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Table of Contents   
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 2  |  Page : 436-439
Sub‐center health profiling and health care delivery services in a rural community of northern India


1 Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
2 Department of SPM, Govt Medical College, Srinagar, Jammu and Kashmir, India
3 Modern Health Care Hospital, Rajbagh, Srinagar, Jammu and Kashmir, India

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Date of Web Publication22-Jun-2017
 

   Abstract 

Background: Sub-Center is the most peripheral point of contact where the staffs is assigned tasks relating to bring behavioral changes in the community and offer services related to maternal and child health, nutrition, immunization, family welfare and contraception, school health services, adolescent health care, water and sanitation, disease surveillance, control of communicable diseases, implementation of national health programmes, house to house visits and outreach/field services. Material and Methods: This paper is based on the secondary data which was available at the Sub-Center which is located in a rural area, 25 kms from the capital city of Jammu & Kashmir state on the hilly terrains. The data was collected from April 2016 to January 2017 by trained FMPHW/ANMs who carried out the door to door visits of each household and recorded data on a predesigned pretested Pro forma. Results: Socio-demographic characteristics of the community subject's shows female predominant population with women outnumber men with a ratio of 94 men to 100 women. 74% of the population is in the adult age group. Among the total households (180), most are joint families with 100% non-vegetarian diet pattern see in the community. 66% of the total households belong to the middle socioeconomic status. Accessibility of health-care services was analyzed using indicators for which all the households mentioned to have easy access to the health care system, always find the health worker at the subcenter during duty hours and find the services provided at the sub-center cost-effective. Most of the households had easy access to the Sub-Center location while some of the households find in difficult in reaching the Subcenter and some household's complaint of non-availability of drugs. Conclusion: Our study was one of its kind studies which demonstrated the health profiling and health services assessment of a particular sub-center located in hilly rural area of Kashmir valley. The presence of the sub-center in the area and the services delivered by it are well accepted by the local rural community, which in turn has resulted in better health status of the community population.

Keywords: Health profiling, northern India, rural community, sub center

How to cite this article:
Saleem SM, Khan S M, Jan SS. Sub‐center health profiling and health care delivery services in a rural community of northern India. Ann Trop Med Public Health 2017;10:436-9

How to cite this URL:
Saleem SM, Khan S M, Jan SS. Sub‐center health profiling and health care delivery services in a rural community of northern India. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Sep 18];10:436-9. Available from: http://www.atmph.org/text.asp?2017/10/2/436/208698

   Introduction Top


The first contact point between the community and the primary health care system is the sub‐center that is manned by one Auxiliary Nurse Midwife (ANM) and one Male Health Worker (MPW) assisted by accredited social health activists.[1] Sub‐center is the most peripheral point of contact where the staff are assigned tasks relating to bringing behavioral changes in the community, and they offer services related to maternal and child health, nutrition, immunization, family welfare and contraception, school health services, adolescent health care, water and sanitation, disease surveillance, control of communicable diseases, implementation of national health programs, house‐to‐house visits, and outreach/field services.[1] The sub‐centers are equipped with basic drugs to treat minor ailments to cater basic health needs of the community.[1] The introduction of National Rural Health Mission in the year 2005 by the Government of India has proved quiet beneficial and has brought significant improvement in the health care delivery system especially in the rural areas.[2] The phenomenal economic growth over the last decade in India has much improved the health care system with easy accessibility to health care services in rural areas.[2] To the best of our knowledge, there is no literature available and no such study has been documented where the delivery of health care services and health profiling of the community under a particular sub‐center has been done in Kashmir Valley. In the present paper, we seek to look at the status of health care facilities and health care delivery services, accessibility of health care services, and overall health profiling of the community members under a particular sub‐center in the rural areas of North India in Kashmir Valley (Jammu and Kashmir).


   Methods and Material Top


This paper is based on the secondary data that were available at the sub‐center located in a rural area, 25 km from the capital city of Jammu and Kashmir state on the hilly terrains. The data were collected from April 2016 to January 2017 by trained FMPHW/ANMs who carried out the door‐to‐door visits of each household and recorded data on a predesigned pretested pro forma. The area was divided into five colonies (Mohallas) with the total population of 1091 and 180 households. Each household was visited by the FMPHW/ANM during day, and information was collected from the head of the family or any other adult member of the family who willingly gave consent to be a part of the survey. The houses that were locked were revisited by the health workers the following day. All the households gave consent to be a part of the survey. Data were collected on the socio‐demographic profiles of the community, socioeconomic status, delivery of health care services, accessibility of health care services, water, and sanitation facilities, and overall health profile of the patients. Outcome variables of the community were measured in percentages.


   Results Top


Socio‐demographic characteristics of the community showed female predominant population with women outnumbering men in a ratio of 94 to 100. In total, 74% of the population were in the adult age group. Among the total households (180), most were joint families with 100% non‐vegetarian diet pattern followed in the community. In total, 66% of the total households belonged to the middle socioeconomic status. Entire community had access to safe drinking water supplied by public health engineering department and used sanitary latrine for excreta disposal. Prevalence of smoking behavior was observed in 14.39% community population [Table 1]. The crude death rate of the area was 2.74 per 1000 population, and infant mortality rate was 38.46 per 1000 live births with 1.83 per 1000 population as the hospitalization ratio.
Table 1: Socio.demography characteristics of community subjects (2016)

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Accessibility to health care services was analyzed by factors which indicated that all the households mentioned had easy access to the health care system, always find the health worker at the sub‐center during duty hours, and find the services provided at the sub‐center cost‐effective. Most of the households had easy access to the sub‐center, whereas some of the households find it difficult to reach the sub‐center and some complaint of non‐availability of drugs [Table 2]. [Figure 1] shows the distribution of disease profile in the community. Chronic diseases such as diabetes mellitus, hypertension, and hypothyroidism were more prevalent in the community. Upper respiratory tract infections seemed to be seasonal and were present in 10% of the community population.
Table 2: Accessibility of health care services at the sub-center

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Figure 1: URTI: Upper respiratory tract infection. COPD: Chronic obstructed pulmonary disease. Disease profiling of community subjects of sub-center

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   Discussion Top


In the present study, we observed that sub‐center acts as the first contact point between the community and the health care delivery system.[1] The staff at the sub‐centers are assigned designated tasks relating to bringing behavioral changes in the community, and they offer services related to maternal and child health, nutrition, immunization, family welfare and contraception, school health services, adolescent health care, water and sanitation, disease surveillance, control of communicable diseases, implementation of national health programs, house‐to‐house visits, and outreach/field services with full dedication.[1]

In the present study, we found that the area has women predominant population and the male to female ratio is 94 to 100, which is at par from the national figures.[3] Most of the families are joint families, and all of them consume non‐vegetarian diet. Literature search reveals that villagers prefer to live in joint families as they find it in good arrangement.[4],[5] About three‐fourth of the population has a socio‐economic status between lower middle and upper class, which shows that the community is prosperous, and all basic living amenities are present in each household, which is in accordance with the available literature.[6] Smoking behavior was present is 14% of the community population; Jindal et al. in his study mentioned that smoking behavior was found in 12.5% of rural population in India, mostly among men.[7] The entire households use sanitary latrines and consume tap water after proper boiling, which highlight the good socio‐economic status, awareness, and practise of hygiene among the community population and might be the reason behind less hospitalization ratio. This finding is not in accordance with the available literature[8] in which Singh found most of the villagers use open fields for defecation in rural India.

Most of the community population have a positive attitude toward the accessibility of health care services provided by the sub‐center with few community members finding it difficult to reach the sub‐center location and complaining about non‐availability of drugs. This may be due to over expectation of community members to receive secondary care at the primary level.

The basic drugs available at the sub‐center are used to treat minor health aliments of the community population, and referral services provide secondary and tertiary care whenever required. The sub‐centers are equipped with basic drugs to treat minor ailments to cater basic health needs of the community. The overall disease burden in the community was analyzed, and 20% of the community members were found affected by one or the other disease. The prevalence rate of hypothyroidism in the community was 3%. Bhat et al. in his study found 21.56% prevalence rate of sub‐clinical hypothyroidism in rural hilly Kashmiri population. This finding shows that there is less burden of thyroid disease on the sub‐center community that may be due to the use of iodized salt in diet. Masoodi et al. mention a high prevalence rate of hypertension in the Kashmiri community, whereas we found only 3% population with hypertension.[9] Upper respiratory tract infection was the most significant finding in our study area that may be due to seasonal variations and cold climatic conditions.


   Conclusion Top


Our study was one of its kind studies that demonstrated the health profiling and health service assessment of a particular sub‐center located in hilly rural area of Kashmir valley. The presence of the sub‐center in the area and the services delivered by it are well accepted by the local rural community, which in turn has resulted in better health status of the community population.

We recommend that tribal, remote, and far flung areas should receive basic health facilities in form of a sub‐center manned by paramedical staff, regular door‐to‐door surveys should be carried out, and disease burden in the community should be reflected in records so that appropriate action is taken on time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Welfare F. Guidelines for Sub‐Centres; 2012.  Back to cited text no. 1
    
2.
Planning Commission G of I. Evaluation Study of National Rural Health Mission (NRHM) In 7 States. Plan Commision [Internet]; 2011; (February). Available from: http://planningcommission.nic.in/reports/peoreport/peoevalu/peo_2807.pdf.  Back to cited text no. 2
    
3.
Statistics V. Data Highlights—20011 Census. Popul (English Ed).Available from: http://pib.nic.in/prs/2011/latest31mar.pdf. [Last accessed on 2017 Mar 20].  Back to cited text no. 3
    
4.
Choudhury RD. Joint Family System? Its present and future. Econ Polit wkly. 1957;9. Available from: http://www.epw.in/system/files/pdf/1957_9/38/joint_family_system_its_present_and_future.pdf. [Last accessed on 2017 Mar 20].  Back to cited text no. 4
    
5.
Prasher CL, Bhardwaj AK Raina SK, Chander V, Badola BP, Sood A. Attitude towards joint family system among undergraduate students of a medical college in rural area. Ntl J Community Med 2011;2:2-6.  Back to cited text no. 5
    
6.
Directorate of Economics and Statistics J. Econ Surv 2014;1:15.  Back to cited text no. 6
    
7.
Jindal SK, Aggarwal AN, Chaudhry K, Chhabra SK, D'Souza GA, Gupta D, et al. Tobacco smoking in India: Prevalence, quit-rates and respiratory morbidity. Indian J Chest Dis Allied Sci 2006;48:37-42.  Back to cited text no. 7
    
8.
Mudit Kumar Singh. Sanitation in Rural India. IMPACT Int J Res Humanit Arts Lit (IMPACT IJRHAL) [Internet]. 2014;2:19‐24. Available from: http://www.impactjournals.us/journals.php?id=11andjtype=2andpage=7.  Back to cited text no. 8
    
9.
Masoodi ZA, Mir RA. Prevalence and determinants of hypertension in Kashmir: A cross sectional study. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2016;15:57-64.  Back to cited text no. 9
    

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Correspondence Address:
Sheikh Mohd Saleem
Post Graduate Scholar, Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_100_17

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