This paper suggests a simple framework to estimate the shortage of medical practitioners in rural and urban areas in developing countries. Shortages are defined with respect to four main considerations. The overall numbers and also the different categories of practitioners in the rural and urban areas, the relatively greater difficulties of access in the rural areas (which reduce the number of accessible practitioners) and the greater health hazards in those areas (which lead to greater need for medical treatment). The quantitative effect of these factors is examined by undertaking simulation exercises with data for the Ujjain district in Madhya Pradesh state, India and also data for that state. The simulations turned up the following results. The un-weighted total number of practitioners, per head of population, is relatively greater in the rural areas; this is because of the relatively large numbers of the unqualified doctors in those areas. On the other hand, a 'quality adjusted' total, with lower weights for the unqualified doctors, found little overall difference between the rural and urban areas. Third, allowance for rural-urban differences in the difficulties of access showed that the number of accessible practitioners is much lower in the rural areas. Fourth, rural-urban differences in the incidence of health hazards and estimates of the need for medical treatment also showed a marked shortage of practitioners in the rural areas. The main implication of the results is that developmental efforts in the rural areas, including improvements in transport facilities and reduction of health hazards, would help to greatly reduce the shortage of practitioners in those areas. Training programmes to improve the quality of practitioners in the rural areas are also required.
The background to this article is the concern about Health Inequities (HI), recently voiced by the World Health Organization. This short article concerns HI in the context of India’s school sanitation programme. Lack of proper sanitation is a major environmental health risk for children, leading to illness and deaths. Analysis of school sanitation coverage in Uttar Pradesh and Rajasthan states showed up the following results. Coverage has been significantly lower in the rural schools, than those in the urban areas, and has also been lower in the Primary schools, than in the Higher-grade schools. These findings are of some concern since rural areas have fewer health facilities for treatment and children in Primary schools are younger and so are more vulnerable to health risks. Some parents may have been reluctant to enrol their children in the ‘without sanitation’ schools and this may affect children’s education.
This article discusses some recent developments that may help bring about more affordable prices of essential medicines for developing countries. Governments of developing countries should support campaigns for such prices. Generic competition will also bring gains, though these may differ between different income groups. Enterprises could be persuaded to provide free, or subsidised, medicines for their employees, by the expenditures being allowed against liabilities for profits tax. The UN Global Fund could complement the efforts of public action groups, enhance a government's fiscal capabilities and also encourage other measures to reduce the costs of providing medicines.
This article is concerned with the prevalence of unhealthy housing (UH) in the rural areas of the state of Rajasthan, India. UH is defined to be the houses that are made with non-permanent materials and those that lack a supply of clean water and proper sanitation. Habitation in such houses poses a health risk, particularly for children and women. The Indian government has initiated various programmes to increase the provision of healthy housing for low-income rural families. However, the progress of these programmes has so far been constrained by the limited availability of resources. The prevalence of UH is measured here as the percentage of families that live in such houses. We test whether this prevalence and the associated risks to children's and women's health are significantly higher in the rural areas than in the urban areas. Our main finding is that the prevalence of UH is at least five times higher in the rural area than in the urban area. Moreover, this difference is much greater than that for some indicators of health care and household poverty.
Many low-income households in developing countries cannot afford the high costs of medical treatment. They often resort to cost-saving, but risky options for their treatment. The article uses data published in earlier studies in India to analyse the treatment decisions of low-income households. We compare parents' decisions about their children's treatment with those about their own treatment.The analysis shows that parents often adopt a cost-saving (and risk-taking) attitude about their own treatment, relative to that for their children. This difference is found even when the parents and children have the same sickness profi les and also, when the parents have a higher incidence of serious sicknesses. There is a need for policies to increase affordable access to medicines. These include poverty alleviation and competition/regulation to reduce prices of medicines.
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