THE ANARCHY OF MEDICAL AND EDUCATIONAL FACILITIES IN THE SMALL TOWNS OF INDIA

INTRODUCTION

Towns, an amalgam of rural and urban India, are envisaged with multiple facets of developing and non-developing notions of life. They believe in Urbanization and modernization as their tones of life. Nevertheless, the primary facilities of life are not up to the mark within these towns due to multiple reasons like their unfixed adherence to any extreme forms of living which predominantly includes a lack of quality education and healthcare facilities, either primary or secondary. Nearly 86% of all medical visit in India are made by ruralites with the majority still travelling more than 100 km to avail health care facility of which 70-80% is born out of pocket landing them in poverty.[1] The appropriate form of medical or healthcare facility for any township should include easy, reasonable and inexpensive access to primary and secondary healthcare facilities with particular emphasis on the illness prevention and management system. As per the National Sample Survey Office, [2]the active health workforce size estimated (NSSO 2017–2018) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million, respectively.[3] That means we can count that, India’s certified active health personnel density is as low as 8.3 and 17.4 doctors and nurses/midwives respectively per 10,000 people. In terms of education, access to it is not enough. The aim should be clubbing the words ‘quality’ and ‘education’ together. It should not merely involve enrolments but the up-gradation of attendance rates, which is possible if affordability comes in. A 2018 report by, the Annual Status of Education Report highlighted that only half of the 5th-grade children could read a grade-level 2 text fluently.[4]  Moreover, this draining education situation in small towns has worsened because of the prominent caste and gender segregation with poverty as its concentration, which is directly proportional to the disparity between low test and high dropout rates among the students. The uneven distribution of facilities, the substantially rising number of immigrants, and related unemployment intensify the state of affairs.

The situation of the denizens of these small towns is regressed as they battle between progress and an itinerant state of life for the sake of quality of life. People often travel across cities only[5] to understand the advice of the highly esteemed Doctors or educators of the developing and developed cities of the country. The lack of education exemplifies this troublesome situation of the townsman and woman by depriving them of other smart options.

THE REALITY CHECK

What goes within the minds of the people of such sub-urban areas is expressed in the following note; they believe themselves to be much ahead of drained rural India but cannot fully adapt to the urbanized standards. The government predominantly labels such areas as ‘smart cities’ and works toward their development. What they need to improve the most is hitting the cornerstone of development, i.e., education and health. Digging up roads at every salient point of the town can never justify the notions of development the agencies burden themselves with. A far-away board, which splashes multiple neon green and pink lights, highlighting the Air Quality Index of the geography, stands only value with erudite citizens around to comprehend it. Such misdiagnosis by the agencies creates another vicious cycle of under-development within these towns. The people are consciously made known of the multiple assets of their arena yet, they struggle to realize the root cause of their disdaining situation, which is the lack of quality education and healthcare. Subsequently, reports of the National Achievement Survey of 2017 gave us a horrifying result wherein only 45.2 per cent of the surveyed students achieved targeted performance levels across all subjects.[6] Here the situation shows that even a minimal level of performance is unreachable by more than half; hence, quality education seems a distant dream. The youth of such towns struggle the most. Either they know the true stance of the facilities and devoid themselves of the same by bugging out of such cities or encircle themselves for the sake of family hood. Either way, what they face is a struggle.

Lately, the COVID-19 pandemic has also allowed educational and medical facilities to flourish due to its impact on access to facilities physically and the exploration of the technological realm. Continuing medical educational (CME) activities have migrated increasingly to virtual events and online programs, a trend that may also continue due to its practicality and cost-effectiveness. Telemedicine was already in place before the COVID-19 crisis however, barriers are rapidly coming down to its widespread use and patients seem to embrace this, even as healthcare systems navigate the complicated issues of cybersecurity and patient privacy.[7] However, the disparity of the impact on different geographies is also apparent. The most evident barrier to the equal adaption of the advancement was the lack of technical equipment or the failure/technical weakness of hardware or software. It was also noted that teachers/physicians often lack technical know-how or are not instructed properly. It requires faculties and universities to impose and develop a range of procedures, policies and activities to overcome unequal opportunities.[8] This crisis has enriched the markets with much advancement in the technological spectrum like the usage of telemedicine and online consultation with features like easy, hassle-free, and rapid solutions. Regardless, its optimization is only open to a few and further stags the ones with non-existent access to opportunities behind. To counter the same, we must realize the differences between the rural and urban and cater to their needs accordingly. Understanding the geographical and sociological standpoint of the locale should be the foremost step in shaping any legislative action.

WAY FORWARD

For better policy-making targeting the development of such towns, the following pointers can be taken into account – 

  • A major portion of financial and strategic support must be given to diagnosing medical or social problems. The medical evils of misdiagnosis due to lack of coordination in the illness prevention and management systems exaggerate the medical problems of these gullible individuals. The social evils at the onset of every development should also be recognized to provide solutions at the core.
  • A coordinated and affordable national medical healthcare and educational curriculum must be the pressing priority, with regulations aiming at bringing equal quality of medical and educational facilities at all levels with access to the national database to everyone. The prime objective should be to incorporate affordability and accessibility.
  • An integrated approach towards penetration of knowledge and awareness regarding the common grounds of life like insurance policies, prominent Indian career options, government incentives, and many others should be essentialized.
  • Digitalization should be the way forward with emphasis on the importance of education in terms of social and medical reality being realized. The crunch of validated medical experience at home should be dealt with by providing better structure, accreditation, registration, and recognition of local medical facilities and systemizing the interconnectivity between urban, suburban, and rural centres. In terms of education, the reaffirmed spirit of online or remote access should not be suppressed.

CONCLUSION

The need is to bring substantial changes to uplift those in ‘need’ over the demanding population. An in-depth analysis of understanding what the need over the demand must be the pressing priority, implying the importance of a philanthropic approach over economics for the initial growth years. The predominating demand of the sub-urban areas is not equality but equity. Health and educational equality means giving every individual equal access to the facilities which is naturally devoid to the rural and sub-urban townsman because of many physical and social barriers between them and the developed facilities of the urban. Nonetheless, what is achievable is ‘equity’, implying the importance of realization of social realities and providing appropriate support thereto. It includes giving extra support to the poorer and uneducated classes of society by supporting the evolution of the facilities near them. Regard to the 1946 Constitution of the World Health Organization (WHO)[9] should be inclined; whose preamble defines Health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”, which must envisage easy access to quality healthcare and education.

Moreover, Article 21[10] of the constitution of India cannot be left out in the cold, which underlines the importance of life and its related dignity as an individual’s fundamental right. The social construct of dignity is achievable through the portrayal of worthy identification, which includes the status of an individual’s quality of education and health. The concept of living beyond mere animal existence and the inhibition against its deprivation extends to all those limbs and faculties by which life is enjoyed[11] which should primarily include access to quality healthcare and educational facilities. Furthermore, labelling cities and setting up goals for infrastructure development without comprehensively realizing the citizens’ actual needs would be like putting salt in the wound. The advancement at all levels of geographies within the medical and educational spectrum is of utmost importance, and other realms of development are of penultimate importance.

Author(s) Name: Disha Bhalla

References:

[1] Kumar R., ‘Academic institutionalization of community health services: Way ahead in medical education reforms’ (2012), 1(1) J FAMILY MED PRIM CARE 10-11, 10

[2] NSSO, ‘Social Consumption in India: Health. NSSO 75th Round 2017–18’ (2017)  National Statistical Office, Ministry of Statistics and Programme implementation, Government of India

[3] Karan, A., Negandhi, H., Hussain, S. et al, ‘Size, composition and distribution of health workforce in India: why, and where to invest?’ (2021) 19(39) HUM RESOUR HEALTH 1, 1

[4] Rajeev Mullick, ASER 2018 : More than half of children enrolled in Class 5 can read at least a standard 2 level text Hindustan Times (India, 16 January 2019) < https://www.hindustantimes.com/education/aser-2018-more-than-half-of-children-enrolled-in-class-5-can-read-at-least-a-standard-2-level-text/story-NMDvefZYbjggcGtx3cDBAI.html> accessed 30 May 2023

[5] Kumar R. ( n 1)

[6] National Council of Educational Research and Training, ‘National Report to Inform Policy, Practices and Teaching Learning’ (2017) NCERT 1, 154  <https://ncert.nic.in/pdf/NAS/WithReleaseDate_NPPTL.pdf> accessed 7 June 2023

[7] Shah S, Diwan S, Kohan L, Rosenblum D, Gharibo C, Soin A, Sulindro A, Nguyen Q, Provenzano DA ‘The Technological Impact of COVID-19 on the Future of Education and Health Care Delivery’ (2020) 23 PAIN PHYSICIAN S367, S367

[8] Egarter, S., Mutschler, A. & Brass, K., ‘Impact of COVID-19 on digital medical education: compatibility of digital teaching and examinations with integrity and ethical principles’ (2021) 17(18) INT J EDUC INTEGR 7-9, 1

[9] WHO Constitution 1948 (Preamble)

[10] Constitution of India 1949, art 21

[11] Kharak Singh v. State of Uttar Pradesh and Ors., (1963) AIR 1295

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