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.