C + B Human DevelopmentChapter Report2009 6 South 24 Parganas HEALTH STATUS IN SOUTH 24 PARGANAS Along with education, health is the most economies. In particular, policy makers important human development indicator. It must ensure equitable access to the health is crucial in determining the level of welfare care system, by providing cost effective of individuals and the community. Health health services (as recognized in the Alma- is important not only as a target important Ata “Health for All” initiative undertaken for its own sake, but for enabling the by the World Health Organisation in 1978) individual to access or utilize the facilities and facilities to the poor especially in rural and services available to the person. areas. Such intervention characterizes an Provisioning of health services to the effective and socially acceptable approach community is therefore crucial in any to poverty reduction. economy, and more so in developing 6.1 Healthcare Institutions in South 24 Parganas: A Stock-taking 6.1.1 Institutional Network CH6 State healthcare system in South 24 Labour Department under State Government Parganas comprises a total of 99 (SGL) and 1 by Central Government (CG) Table 6.1: No. of Healthcare Institutions . Healthcare institutions under the control of CMOH include District hospital (DH), Sub-division Hospitals (SDH), Rural Hospitals (RH), Block Source: Office of CMOH, South 24 Parganas Primary Health centers (BPHCs), Primary health healthcare institutions under the control centres (PHCs) and sub-centres (SCs). The of the Chief Medical Officer (CMOH), health sub-centers are functionally grouped 141 private healthcare institutions, 5 into government clinics and dispensaries institutions run by Local Bodies, 1 by (Table 6.2). 143 C + B C + B South 24 Parganas Human Development Report The three-tier referral health care system is an unwelcome trend that should be is as follows: reversed. At the lowest level we Table 6.2: Healthcare Institutions under the Control of CMOH, have Government South 24 Parganas clinics and dispensaries, which offer only out- patient treatment, PHCs providing basic in-patient facilities, Government Hospitals Source: Office of CMOH, South 24 Parganas situated at the block, sub-division and The GIS map of villages of the District district head quarters, offering full shows that there are a large number of fledged out-patient and in-patient villages without medical facilities. Further, services to the district population. these are not concentrated in the Sundarban On an average, for each SD and SG Region but also occur in the North-Eastern hospital-level healthcare facility there are part of the district and even on the periphery 3 RHs/BPHCs; each RH/BPHC has under of Kolkata. Table 6.3: No. of Healthcare Institutions – Trends in South 24 Parganas 6.1.2 Settlement CH6 Density and Infrastructure Apart from the infrastructural set-up Source: Bureau of Applied Economics & Statistics, District Handbooks other important issues are size of the health care service sector it 2 PHCs and each PHC has 17 SCs under and the size of the population for whom they its control. extend health care coverage. Table 6.4 It can be seen from Table 6.3 that over examines the situation with respect to time there has been an increase in all different blocks in South 24 Parganas for health care facilities. There has been an some critical parameters. For analytical increase in the number of Hospitals and purposes the blocks are divided into three particularly in the number of Clinics after principal regions: 1999. While upgrading has led to a Region-I: North West (Kolkata marginal decrease in Health Centres Surroundings), between 1999 and 2004, there has been Region-II: North East and Mid West, and a some reduction in number of beds. This Region-III: South (Sundarbans) 144 C + B C + B Human Development Report2009South 24 Parganas Figure 6.1 Availability of medical facilities in south 24 parganas CH6 145 C + B C + B South 24 Parganas Human Development Report Table 6.4: Health Care Infrastructure : Block-wise, 2006 CH6 Source: Office of CMOH; Health On the March The volume of health care services is Pharmacists and Technicians. measured in terms of the physical It can be seen that Region-I has the lowest infrastructure (consisting of the number of population, and Region-III the largest SCs, PHCs, BPHCs and RHs) Medical population. We would expect that the Officers, Nurses, Health Assistants, parameters studied would also increase 146 C + B C + B Human Development Report2009South 24 Parganas Figure 6.2: Indication of Hospital Performance in South 24 infrastructure – both physical and Parganas service providers. Region-III blocks like Patharpratima, Basanti, and Mathurapur I also have very high populations (second, third and fourth highest, respectively). However, while Basanti has a satisfactory number of RHs/BPHCs and Sub-Centers, the number of beds (in hospitals) and medical staff is very low. proportionately with the population. Such a Similarly in Patharpratima, the number of trend can be observed in general with two doctors and nurses is inadequate. exceptions – the increase in number of beds Mathurapur I has a satisfactory physical and technicians and pharmacists between infrastructure, but the staff strength is low. Region-I and Region-III is substantially less A contrasting picture of plenty can be seen than the increase in population between in Sagar where the population is low, but these two regions. On the other hand, the both staff and particularly the physical increase in the physical infrastructure and infrastructure are very satisfactory. CH6 manpower is significantly higher than the An interesting ratio is that of the number population increase between Region-II and of BPHCs, RHs and SDHs to the number Region-III. However, this analysis merely of Sub Centres. While the former provides examines whether the expansion in health in-patient admission facilities, the facilities infrastructure has been commensurate with extended by Sub Centres is limited to out- respect to the increase in population – it patients. This ratio does not vary does not take into account whether the substantially across blocks in each region health infrastructure is capable of – the coefficient of variation in the three supporting the population pressure or not. regions are 48%, 43% and 34% – but varies The latter analysis is undertaken significantly across all blocks in the subsequently. District (coefficient of variation is 80%). The regional perspective also hides the This variation is the highest in Region-I, considerable block-wise variations. For adjoining Kolkata, and lowest in the instance, Mandirbazar (Region-II), ranking Sundarban region. eighth according to population, has a poor 147 C + B C + B South 24 Parganas Human Development Report 6.2 Performance of Hospitals It can be seen that the health infrastructure to constitute the major share of admissions, in blocks is not always consistent with the particularly in a District with low average demographic pressure. This is reflected in age of marriage and long period of fertility. indicators like Bed Occupancy Rate However, the extremely low figures for (BOR), Bed Turn Over Rate (BTOR), DAR clearly indicate that institutional Emergency Admission Rate (EAR), and deliveries are relatively few. This issue has Delivery-Admission Ratio (DAR). been discussed in greater details in a The aggregative performance appears subsequent section. Data from Health on relatively satisfactory and compares the March, published by the State favourably with existing standards accepted Government, also shows that the proportion by the Health Department, Govternment of of major and even minor surgeries is West Bengal (see Figure 6.2). Thus, BOR relatively low in the public sector. – reflecting the extent to which existing It is of course possible that the proximity facilities are utilized – was within the of most of the blocks to Kolkata enables the norms in 2004. In 2005, however, it fell district population to readily access by 7 percentage points to a level that is hospitals in the latter. While this may CH6 marginally below the WHO norm. The explain why pressure on the District health BTOR indicates the load on the health facilities is low, it would also indicate a infrastructure. The performance is slightly break-down of the three-tier referral better in this regard, as BTOR level has system, lying at the core of decentralization increased from 2004 levels by 5 of health facilities. percentage points, and attained the BOR is worst in Garden Reach SGH, accepted standards of 72-96%. The followed by Bijoygarh and Bagha Jatin SGH. problem with these figures is that they may A considerable extent of under-utilisation of be interpreted as evidence that people are existing facilities – reflected in a low BOR ‘healthier’ and do not have to access health - is also seen in Diamond Harbour and services. In reality, these figures are more Vidyasagar SGH. The load on the health likely to reflect the low reliance of the infrastructure is reflected in BTOR. The population on public health services. This worst performance is by Diamond Harbour is supported by the low figures for EAR SGH, followed by Garden Reach and and DAR. While the standard for EAR is Baruipur SGH. EARs are substantially below 40-45%, the actual rates were lower in the norms indicating the inability of SGHs 2004 and just attained the standard in 2005. to address the needs of patients. On the other hand, deliveries are expected Apart from the referral institutions, the 148 C + B C + B Human Development Report2009South 24 Parganas situation in blocks is also worth examining. considerable block-wise variations. Only This is not an easy task as there are six blocks out of 29 have satisfied norms Table 6.5: Indicators of Individual Hospital Performance, 2006-07 CH6 Source: CMOH (South 24 Parganas) NOTE: Since complete data not found for BTOR, the aggregate percentage for BTOR was not calculated 149 C + B C + B South 24 Parganas Human Development Report for BOR – Kultali, Falta, Mathurapur-II, RHs in many of the blocks indicate that the Kulpi, Namkhana and Sagar.