Great things are not done by impulse, but by a series of small things brought together – Vincent Van Gogh

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Shrinking health services a growing concern for people with disabilities


Access to health services is a matter of growing concern everywhere and to everyone, with Government budgets falling and rapid privatization, access to health care is becoming yet another symbol of social inequality. What happens to marginalized sections like people with disabilities (PWDs) who are dependent on public health care services for long periods of time and sometimes lifelong, is any ones guess. The Human Development Report 2006 shows that public expenditure on health in India was a shocking 1.2 % of the GDP, one of the lowest in the world. In Karnataka too the Governments allocation for health has been annually declining from 5.85 % in 1998 to 3.73% of its GDP in 2006.

Almost 70% of the causes of disability in India is due to communicable diseases, pregnancy related illness, illness during childhood, polio, ear discharge, eye diseases, cataract, accident, violence and untreated injuries and diseases. All of which have a strong relationship to lack of access to health care facilities for treatment and poverty.

PWDs require health intervention at three phases, namely early detection of the disability, counseling & medical interventions and provision of aids & appliances or medication as the need requires. Presently 75 % of the 70 million PWDs live in rural areas. With health and rehabilitation facilities concentrated in urban areas a mere 2% of PWDs have access to rehabilitation facilities. The health intervention on disability is a complex one and gets compounded by the fact that there are different types of disabilities, degrees of disabilities and drug and non-drug therapy. Intervention involves the need for trained and skilled personnel to identify and plan the medical rehabilitation besides specialized equipment and infrastructure. Much of this is resource intensive and cannot be done without the financial inputs from the government, especially for corrective surgery and assistive devices.

Besides the four specialized national institutes set up in Kolkata, Dehradun, Secundrabad and Mumbai, the Government of India launched the District Rehabilitation Centres (DRC). The 500 DRCs across the country aim at providing a complete package of model rehabilitation services at every district level. Four Regional Rehabilitation Training Centres were established to support the DRCs. In addition the government also introduced ‘The Scheme to Promote Voluntary Action for Persons with Disabilities’ which provides grant-in-aid to voluntary organisations for the promotion of community based rehabilitation and the Assistance to Disabled Persons. More recently the government launched the ‘National Programme for the Rehabilitation of Persons with Disabilities’, whose sole aim is to reach disabled people in remote areas and the plan it proposes will have a delivery system directly from the State level to the Gram Panchayat level. However with all these efforts the Government has still not been able to reach more than 10% of PWDs. In an effort to widen its reach, the Central Government put disability rehabilitation as one of the many tasks of the Gram Panchayats under the 73rd Constitutional Amendment, but studies show that Panchayat officials are overwhelmingly ignorant about disability, the laws and various benefits available to PWDs.

The present situation on health for PWDs is that there is little networking between the Ministry of Social Justice and Empowerment and the Ministry for Health at the central level. The Government at both the National and State level have been paying lip service to prevention and early detection of disability by promising to engage in awareness programmes in primary health centres (PHCs) but this is yet to take shape. PWDs are now demand that PHCs which are the first interface of the government health system be upgraded and skilled to handle the needs of PWDs such as providing physio-therapy, speech therapy, providing the required medication for cerebral palsy, mental retardation, spinal cord injury and mentally ill patients. Here the doctors and auxiliary nurses and midwifes need to be sensitized to detect disability through basic screening and provide referrals. The next phase of service delivery in desperate need of upgradation is the district hospitals. The mentally ill who require life long medication which is often expensive are demanding free medication. The disability sector is also asking that the District Rehabilitation Centres be set up in every district of the country and those that exist be reactivated and upgraded as hubs for providing the entire range of heath services for PWDs.

The above article was published in the Deccan Herald on 11th April 2007

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