ORGANISATION OF MEDICAL HEALTH IN RURAL AREAS OF INDIA, RUSSIA AND NIGERIA

AND NIGERIA
BY
PUJA PRIYA
LA2-CO-161A

is given by census of india which defines an ares

as rural area if it fuifills the following coditions:
1) Population density of less than 400 sq km
2) Atleast 75% of the male population engaged in agriculture
3) No presence of Municipal Corporation or Board

Most peripheral contact point of community with primary

health care systems ;manned with one MPW(M) and MPW(F).

2)Primary Health Centre (PHC)
A referral unit for 4-6 subcentres;4-6 bedded manned with a Medical officer in charge and 14 subordinate paramedical staff no.of PHCs with specialized health Services.

3)Community Health Centre(CHC)
A 30 bedded Hospital /Refferal unit for 4 no .of PHCs with specialized Health Service.

determining methods of work of rural medical health:
.charecter of spreading

of population
.area of coverage
.seasonal prevalance of works
.influence of weather conditions at the field works
.specific conditions of labour process
.disorder of economic-household activity and conditions of life
.regional and national features and customs
.educational and cultural level

institutions from the residence of patients
enough qualified personnel and equipment
opportunities

to receive specialized medical aid
opportunity for realisation of specifications of medico social security

bol'nitsy)
These are small hospitals with average capacity of

30 beds offering fairly basic inpatient cover, often with a staff team of a surgeon

.District (raionnye) hospital
These hospitals serve the population of large rural municipalities.
The average capacity of such hospitals is about 130 beds
.Central district hopitals
These hospitals serve the population of rural municipalities at the administrative centre of the area
The average capacity of a central district hospital is 200 beds

(500-1000 beds) and a general hospital for children (300-600 beds)

that accepts referrals of complex cases from district hospitals and polyclinics.
REAGIONAL SPECIALIZED CLINICS (dispanserii):
Most specialized clinics are integrated facilities with outpatient and inpatient departments ;about one-third have only outpatient departments.Specialist outpatient services are also provided at the regional level.
FEDERAL HOSPITALS AND FEDERAL SPECIALIZED CLINICS:
These offer the most complex care at large and highly specialized hospitals or clinics.These are often associated with research institutes in their respective
HOSPITALS AND SPECIALIZED CLINICS IN PARALLEL SYSTEMS:
Parallel systems under ministries other than the MoHSD tend to concentrate their secondary and tertiary care services to other ministries

institution on a rural medical outpost is the local hospital

or polyclinic
Character and volume of medical aid in local hospital basically are determined by its capacity, equipment and presence of doctor experts.
The number of staff of rural hospital is depending on its capacity, population and distances up to central regional hospital, there have to be doctors of the basic specialities (therapy, pediatric, stomatology, obstetrics, gynecology and surgery)

link in public health service of rural area is central

regional hospital (CRH), Which carries out the specialized medical health by its basic kinds and an organisational-methodical management of all medical institution of area
in its structure CRH has the following divisions:
- Hospital with basic specialized branches
-Polyclinic with advisory receptions of doctors-experts
-Medical-diagnostic branches
-organisational-methodical cabinet and other structural divisions (mortuary, mess, pharmacy etc)

departments. 60% of day care beds are placed in outpatient

facilities.Since 2000 the number of day care beds in hospitals increased by 26% and the number of patient-days in both types of day care units increased by 55%.In 2008 average length of treatment provided in day care units was 11.4 days and the number of operations provided in these units was 5 per 100 discharged
REHABILITATION/INTERMEDIATE CARE
There are 47 sanatoria and health resorts under the juridiction of the MoHSD with a total bed capacity exceeding 11000. In 2009 more than 112000 individuals received sanatorium resort care whose treatment funding was funded with public money

there is strong collaboration between the statutory health systems and

the international hospice movment. Approximately 90% of palliative care services are state funded

MENTAL HEALTH :
Mental health services are oirganized “vertically” in the same way as specialist sevices for other priority diseases such as diabetes,TB, HIV/AIDS ,Sexually transmitted diseases , cancer services and vaccine preventable disease. NevertHeless mental health has traditionally been a low priority.

pluralistic. It includes orthodox , alternative and traditional health care

delivery systems operating alongside each other.
The Government recognizes and regulates these three systems.
A world health report ranked Nigeria 177 out of atotal of 191 countries, on its degree of responsiveness to healthcare needs (WHO)

tiered of Government namely Federal, State and local Health care

in Nigeria is administered through three tiers :primary, secondary and tertiary levels. The primary level is run by the local Government , the secondary by the state and the tertiary is run by the federal government

health workers in Africa comparable to Egypt and South Africa

About 60% of the states in Nigeria , provides rural incentives to health workers that volunteer to serve in the rural areas, while others make rural service a condition for some critical promotions

National youth service corps

Service Structure
-Federal Government -Tertiary health service
-State Government

-Secondary health services
-Local Government -primary health services
-Private Sector -private services

Person in charge
-Federal ministry of health
-State Ministry of health
-Local Government areas
-Private providers

)maldistribution and attrition include:

use of telemedicine;
financing/aid arrangements with other countries

where significant populations of Nigerian health workers live plus efforts to enable easier transition to Nigeria; and
actively managing brain drain.

objective analysis;
implementing and monitoring measures;
aligning health worker supply with health

sector needs;
applying best practices to HRH management and development to promote equitable distribution and retention of the quality and quantity of HRH to ensure universal access to quality health services;
institutionalizing performance incentives and management systems that recognize hard work and service in deprived and unpopular locations;
fostering collaboration among public sector, non-government providers of health services and other HRH stakeholders; and
strengthening the institutional framework for HRH management practices.

to make them more profitable and effective in delivering the

health care
The government need to give adequate subsidies and tax benefits to the hospitals operating in rural health care to make the care more scelable which can enhance the reach of tele-medicine in different part of country