it 40-45 km away from the of vomiting and headache problem. But taluk. earlier days the chemical fertilizers and Borli is situated in Igatpuri taluk. pesticides were not at all known to farmers Galane is situated in Malegaon taluk, to be used in fields, naturally they didn’t face Hatane is 20-25 km away from any problems. Malegaon taluk.

6) Alcoholism: 1) Water and Sanitation:

Alcohol shops are not seen in the Water: Wells are the main source of selected villages of Gadchiroli district, water for villagers of Nasik district. One alcohol is prepared by villagers in their house hand pump is working, the villagers of only, the consumption of alcoholism is high Adharwad and Galane have to spend 20- among the villagers, however, villagers have 25 minutes to fetch the water, only one pond not been reported about the extent of is working, which is 2 km away from the alcoholism and alcohol consumption was Borli village and ‘nal yojan’ is sanctioned, considered as traditional rite as generally but it’s not properly working, Earlier, villagers consumed by all elder member of the family. were not paying any ‘water cess’ to the In Kottamal village a major set back taken Grampanchayat, but now they are paying place at preasent. and it varies form village to village. Now the Grampanchayat is using TCL as purifier 18 CMDR Monograph Series No. - 46 of water, but earlier only one village has been infection, cold&cough, jaundice, fever, adopted this facility. Compare to last 10 typhoid, scabies, mumps, asthma, leprosy, years water scarcity is increased in the eye problem, mental health problem, district. malnutrition, whopping cough. Sanitation: Sanitation is one of the key indicators for good health and environment 3) Availability of health care in any community. It is pertinent to note that facilities: earlier there were no sanitation facilities such as drainage, garbage cleaning and toilet, but Availability of health care facility is now Galane and Hatane villages are getting increased in the selected villages of Nasik sanitation facilities, there are 2 public toilets district. Earlier 1 ANM center and 2 private in the villages, those are only for women and doctors were providing health care facility 2 public bathroom for males in both villages. for the villagers of Nasik district, they were ‘Dumping bin’ facility is working in 4 villages, satisfied with private doctors treatment and people put the garbage in dumping bins and villagers prefer to go taluk place where they make use of it for preparing compost, but get PHC and qualified private doctors, earlier there was no such activity. normally Rs-5 is being charged in PHC as case paper fee, but where as Rs-20-30 is Due to lack of maintenance unhygienic being charged by private doctors. Now was seen around the houses, it leads to also villagers prefer for private treatment, at diseases like diarrhoea, dysentery vomiting present 2 ANM centers and 3 private fever, cough&cold, now also these are doctors are working in the villages. appearing among the villagers. a. There is no Medical shop in the selected 2) Morbidity pattern: villages, villagers have to go taluk place to get medicine, in Adharwad and Morbidity pattern is increased, adult and Galane village only basic medicine is children are suffering form both available in general shops, 10 years communicable and non-communicable before the condition was quite similar. diseases. Earlier days- adults were suffer b. Health education programmes were not from diseases like malaria, diarrhoea, skin conducted in earlier days. But now infection, typhoid, leprosy, jaundice, Programme held in 2 villages out of 4 cold&cough, gastro, asthma, flue, eye villages (Adharwad and Galane), those problem, but now along with these few more are medical checkup camp and eye are appearing like cholera, scabies, camp, during that time some information dysentery, vomiting, cancer, paralysis, heart was given on basic sanitary needs and attack. Children are suffering from diseases hygiene etc., like malaria, diarrhoea, measles, skin What Do The People Say About Health Care Facilities? 19 c. Road and transport facilities are 6) Consumption of Alcoholism: improved, all villages have getting bus and private vehicles, villages are Alcohol shops are not seen in the connected with pucca roads, but still the selected villages of Nasik district; villagers villagers of Adharwad are facing in their house prepare alcohol. The inadequate buses. Earlier villages were consumption of alcoholism is high among the connected with kutcha roads and buses villagers, however, villagers have not were only mode of conveyance, but reported about the extent of alcoholism, frequency of buses were very less, that earlier also it was there, but in Galane village was once in a day and at night time alcoholism is decreased, now only 10% of villagers had faced lot of problems. people are consuming alcohol in the village. Moreover adults are started consuming 4) Nutritional support for children: alcohol and other drugs like Ghutka.

Anganwadi centers are providing 7) Functioning of PDS: nutritional support for children, earlier there was no Anganwadi center was working in 4 Public Distribution Shops (PDS) the selected villages. Now 6 Anganwadi are giving service to the villagers, and rice, centers are working in all 4 villages since 6 wheat, sugar, oil and kerosene are being years, children are getting ‘Usal, Khichadi, provided at govt rates. But 10 years before Maize powder and Milk powder’ as diet to only 2 PDS were working in Adharwad and eat. Hatane villages, that time they were providing rice, sugar, and kerosene at fixed rate. 5) Agricultural related health problems: District wise FGD Report There are few agricultural related health of problems seen among the villagers, skin Maharashtra State diseases, fever, cold&cough are seen among the villagers of Adharwad and Galane, but Four villages were selected for FGD in the 10 years before skin disease was appeared Amravati district – Bordi, Kakada, Churni, in Galane village, other villages hadn’t faced Hatru. any problems, because they might have used Bordi village is situated in Achalpur taluk. less chemical fertilizers and pesticides or Kakada village is situated in Achalpur hadn’t any idea of chemical fertilizers and Churni villages is situated in Chickhalda. pesticides. Hatru is 70 km away from the taluk Chickhalada, it surrounded by the forest area. 20 CMDR Monograph Series No. - 46

1) Water and Sanitation: villages. In Bordi village open drainage facility is there, Grampanchayat regularly Water: Water is sufficient enough for cleans garbage. In Churni village public toilet Kakada and Hatru villages, because in Hatru facility is available since 5 years. Village village a river goes near by the village, for Hatru don’t have any drainage and sewerage washing cloths and animal raring villagers go system, stagnant water flows surrounding the to river only, naturally villager have water houses, totally unhygienic and uncleanliness throughout the year. And in kakada village was seen in the village. 10 wells, 1 hand pump and 2 bore wells are working, drinking water come form tap and Diseases were found in the villages like tap water available throughout the year. All malaria, typhoid, dysentery, gastro, these resource are within the village. Where cold&cough, cholera, now also diseases like as in other 3 villages people have to walk malaria and dysentery are appearing among 0.5 km and have to spend 25-30 minutes to the villagers due to unhygienic. get water. 2) Morbidity pattern: Villagers of Bordi and Churni are facing water scarcity problem. In Churni Ten years before morbidities were village one pond is working, but water is not few among the adult and children, Adult were potable, usually for washing cloths, bathing suffering from cancer, paralysis, malaria, and animal raring people use pond water, diarrhoea, cholera, typhoid, but now along but water is banned for farming. Nal yojan with these few more are appearing like is there, but it is not functioning and it has dysentery, mumps and gastro. been reported that different types of germs present in drinking water, still villagers have Children were suffering from to drink water. In all villages people are diseases like polio, cancer, paralysis, malaria, paying ‘water cess’ about Rs-40 and TCL typhoid, cholera, diarrhoea, and dysentery. is being used as purifier of water, earlier, also Now polio is not seen among the children, situation was similar. few more are coming up measles, mumps, malnutrition, eye problem, gastro. Sanitation : Sanitation facility is available in Kakada, Bordi and Churni villages. In 3) Availability of health care Kakada and Bordi villages, Zillapanchayata facilities: has given 148, 70 toilets respectively to BPL category people under their scheme, few of Amravti district having a good position them are using and remaining go to outside, in health care facility compare to other 4 but there is no public toilets facility in the districts, totally 2 PHC, 9 Private doctors, What Do The People Say About Health Care Facilities? 21 one ayurvedic clinic and Nurse visit to Bordi Kakada village connected with pucca village. The villagers of Chruni prefer to road and other villages connected with public as compare to private doctors in case kutch road, S.T. buses were mode of of costliness and they feel effectiveness, conveyance. But villagers of Bordi were earlier people didn’t feel satisfaction from using bullock cart as mode of PHC. Other 3 villagers satisfied with private conveyance. health facilities, private doctors are giving prompt services to the villagers, some time 4) Nutritional support for children: they give home visits. Anganwadi centers are providing The Christian Missionary has set up a nutritional support for children, earlier only hospital in Raseaon (6 km from Bordi) many 2 Anganwadi center were working in patients from Bordi visit that hospital, NGO Kakada and Bordi villages. Now 4 hospital has gained much popularity (for Anganwadi centers are working in all 4 snake bites) that some time people from villages, children are getting ‘Usal, Khichadi’ Amravati and also visit there. But as diet to eat. earlier, in Bordi village no health care facility was there. 5) Agricultural related health problems: a. Two Allopathic medical shops are functioning in Kaka village since 11 years, Agricultural related health problems but other 3 villages even not having basic were not seen among the farmers in early drug facilities. Ten years before also the days, but now the problems like vomiting, condition was similar, if villagers want eye problem and skin diseases are appering medicine they have to go taluk place. among the farmers, due to chemical b. Health education programmes like eye fertilizers, pesticides and fungicides. But in camp, polio camp are held in villages Kakada village 80%-90% of farmers use except village Hatru still now. If at all the chemical fertilizers and pesticides since 20 programme will be held in taluk place the years, but they haven’t experienced any kind villagers have to go there, earlier days of problems. except Kakada no where health education programme held, now people 6) Alcoholism: are getting little awareness of health. c. Road and transport facilities are Alcoholism was high among the villagers improved, all villages have getting bus and in earlier days, it has been reported that “in private vehicles, frequency of vehicles are Bordi village lot of alcohol shops were there”, good and villages are connected with but within this 2-3 years those are closed, pucca road, but ten years before only now villagers bring alcohol from outside and 22 CMDR Monograph Series No. - 46 in other villages also alcoholism reduced scarcity of water 3 villages are facing (Korle, slightly, but youngsters are started Patan, Asali) only Budaki villagers are getting consumption of alcohol. water throughout the year. Now from 5 years Grampanchayat has started ‘Nal 7) Functioning of PDS: Yojan’ and villagers are paying ‘water cess’ to Grampanhayat , but it varies from village Public Distribution Shops (PDS) are to village( 20, 40, 360) and TCL is being working in selected 4 villages; they are used as purifier of water by Grampanchayat, providing rice, wheat, kerosene and sugar. earlier villages like Budaki and Patan were Only in Bordi village villagers, who belong getting water throughout the year and to below poverty line are not getting ration villagers of Budki were paying the ‘water in government rate, instead only rich people cess’ on those days. are getting at government rate. But ten years before only Kakada and Bordi having 2 Sanitation: Sanitation facilities are available PDS, the services provided by them were in selected villages of Dhule district, earlier somewhat ok. there was no such facilities for villagers, now drainage, garbage cleaning and toilet facilities are available, in Korle village, 2 public District wise FGD Report bathrooms built by Grampanchayat for Dhule District of Maharashtra State males, but drainage, sewerage and toilet cleaner is not in the village, villagers use to Four villages were selected for FGD in the through garbage on public bin, 6 toilets are Dhule district - Patan, Karle, Asali, Budki. working in Patana village, the public toilets Village Patan is situated in Sindhkheda taluk. are only for ladies. Ten years before this Karle is situated in Sindhkheda taluk. type of facilities were not there, simply Asali is situated in Shirpur taluk, villagers put the garbage near their house, Budki is 20-30 kms away from Shirpur taluk. this caused for unhygienic around the houses, than the diseases like skin disease, typhoid, 1) Water and Sanitation : Water: flue, fever, diarrhoea were appeared among Availability of water facility in the villagers. selected villages of Dhule district is improved, earlier only wells and river were main source 2) Morbidity pattern: of water, but now along with these two sources, others like hand pumps, taps, bore Morbidities are increased at present well and tank are working in the selected compare to the earlier days, earlier adults villages, except Korle village other villagers were facing diseases like malaria, typhoid, are getting water within the village, regarding cold&cough, skin disease, diarrhoea, What Do The People Say About Health Care Facilities? 23 dysentery, fever and choler, now along with programme has conducted before 2 years these few more are appearing like gastro, in Budaki village. eye problem, flue, vomiting, heart attack,  Regarding transport facility in selected all body pain, asthma, T.B, cancer and scabies. villages are connected with pucca roads Where as children are suffering with diseases and frequency of bus and private vehicles like eye problem, flue, diarrhoea, vomiting, is good, but before ten years buses were malaria, typhoid, measles, polio, dysentery, the only mode of conveyance and Korle skin diseases, asthma and malnutrition, & Asali villages have pucca road facility. whopping cough and some of them are controlled, but earlier days few of them were 4) Nutritional support for children: there. Anganwadi centers are providing 3) Availability of health care nutritional support for children, earlier only facilities: 2 Anganwadi center were working in Korle village. Now 7 Anganwadi centers are Availability of health care facility is very working in all 4 villages, children are getting less in selected villages of Dhule district as ‘Usal, Khichadi’ as diet to eat. In Korle compare to other 4 districts of Maharashtra village ‘Bhil’ pada children can’t come to state. Only 2 private doctors and two ANM these Anganwadis as the pada is much longer centers are working in the Korle and Budaki distance for the Anganwadis and in Patana villages, earlier there were no such health village one separate Anganwadi is working facility in selected villages, if they want for Adiwasi people and another one for medical facility they have to go taluk place villagers. or some where else where PHC or private doctor available, Rs-5 is charged as case 6) Agricultural related health problems: paper fee in PHC and Rs-20-25 is charged in private doctors. Regarding costliness is Due to use of chemical fertilizers and they prefer PHC rather than private doctors. pesticides farmers are facing problems like body reaction, skin diseases and poisoning,  There is no Medical shop in the selected but earlier farmers were not faced such villages, but in village Patana and Budaki problems. basic drugs are available in general shops. If villagers want medicine they have to 7) Alcoholism: go taluka place.  Health Education Programmes were not Alcohol shops are not seen in the conducted till now; it has been reported selected villages of Dhule district, alcohol is that only once AIDS awareness prepared by villagers in their house and 24 CMDR Monograph Series No. - 46 consumption of alcohol is increased among Sanitation: the villagers, earlier also the situation was Earlier, there were no sanitation similar, now youngsters are also started facility in the selected villages, but now 50% consuming alcohol, gutaka and tobacco. of selected villages have drainage and sewerage facility and some households in the 8) Functioning of PDS: 50% of the selected villages have private toilet. It shows that sanitation facility have Public Distribution Shops (PDS) are improved over the period of time. giving regular service to the villagers, rice, wheat, sugar, and kerosene are being Morbidity pattern: provided at government rates, but in Budaki Earlier, villagers were suffering from village 2 PDS are functioning. But 10 years leprosy, T.B, cholera, malaria, skin disease, before such facilities were not working in paralysis, diarrhea/dysentery. Now these are the selected villages. controlled by the government. In children the diseases like malaria and cholera controlled and others like skin disease, District wise FGD Report cold&cough are declined, due to good quality water and precautionary measures by government. Availability of water and sanitation: Water: Availability of health care facilities:  There are no such medical facilities are Households in the selected villages available either by public or by private in use to get water for drinking and other the selected villages. In one village district purposes from wells, pond, and tube wells. health administration provided And they are getting potable water in all Homeopathic center, but not provided season, but in village Bachepalli, the villagers any doctors. Villagers have to visit taluka had to walk .5 km to fetch the water in head quarters for getting health care summer season. Now implementation of facilities and they have to travel 10-40 National Rural Water Supply Scheme km. (NRWS) and Mini Water Supply Scheme  Earlier, one village had a medical shop, (MWS), villagers have good quality tap but now two villages have medical shop. water. ‘Water cess’ is collect from private But other two villagers have to go taluka tap holders and ‘general water cess’ is head quarters to get medicine. included in ‘house tax’ by the  There are no health education Grampanchayat. programmes are conducted either by public or by NGO’s What Do The People Say About Health Care Facilities? 25

 Earlier, 75% of the selected villages had District wise FGD Report connected with kutch roads, but now Chikkamagalur District 75% of the selected villages have connected with pucca roads and Water and Sanitation: frequency of buses have increased. Nutritional support for children: Water: The Nutritional support given by Earlier, households of the selected Anganwadis are increased, earlier 4 villages depended on the wells for drinking Anganwadi were functioning in the selected and daily routine purposes, but now all villages. Now total 8 Anganwadi centers selected villages have ‘tap water’ facility are providing Nutritional support for children. under the National Rural Water Supply Compare to other 4 districts it is highest in (NRWS) Scheme. In two villages people number. are using well water for drinking even though the tap water is available, this is because of Agricultural related health problems: sweetness of the well water, in these villages In the selected villages of Bidar no. of wells are more than no. of houses, district chemical fertilizers and pesticides are because that area comes under the hilly being less used, because of non-irrigation region and all selected villages in the district land, naturally agricultural health problems have adequate water supply throughout the are not seen, earlier also the situation was year. But it has been reported in FGD that similar. the water has more fluoride content, as a result of this more people are suffering from Consumption of Alcohol: ‘Dental Problem’ i.e., ‘Floroses’. Now Numbers of alcohol shops in the villagers are paying ‘water cess’ for the selected villages are increased from 8 to 11 ‘private and public tap’ facility, but earlier over the period of time. It shows that alcohol this was not there and in village Kigga the consumption has increased in the villages, villager don’t have any ‘tap water’ facility. due to poverty. Sanitation: Functioning of PDS: Ten years before there were no Public Distribution System is sanitation facilities in the selected villages, functioning well in 3 villages out of 4 selected but now two villages have ‘open drainage villages. But earlier in all 4 selected villages facility’ under the ‘Nirmal Gram Yojan’ and PDS facility was good. some households are having toilet facility, but there no garbage cleaning facility in the selected villages. 26 CMDR Monograph Series No. - 46

Morbidity pattern: pucca roads and bus and tempo are In Chikkamagalur district, it has providing services to the villagers. been reported in FGD that ‘Dental Problem’ is the main disease, because excess fluoride Nutritional support for the children: content in the water. Earlier disease like Anganwadis centers are providing leprosy, skin diseases, T.B, Scabies were Nutritional support for children, earlier, 5 prevailed, now they are controlled, but in Anganwadi centers were providing Kadur taluk no. of malaria patients are Nutritional support for children, but now 6 increased, more than 9800 malaria +ve cases Anganwadis are functioning in the villages. are recorded, it is believed that it has come from immigrants, i.e., shepherd people from Agricultural related health problems: chitradurga district. Children are suffering For Agriculture purpose farmers are from diseases like skin disease, cold & using chemical fertilizers, pesticides and cough, cholera, diarrhea/dysentery, those are fungicides, as a result of this they facing controlled and in children also malaria has problems like head ache, skin irritation, increased. vomiting and eye irritation since 15 years.

Availability of health care facility: Use of Alcohol:  The selected villages have no good health Alcohol shops are increased, earlier care facilities, only one village have PHC, 5 shops were there, but now 10 shops are it is providing good service to the working in the selected villages and villagers, but other villages have no consumption of alcoholism also increased. qualified doctors, if they want to get medical treatment they have to go for Functioning of PDS: taluk head quarters. Public Distribution Shops are  Medical shops are not functioning in the working well in the selected villages since selected village of Chikkamagalur district 15 years. and even villagers are not getting basic drugs in the villages.  Regarding Health Education Camps, in District wise FGD Report only one village Health Camp is Chitradurga District conducted; those are eye camp and malaria camp, where as in other villages Water and Sanitation: no such camps are conducted till now. Water:  Compare to the earlier days Earlier, households of the selected transportation facility is improved, now villages were depended upon wells and all selected villages are connected with ponds for drinking purpose and they had What Do The People Say About Health Care Facilities? 27 adequate potable water in all season. Now villagers have to go taluk place for except one village other three villages have treatment. ‘tap water’ facility under the National Rural  Only one medical shop is functioning Water Supply (NRWS) Scheme. Earlier in one village, other three villages don’t Giriyapur village households were using well have such facility, if at all they want water for drinking, but now wells are not medicine they have to go taluk place. working and quality of pond water turned Earlier, there were no medical shops to salinity. Now villagers are paying ‘water in all selected villages. cess’ for ‘public and private tap water’  Recently, in three villages Health facility, but earlier this was not there. Camps are conducted, those are family planning camp, health Sanitation: awareness and child check up camp, Earlier, two villages have drainage but earlier no such camps were and sewerage facilities, but the condition was conducted in the selected villages. very bad. Now three villages have sanitation  Now all selected villages have facilities and the condition of sanitation connected with pucca roads and facilities are improved. Govt & private bus are the mode of conveyance, but earlier days, Morbidity pattern: villagers of Kengunte didn’t have any Earlier, adults were suffering from bus, they had to go by walk, but the diseases like skin diseases, malaria, T.B, other villages had bus facilities. cough & cold, fever, typhoid and asthma, now T.B. and typhoid are controlled. Nutritional support for children: Children were suffering from the diseases Earlier, only three villages had like malaria, cholera, cough & cold, eye Anganwadi centers, but now all 4 selected problem, diarrhea/dysentery and eye villages have Anganwadi centers and these problem, but now these are controlled. In are functioning well. case of adults new disease like head ache and asthma are increased. Agricultural related health problems: In recent years farmers of the 4 Availability of health care facilities: selected villages are using chemical fertilizers,  Earlier, only one village had PHC pesticides and fungicides, as a result of this facility and service provided by that farmers are facing problems like head ache, is not so good. But now along with skin irritation, eye irritation and respiration one PHC, one qualified private problem, but earlier these problems were doctor is providing medical facility not seen among the farmers. for the villagers, but other three 28 CMDR Monograph Series No. - 46

Consumption of alcohol: garbage-cleaning system is functioning well. The no. of alcohol shops are And in Alattur and Hura villages toilets are increased, earlier only 2 alcohol shops were constructed for habitants under ‘Nirmal present in the selected villages, but now 2 Gram Yojan’. un-authorized and 8 authorized shops are working in the villages and consumption of Morbidity pattern: alcohol also increased. Earlier days, adults were suffering from the diseases like skin diseases, cough Working of PDS: & cold, fever, weakness and typhoid, now Except Giriyapur village, other 3 typhoid is controlled, but diseases like AIDS villages have Public Distribution Shops and head ache are coming up in the adults. (PDS), earlier also the situation was similar In care of children, they were suffering from in the selected villages. the diseases like measles, cold & cough, skin disease, polio and fever, now polio and skin diseases are controlled and new diseases like District wise FGD Report stomach ache is coming up. Mysore District Availability of health care facility: Water and Sanitation:  Earlier, one village has PHC and Water: another one village had PHU, but now PHU Earlier, households of the selected is upgraded to PHC, means both villages villages were mainly depended on the wells have PHC and one village has private doctor for drinking and other purpose, now all facility, but remaining villagers have to go taluk selected villages have ‘tap water’ facility place for medical treatment. under the National Rural Water Supply  Earlier, there were no medical shops (NRWS) Scheme, the water level in the wells in the selected villages of Mysore district, and ponds are decreased and some wells but now one village has Allopathic medical are not functioning in the villages. For shop, remaining villages don’t have any ‘private tap water’ villager are paying ‘water medical shops, they have to go taluk place cess’ to concerned authority. for medicine.  Only in one village Health Education Sanitation: Camp is conducted that is ‘Nutrition support Earlier there were no sanitation and Health Education Camp’, other 3 villages facilities in the selected villages, but now three haven’t seen any Health Education Camps. villages have drainage and sewerage facility Earlier days also no such camps were and these are maintained properly, moreover conducted in the selected villages. What Do The People Say About Health Care Facilities? 29

 Transportation facilities are A Consolidated Report of Focus improved, earlier all 4 villages were Group Discussion connected with semi-pucca roads, but now (Organized in 12 villages in Orissa) two villages have pucca roads and other two By Sanjay Pradhan villages are connected with semi-pucca roads, private bus are the mode of The fieldwork of the action research conveyance. project entitled “Effect of Economic Reform on Health Sector in India” was undertaken Nutritional support for children: in three districts namely Balasore, Gajapati Anganwadi centers are providing and Malkangiri of Orissa. From each district Nutritional support for children, earlier four two blocks and two villages from each block Anganwadi centers were functioning in the were selected on the basis of humidity villages, but now six Anganwadi center are climatic zone and proportion of SCs and STs functioning, they are providing regular population. A total of 12 villages were service to the children. covered under the present study with a view to elicit the relevant information. Besides Agricultural related health problems: the structured household survey schedule, Farmers are using chemical Focus Group Discussion (FGD) was fertilizers, pesticides and fungicides in their considered as a major tool for collection of fields and they are facing problems like body relevant and authentic information directly pain, weakness, skin irritation and eye from the villagers. Governed by this problem in the four selected villages of consideration FGD was organized in twelve Mysore district. But earlier days no such villages in Orissa with active participation of problems were appeared among the farmers. villagers, Anganwadi Workers, CDPO and Investigators. Use of Alcoholism: Alcohol shop is increased, earlier Objective of the FGD only one alcohol shop were working in the The very purpose of organizing FGD Hura village, but now along with this, one is to have a understanding of various un-authorized shop is opened in the Abbur diseases, level of awareness of the villagers village and consumption of alcoholism also about the diseases, available of health care increased. facilities and utilization of health facilities by the villagers before ten years and now. Functioning of PDS: Earlier days 3 villages have Public Process Distribution Shops (PDS), but now in all The process began by briefing them selected villages PDS are functioning. about the purpose of our visit to the villagers. 30 CMDR Monograph Series No. - 46

The Anganwadi Worker was asked to gather a result they use water of pond, canal, open the people of all communities in Anganwadi well for cooking and drinking which center of the village. Though there were initial sometimes create harmful for their health. jerks in discussing about the health issues, The water is not filtered nor any method of the process gathered momentum in due cleaning water is applied. The water of course. It is positive to note that people of pond, canal are used for bathing of human all communities were actively involved in and animal. Focus Group Discussion and participation of women were found more active than their There is no drainage system in any village counterpart in all villages. for disposal of dirty water. Most of the houses are surrounded by stagnant dirty Issues raised in FGD water that creates mosquitoes. There is no The following issues were raised in separate place to put garbage. Garbage is Focus Group Discussion in selected villages. put nearby house, which keeps the  Water and sanitation facilities surrounding in very much unhygienic  Morbidity pattern in the village condition. People use open space for their  Availability of health facilities toilet. Although some of the villagers who  Nutritional support for the children are under below poverty line are provided  Maternity care latrine at payment of Rs.50/, yet they prefer  Health problem related to modern open space for latrine. agriculture practices  Alcohol use and its effect 2.Morbidity patter:  Function of PDS Before ten years people in Balasore  Health Care Cooperative district were suffering from diarrhoea/ dysentery, typhoid, cold and fever, T.B, small Results of FGD issues pox etc. Now as the majority of people 1. Water and sanitation facilities: seem to be conscious of these types of serious diseases only few people suffer from Before ten years people were using the dysentery, cold and fever during rainy and water of the pond, river and open well for summer session. In Gajapati and Malkangiri drinking purpose. At present there are three district majority of people severely suffer to four bore well in every village to meet the from brain malaria, typhoid due to lack of need of drinking water. But due to lack of awareness and lack of health facilities. The proper maintenance and repairing of those children suffer from measles, skin diseases, well time to time only one or two are cold and fever due to water and unclean functioning, which is insufficient to meet the surrounding. demand of villagers for drinking water. As What Do The People Say About Health Care Facilities? 31

3.Availability of health care facility: ICDS scheme to all pre-school children. People used to go to PHC and Anganwadi worker plays an important role Govt. Hospital for treatment some ten years to create awareness among pregnant back. Now they prefer private doctor due women, lactant women and children about to irregular doctor, insufficient of medical proper health and nutrition. Although facilities (i.e., homoeopathy, aurvedic etc.) Anganwadi worker distributes vitamin tablets in the villages. In Malkangiri district people to the children, which are provided by Govt., prefer aurvedic medicines and traditional yet more number of children suffers from healer for treatment of their health. severe malnutrition in Gajapati and Malkangiri district of Orissa. The children It is important to note that people are provided with polio, DPT and other such face inconvenient clinic hours, inadequate type of immunization time to time. Besides supplies and drugs, irregularity of doctors, ICDS scheme, some voluntary organizations long waiting times in public health sector. are also working for the development of Whereas in private health sector they face health and nutritional status of women and high cost of drug prices and financial children in rural area of Orissa. exploitation by doctors, quacks and dangerous of spurious drug intake. As a 5. Agriculture and related health result of it tendency in people for self- problems: prescription was found growing particularly 70% of people in rural area of Orissa in Malkangiri and of Orissa. depend on agriculture. Ten years back people were using compost for their People are less aware about the cultivation. Now they use chemical fertilizer, various health programmes like T.B, leprosy, spray of insecticides and pesticides to get malaria run by Govt, and NGOs. However, large quantity of crops. By using these they seem to be conscious about the family chemicals they suffer from skin irritation in planning and some people use contraceptive the hands and head reeling etc. It is also method for family planning. Before ten years important to note that using chemical fertilizer there was connectivity of katcha road to destroys the fertility of the soil. The crops every village and people were suffering grown by using such fertilizer when used for transportation problem for getting medical food cause stomach upset. facilities. Now many villages are well connected with pucca road and having good 6. Alcohol use and its effect: transportation facilities. The SC and ST people take arrack (handia) and country liquor regularly which 4. Nutritional support for the children: is locally prepared. The people are Nutritious foods are being provided in conscious about the vices of alcoholism still 32 CMDR Monograph Series No. - 46 they suffer from T.B., bronchitis, gastric etc, any decision about the same. It was found by using alcohol. Female members are very that in some villages there is no mahila careful about the drinking habits of their mandal, youth club nor such organization to husbands in spite of low female literacy rate. take joint decision for the village. They are In some villages it was also found that mahila reluctant to give any thing for the purpose. mandal had also run Nesha- Mukt- In FGD some people demanded that instead Andalan. of forming HCC it is better to provide minimum facilities like regular doctor essential 7. Function of PDS: medicines connection of pucca road There is one PDS unit in every village. electricity for the exiting of PHC. Whereas Only the people who are BPL cardholders in Gajapati and Malkangiri district the people get the articles like rice, sugar, and kerosene. welcome the idea of starting HCC. Some The APL cardholders get only kerosene. people are willing to pay cash but no fixed, Discussing in FGD people asserted that the some people willing to do voluntary services, things available in the PDS unit are very poor but nobody was interested to give land. in quality, irregular distribution and also Regular presence of doctor, ANM, insufficient to meet the demand of the minimum essential medicines etc, are the villagers. kind of services expected by the people from HCC. 8. Health Care Co-operative: In people are in favor of HCC but they are not willing to take What Do The People Say About Health Care Facilities? 33