Inter-District Variation in Health Services in Uttar Pardesh

Home , Ghaziabad

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

INTER-DISTRICT VARIATION IN HEALTH SERVICES IN UTTAR PARDESH

Naushaba Naseem Ahmed, Research Scholar, Department of Geography, AMU, Aligarh. Email: [email protected]

Prof. Sayeed Ahmed Khan Department of Geography, AMU, Aligarh. [email protected]

Abstract: Health as accepted by Indian constitution is one of the fundamental human rights. To attain a better health condition, health services play an important role in providing health facilities. Present paper is an attempt to highlights the inter districts variation in health services in Uttar Pradesh. Data are collected for seven variables such as No. of allopathic hospitals /dispensaries per lakh of population, No. of beds in allopathic hospitals /dispensaries per lakh of population, No. of Primary Health Centers per lakh of population, No. of Maternal and Child Health Care Centers/ Sub Centers per lakh of population, No. of doctors per lakh of population, No. of Para medicals officers per lakh of population, No. of other workers per lakh of population (for the year 2001 and 2011). With the help of composite Z-score technique the 70 districts are divided into 5 categories. Result shows the pathetic condition of health facilities in the state. Overall development in 2001, two districts lies in very low and four districts very high category. And in 2011 one and seven districts came under very low and very high category respectively. To overcome the problem of shortage of human resource in health services, it’s a need to develop trained non-physician and public and private partnership in providing the health care facilities will definitely be helpful.

Keywords: Health services, Composite Z-score, Development.

46 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

Introduction: Health as accepted by our constitution is one of the fundamental human rights. Health defined by the world health organization (WHO) “are a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. Health is a dynamic concept embracing biological and social dimension of well-being of a person. On the other hand health services system is a complex of research, education and delivery system (for preventive, promotive and rehabilitive services) and is only one of the many inputs required to improve the health of the people (Qadeer, 2011). It is well recognized that the health status of a population is shaped by a variety of factors like food, water, sanitation; housing, income, education and availability and accessibility to health care facilities. Health services are just one of the inputs required to improve the health status of a population.

The provision of health care services is largely govern by the socio-economic, historical, geographical and political factors of the state in one hand, on the other government policies, resource allocation and managerial efficiency to improve the health of the population. But health care system in developing country like India faced the problem of extreme poverty, minimal level of economic development and high level of population (about one fifth of total world population)( Dreze and Sen, 1995). According to the recommendation of the Bhore committee report, the govt. of India set up a network of health center on a hierarchal pattern with sub- center at the base and district hospital at the apex.

Theses center were established according to fixed population norms for example the norm was that there would be a sub- center for every 5000 population and a primary health care for every 30,000 population (Human Development Report, 2003). There is a server shortage of health care professionals in some of the developing countries like India, which have only 0.69 doctors /1000 population, while according to WHO recommendation 1:1000 people. India cannot achieve it till 2028. According to estimates India is having shortage of six lakh doctors, ten lakh nurses and two lakh dental surgeons (Abhishek et al, 2013) Same situation is also persist in Uttar Pradesh, government is bound to provide adequate health care facilities as to reduced morbidity and mortality but due to less financial resource, poor monitoring as well as lack of political commitment hampered the minimum health care requirement in the state (Saiful, 2013). In order to reduce inter districts variation in health services in Uttar Pradesh, it is necessary to determine 47 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

the extent of the existing inequalities and identify the lagging regions separately so that corrective measures could be initiated to rectify the imbalances. The objectives of this study are highlights the levels of Inter-districts variation in Health services in Uttar Pradesh with the help seven variables.

Study area: U.P situated in the north of India, lies between 23 52’ N and 31 28’ S latitudes and 77 3’E and 84 39’ E longitudes. Uttar Pradesh enjoys central location in south Asia with total area of 2, 40,928 sq. km. This northern state is surrounded by Bihar in the east, Madhya Pradesh in the south, Rajasthan, Delhi, Himachal Pradesh and Haryana in the west; Uttarakhand and Nepal in the north. According to census 2011 total population of Uttar Pradesh is 199 million, it contributes 16.16% of India`s population. The population density is 828 people per sq. km. Sex ratio is 908 female per 1000 male which is lower than the national average (940 female per thousand male). The literacy rate in 2011 is 70% which is below national average (74%) out of which 79% male literacy rate and 59 % of female literacy rate. Below provided some basic figure related with health infrastructure of Uttar Pradesh.

Health infrastructure facilities India (2011) Uttar Pradesh (2011) Number of Rural Hospitals (Govt.) 26604 515 Number of beds in Rural Hospitals (Govt.) 362996 15450 Number of Urban Hospitals (Govt.) 8812 346 Number of beds in Urban Hospitals (Govt.) 1013017 40934 Number of Total Hospitals (Govt.) 35416 861 Number of beds in Total Hospitals (Govt.) 1376013 56384 Average Population Served Per Govt. Hospital 34163 229118 Average Population Served Per Govt. Hospital Bed 879 3499 Source: downloaded from data.govt.in Data base and methodology:

Present work is based on secondary data and sources are District statistical handbook (2001 and 2011), National family health survey report (2001 & 2011) and Shankhikya Patrika (2001 and 2011). To highlight the variation in health services in Uttar Pradesh, Z- score statistical techniques were used.

48 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

Zi =Xi-X /SD

CSS= ∑Zi/N

Zi is the standard score, Xi is the original values of individual values for observation (i), X is mean for the variables ,SD is the standard deviation, CSS is composite score, N is number of variables. Then the 70 districts are categorized into 5 groups such as very low, low, medium, high and very high category.

List of variables:

1. No. of allopathic hospitals /dispensaries per lakh of population (X1) 2. No. of beds in allopathic hospitals /dispensaries per lakh of population(X2) 3. No. of Primary Health Centers (PHC) per lakh of population(X3) 4. No. of Maternal and Child Health Care Centers/ Sub Centers per lakh of population(X4) 5. No. of doctors per lakh of population (X5) 6. No. of Para medicals officers per lakh of population (X6) 7. No. of other workers per lakh of population (X7) RESULT AND DISCUSSION 2001

No. of allopathic hospitals /dispensaries per lakh of population (X1)

As a matter of fact that Uttar Pradesh having highest population in the country which shows population pressure on each of the infrastructure facilities. If the number of persons depends on each services is higher the quality of health services will definitely get degrade

2001 2011 CATEGORY RANGE No. of districts Share in %age No. of district Share in %age VERY LOW >-1.5 2 3 4 6 LOW -0.5 to -1.5 16 23 16 23 MEDIUM 0.5 to -0.5 35 50 33 47 HIGH 1.5 to 0.5 10 14 11 16 VERY HIGH >1.5 6 9 5 7 Calculated by Research Scholar

49 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

From the table, level of disparity is increased from 2001 to 2011. In 2001 only two districts (Gorakhpur and J.P. nagar) is lying in low category but it get double in 2011and 4 districts (G.B. Nagar, lucknow, Kanpur nagar, Ghaziabad) fall in this category with 6% share. In very high category 6 districts (Rampur, Jhansi, Hamirpur, Banda, Farrukhabad and Chitrakoot) was laid in 2001 and 5 districts namely Mahoba, Etawah, Hamirpur, Sultanpur, Siddhartha nagar and Chitrakoot in 2011. In 2001 and 2011, 16 districts are in the low range. 35 districts with half of the share (50%) and 33 districts with 47% share come under medium category, 10 and 11 districts come under high category in 2001 and 2011 respectively.

Variables 2001 2011 Top ten districts Bottom ten Top ten districts Bottom ten districts districts X1 Rampur ,Jhansi, JPN, Gorakhpur Mahoba ,Etawah, Ghaziabad, Kanpur Hamirpur, Banda, SRN, AN, Hamirpur nagar, Lucknow, Farrukhabad, Ghaziabad, Sultanpur, GBN, Aligarh, Chitrakoot Jaunpur, Siddhartha nagar Moradabad, Lalitpur, Lucknow, SKN, Chitrakoot Varanasi, Jaunpur, Raebarelli, Muzaffarnagar ,Mainpuri Agra, Meerut Kanpur nagar GBN Jalaun ,Banda Kaushambi ,Kaushambi

No. of beds in allopathic hospitals /dispensaries per lakh of population(X2)

Number of beds in hospitals is one supporting infrastructure which is essentials for the provision of the better health care facilities

50 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

2001 2011 CATEGORY RANGE No. of districts Share in %age No. of district Share in %age VERY LOW >-1.5 nil nil 6 9 LOW -0.5 to -1.5 24 34 15 21 MEDIUM 0.5 to -0.5 33 47 34 48 HIGH 1.5 to 0.5 6 9 10 14 VERY HIGH >1.5 7 10 5 7 Calculated by Research Scholar

This indicator shows wide variation from high to low range. clearly from the figure that in 2001 not a single occupied the lowest position but in 2011, 6 districts with 9% share came under this range In very high level in 2001 only 7 districts are there but in 2011, 5 districts are lies in this category which decreased of 3% . Maximum number of districts lies in both the period in medium category with 47% and 48% respectively.

Variables 2001 2011 Top ten districts Bottom ten Top ten districts Bottom ten districts districts X2 Lucknow, Kanpur Jaunpur ,AN, Lucknow, Jalaun, Jaunpur, nagar, Varanasi, SKN Chitrakoot, Mahoba Ghaziabad, Bijnor, Aligarh, Jhansi Maharajganj, Kaushambi ,Lalitpur Shrawasti, GBN, Agra, Mathura, Mainpuri, JPN, Basti ,Kannauj, Mau, AN, Kheri, Meerut SRN, Auraiya Pratapgarh Ghazipur, Allahabad ,Sitapur ,Kushinagar, Hamirpur Sonbhadra. Gorakhpur

No. of Primary Health Centers (PHC) per lakh of population(X3)

51 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

Primary health centers services are not efficient for which they are meant. And more of the primary health center does not adequate equipment, drugs and emergency treatment even in the best cities often not available.

2001 2011 CATEGORY RANGE No. of districts Share in %age No. of district Share in %age VERY LOW >-1.5 5 7 nil nil LOW -0.5 to -1.5 12 17 6 9 MEDIUM 0.5 to -0.5 35 50 62 88 HIGH 1.5 to 0.5 11 16 nil nil VERY HIGH >1.5 7 10 2 3 Calculated by Research Scholar

In the table it should be note that in 2011 in two categories, very low and high prevalence of the districts in nil. And maximum concentration is in the medium range with 88% share, in low range and very high range 9 and 3 districts occupied the position. While in 2001 half of the share of the districts came under medium while remaining 50% dispersed in very low (7%), low (17%), High (16%) and in very high (10%) range.

Variables 2001 2011 Top ten districts Bottom ten Top ten districts Bottom ten districts districts X3 Azamgarh, Auraiya, Etawah, Budaun, Kanpur Lucknow, Hamirpur, Banda, lucknow, nagar Sultanpur, Ghaziabad, Aligarh, Chitrakoot Varanasi, Kanpur Siddhartha nagar, Moradabad, Lalitpur, Ballia, nagar Etawah, Hamirpur Varanasi, G B N, Deoria, Basti, Maharajganj, Chitrakoot, Mirzapur, Meerut, Jhansi Kaushambi Pilibhit,Ghaziabad, Mainpuri Mahoba Agra, Allahabad, SRN, AN ,Banda

52 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

No. of Maternal and Child Health Care Centers/ Sub Centers per lakh of population(X4)

Maternal and child health care center are important because it’s helps in identifying the existing health risks in women and also prevent from the future health problems in women and their children. In the family welfare program the MCH care provision are unbalanced have focused on immunization and the provision of iron and folic acid rather than on sustained care of women and children or the detection and referral of high-risk cases.

2001 2011 CATEGORY RANGE No. of districts Share in %age No. of district Share in %age VERY LOW >-1.5 5 7 3 4 LOW -0.5 to -1.5 13 16 16 23 MEDIUM 0.5 to -0.5 36 51 40 57 HIGH 1.5 to 0.5 11 16 3 4 VERY HIGH >1.5 5 7 8 11 Calculated by Research Scholar

From the table we can say that the maximum share of districts in 2001 (51%) and in 2011 (57%) lies in medium category. Lowest share in 2001 occupied by very low and very high level that is 7% and in 2011 very low range has only 3 districts with 4% share. Above figure suggest that much more need to be done to enhance the access to comprehensive services for pregnant and lactating women as well as infant babies.

Variables 2001 2011 Top ten districts Bottom ten Top ten districts Bottom ten districts districts X4 Lalitpur, G BN, Lucknow, Hamirpur, Jalaun, Ghaziabad, GBN, Hamirpur Kanpur nagar, Mahoba, Banda, lucknow, Kanpur Mahoba, Ghaziabad, Jhansi, Baghpat nagar, Meerut, Mathura, Jalaun, Varanasi, Hathras, Lalitpur, Chitrakoot, Varanasi, Agra, Chandauli, Agra, Allahabad, Auraiya, Kaushambi Moradabad,

53 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

Banda, Baghpat, Rampur Sonbhadra, Shrawasti, Allahabad, Jhansi, Kanpur Dehat

No. of doctors per lakh of population (X5)

As a matter of serious fact there is shortage of manpower or human resource at all the levels in the public health delivery system. Every health functionary is under a lot of pressure on account of large number that doctors are expected to serve, that effect the quality of services rendered and up take services.

2001 2011 CATEGORY RANGE No. of districts Share in %age No. of district Share in %age VERY LOW >-1.5 nil nil nil nil LOW -0.5 to -1.5 9 13 12 17 MEDIUM 0.5 to -0.5 55 78 53 76 HIGH 1.5 to 0.5 3 4 1 1 VERY HIGH >1.5 3 4 4 6 Calculated by Research Scholar

Table depict that in both the period of study very low category was left out vacant. In both the decades above 50% of total district came under medium group. And in 2001 high and very high range comprising 6 districts with 8% share, while low 9 districts came under low range. On the other hand in 2011 in high and very high category only one district (Lucknow) and 4 districts is came under.

Variables 2001 2011 Top ten districts Bottom ten districts Top ten districts Bottom ten districts X5 Kanpur Dehat, Shrawasti, Banda, Kanpur Dehat Moradabad,

54 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

Jhansi Kanpur Budaun, Auraiya, ,Jhansi, Kanpur Balrampur, nagar, lucknow JPN, Balrampur nagar ,Varanasi, Shrawasti, Varanasi, Meerut, Maharajganj, lucknow, G BN, Bahraich, Agra, Lalitpur, Pratapgarh, Lalitpur, Pilibhit, JPN, Farrukhabad Bahraich, SK N Gorakhpur, Budaun, Aligarh, Mathura, Aligarh Barabanki , Ghaziabad Farrukhabad

No. of Para medicals officers per lakh of population (X6)

Para medical officers include pharmacist, staff nurse, ANM (Auxiliary Nurse Midwife), ASHA (Accredited social health activist), optometrist, lab technician, x-ray technician, darkroom assistant and physiotherapist. Below table shows the shortage of paramedical officers in the state.

Availability of the paramedical officers in UP Para medical staff Required Available Gap Pharmacist 5078 4695 383 Staff Nurse 4528 3678 850 ANM 23656 21944 1712 Optometrist 923 833 90 Lab. technician 1915 1442 473 X-ray technician 514 452 62 Dark Room Assistant 163 102 61 Physiotherapist 19 16 3 Source: 11th five year Plan Documents. Planning Commission Go UP, 2007-12

2001 2011 CATEGORY RANGE No. of Share in No. of Share in %age districts %age district VERY LOW >-1.5 nil nil nil nil -0.5 to - LOW 26 37 16 23 1.5

MEDIUM 0.5 to - 33 47 45 64

55 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

0.5

HIGH 1.5 to 0.5 9 13 6 9 VERY >1.5 2 2 3 4 HIGH Calculated by Research Scholar

Above table shows wide variation in 2001 between low range (37%) to very high range (2%) and in 2011, 23% to 4% within the same range. From 2001 to 2011 there is increase of 17% in medium category and decreased of 14% in low category.

Variabl 2001 2011 es Top ten districts Bottom ten Top ten districts Bottom ten districts districts X6 Kanpur Dehat, JP N, Ghaziabad, Kanpur Dehat, Ghaziabad, Agra, Kanpur nagar Bahraich, Agra, Kanpur nagar, Moradabad, Farrukhabad, Etah, Muzaffarnagar, Varanasi, Gorakhpur, Sitapur, Jhansi, Chitrakoot Budaun, GB N, Chitrakoot, Muzaffarnagar, Deoria, Gorakhpur Hardoi, Siddhartha Hamirpur, Hardoi, SRN, Varanasi, Mathura nagar, Moradabad Farrukhabad, Deoria, Sonbhadra, Ballia, AN, Mathura Budaun

No. of other workers per lakh of population (X7)

2001 2011 CATEGORY RANGE No. of districts Share in %age No. of district Share in %age VERY LOW >-1.5 nil nil nil nil

LOW -0.5 to -1.5 24 34 21 30 MEDIUM 0.5 to -0.5 32 46 36 51 HIGH 1.5 to 0.5 12 17 8 11 VERY HIGH >1.5 2 3 5 7 Calculated by Research Scholar

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

From the figure and above table it is highlight that in 2001 low and medium category cover 60 % share with 42 district coverage in totality, while this figure is 63% with 44 districts in 2011. There is fall from medium range in 2001 to 2011 with 21 districts in former period and 18 districts in later period.

Variables 2001 2011 Top ten districts Bottom ten Top ten districts Bottom ten districts districts X7 Kanpur Dehat, SR N, Lalitpur, Kanpur Dehat, Bahraich, Kanpur nagar, Bahraich, Deoria, Jhansi, Kheri, Lalitpur, Gonda, Jhansi, Saharanpur A N, Gonda, Unnao, Kanpur Fatehpur, Siddhartha nagar, Baghpat, Nagar, Siddhartha Mathura, Pilibhit, Unnao Hathras, Barabanki, SKN, nagar, Basti, Hardoi, SKN, Shrawasti Aligarh, Jaunpur Mirzapur, Firozabad, Bijnor Saharanpur, Banda Auraiya

Overall categorization of health services in Uttar Pradesh

RANGE 2001 2011 CATEGORY 2001 No. of districts Share in %age No. of district Share in %age VERY LOW >-1.5 2 3 1 1 LOW -0.5 to -1.5 19 27 21 30 MEDIUM 0.5 to -0.5 35 50 33 47 HIGH 1.5 to 0.5 10 14 10 14 VERY HIGH >1.5 4 6 5 7 Calculated by Research Scholar

Table shows the overall development of Uttar Pradesh, in 2001 there are 2 districts in very low category while in 2011 figure only district is take hold of the position. Highest share is found in

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

medium category including half of the districts with 50% in 2001 and 33 districts with 47% share in 2011. In 2001 and 2011 there are 10 districts in high category.

Composite score of health facilities in 2001 Composite score of health facilities in 2011 Comp

osite

Districts Districts Districts Districts Z-

Score Score Score Score

Score

- - -

Z Value Composite Z Value Composite Z Value Composite Value Kanpur 2.73 Allahabad -0.08 Kanpur Dehat 2.82 JBN -0.10 Dehat Jhansi 1.67 Saharanpur -0.10 Hamirpur 1.03 Fatehpur -0.13 Hamirpur 1.10 Etawah -0.11 Jhansi 1.03 Mathura -0.14 Kanpur 0.95 Chandauli -0.15 Mahoba 0.95 Kheri -0.15 Nagar Lalitpur 0.78 Sajahanpur -0.15 Kanpur Nagar 0.88 Maharajganj -0.19 Banda 0.71 Gonda -0.17 Banda 0.73 Balrampur -0.19 Chitrakoot 0.64 Balrampur -0.17 Jalaun 0.70 Faizabad -0.20 Muzaffarnag Farrukhabad 0.56 Sonbhadra -0.17 Chitrakoot 0.68 -0.20 ar Mathura 0.54 Mau -0.18 Budaun 0.58 Kushinagar -0.20 Azamgarh 0.43 Lucknow -0.18 Lalitpur 0.56 Etah -0.23 Aligarh 0.34 Faizabad -0.19 Basti 0.48 Pilibhit -0.25 Basti 0.34 Bareilly -0.22 Etawah 0.47 SKN -0.26 Siddhartha Raebarelli 0.30 Hardoi -0.26 0.46 SRN -0.26 nagar Jalaun 0.29 Kheri -0.28 Sultanpur 0.32 Gonda -0.32 Ballia 0.26 Kushinagar -0.29 Kaushambi 0.31 Rampur -0.34 Siddarathnag 0.25 Hathras -0.31 Deoria 0.27 Firozabad -0.34 ar Deoria 0.21 Mainpuri -0.31 Kannauj 0.27 Mau -0.35 Varanasi 0.20 Bijnor -0.32 Baghpat 0.23 Ghazipur -0.36 Meerut 0.18 Jaunpur -0.35 Pratapgarh 0.22 Sonbhadra -0.36 Agra 0.17 Bahraich -0.39 Barabanki 0.13 A N -0.40 Mahoba 0.13 Firozabad -0.39 Varanasi 0.12 Meerut -0.42 Etah 0.13 Gorakhpur -0.40 Mainpuri 0.12 Bareilly -0.44 Mirzapur 0.12 Pilibhit -0.42 Gorakhpur 0.11 Sajahanpur -0.44 Pratapgarh 0.11 Budaun -0.42 Mirzapur 0.07 Allahabad -0.44 Muzaffarnag Rampur 0.10 -0.45 Auraiya 0.05 Hardoi -0.44 ar Fatehpur 0.10 SKN -0.46 Ballia 0.04 Bahraich -0.46 Kaushambi 0.09 Moradabad -0.50 Azamgarh 0.04 Bijnor -0.47 58 © Universal Multidisciplinary Research Journal (Online)

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

Sitapur 0.07 Baghpat -0.51 Unnao 0.02 Sitapur -0.48 Sultanpur 0.03 Maharajganj -0.54 Bulandsahar 0.01 Shrawasti -0.52 Unnao 0.03 Auraiya -0.58 Farrukhabad 0.01 Moradabad -0.59 Bulandsahar 0.02 GBN -0.75 Lucknow 0.01 Agra -0.61 Shrawasti -0.05 SRN -0.81 Chandauli 0.00 Aligarh -0.62 Barabanki -0.06 Ghaziabad -0.83 Saharanpur -0.05 Jaunpur -0.70 Ghazipur -0.08 AN -0.89 Raebarelli -0.08 GBN -0.74 Note: GBN- Gautam Buddha Nagar, SRN- Sant ravidas Nagar, SKN- Santkabir Nagar, AN- Ambedkar nagar, JPN- Jyotiba Phule Nagar (Arranged in descending order)

Fig 2

Conclusion and suggestions:

Health care system generally a combination of all personal and community health services including medical care and related education and research which are oriented towards the protection and promotion of the health of the community (Sarma, 2004). The causes of variation in the accessibility of the health services are effected by variety of factor like geographical (topography, soil, etc), political, socio-economic and institutional factor. For the improvement of the health services especially in backward and rural areas, in last few years there have been many

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

initiatives to improve the efficiency, effectiveness and equity (as equal access to available care for equal need, equal utilization for equal need, and equal quality of care for all) in provision of health care services in the country. In this context World Bank assisted the Uttar Pradesh Health System Development Project (UPHSDP), various scheme lunched by National Rural health Mission which guaranteed for the maternal and child health care. Schemes like scheme Jnani Shishu Suraksha Karyakaram (JSSK) meant for providing cashless treatment for all services related to moderate and neonatal health facilities, Janani Suraksha Yojana (JSY) provides cash incentives for the institutional delivery, Rashtriya Bal Swasthya Karyakaram (RBSK) meant for identification and early intervention and free management for the from birth to 18 years related to health condition, Rashtriya Kishor Swasthya Karyakaram, National Ambulance and many more. But at the micro level the tremendous pressure of population is creating extra demand on every beneficial move taken by the state government in the health facilities development and is gradually dim the real benefits those should be derived out of them. Wide spread measure for the checking the growth rate of population need to be strengthened on a more extensive scale to check the initial source of the entire problem. The insufficient health services in the rural areas are one of the main factors which create the push from the rural population and causes overcrowding in the urban areas. In response to the increasing shortage of physicians in rural areas, non-physician health care providers other than Auxiliary Nurse Midwife (ANM), Accredited Social Health Activist (ASHA), who are locally recruited as community volunteers and other locally recruited paramedics should be trained as per the demand of the services, for instances in physiotherapist in the areas where injuries are high, laboratory technician and home nursing where old age and palliative care requirements are high. Improving the condition of work is essential for attracting and retaining doctors within the public services. Although inequitable, expensive the private sector is easily accessible, properly managed and more effective than our public sector health facilities. So it is good to have public private partnership that will definitely improve the health care system in the state.

Vol. I, Issue VIII – December 2015 ISSN No. 2395-6941 Article ID # 404 Website: http://www.umrjournal.com/ Peer–Review Refereed Research Journal

References:

1. Baru, R.V.(1993): ‘Inter-Regional variations in Health Services in Andhra Pradesh’, Economic and Political Weekly, May 15, pp.963 2. Dreze, J and Sen.A. (1995): ‘India, Economic Development and Social opportunity’, Oxford University Press, New Delhi. 3. Gill, et al.(2000): ‘Rural Health: Proactive Role for the State’, Economic and Political Weekly, Dec.16, pp.4474-4477. 4. Kozel, V. and Parket.B. (2003): ‘A Profile and Diagnostic of Poverty of Uttar Pradesh’, Economic and Political Weekly, Vol.38, No.4, pp.385-403. 5. Banerjee, et al. (2004): ‘Healthcare Delivery in Rural Rajasthan’, Economic and Political Weekly, Feb.18, pp.944-949. 6. Sarma, S. (2004): ‘Public Investment in Primary Health Care’, Mittal Publication, New Delhi. 7. Purohit, Brijesh. (2010): ‘Efficiency Variation at the Sub- State Level: The Healthcare System in Karnataka, Economic and Political Weekly, Vol.XLV, No.19, pp.70-76. 8. Baru, Rama, et al (2010): ‘Inequalities in access to health Services in India: Caste, Class and Region’, Economic and Political Weekly, Vol. XLV, No.38, pp.49-58. 9. Qadeer, Imrana. (2011): ‘Public Health in India: Critical Reflection’, Danish Books, New Delhi, pp.63. 10. Kundu, Nandita. et.al (2012): ‘Understanding Health Information Needs and Gaps in the Health Care System in Uttar Pradesh’, Journal of Health Communication: International Perspective, Vol.27, No.2. 11. Kumar, Anurag. et al (2012): ‘Poor Medical Care in Rural Areas of Uttar Pradesh: Perceived Reasons and Strategies for Improvement’, International Journal of Life Sciences Biotechnology and Pharma Research, Vol.1, No.3, ISSN. 2250-3137. 12. Roux, A.V.D.,(2012): ‘Conceptual Approaches to the Study of Health Disparities’, Annual Review of Public Health, 33:40-58. 13. Sharma,A.,et al, (2013): ‘Healthcare Inequality And Physician Scarcity Empowering Non- Physician Healthcare’, EPW, Vol.XLVIII, No13, p.112

14. Islam, Saiful, (2013): ‘Who Pays, Who Cares’, The Shifting Trajectory of health Care Financing and Implications in India. Understanding Health Approaches and Issues, GRP, New Delhi. 15. Anand,M. (2014): ‘Health Status and Care Services in Uttar Pradesh and Bihar: A Comparative Study’, Indian Journal of Public Health , 58:174-9.