VISVESVARAYA TECHNOLOGICAL UNIVERSITY

"Jnana Sangama", Belgaum: 590 018

A Detailed Project Report [DPR]

on
“Improve Health Parameters Of Rural Women”
As part of AICTE Activity Point Programme

A report submitted in partial fulfillment of the requirement

for the award of the degree of

Bachelor of Engineering
In
Computer Science & Engineering

Submitted by

Nazmeen Begum(3SL19CS027)

Under the Mentorship of

Prof. Jyothi .N
Department of Computer Science & Engineering

DEPARTMENT OF COMPUTER SCIENCE & ENGINEERING

H.K.E Society’s S.L.N. COLLEGE OF ENGINEERING
(Affiliated to VTU - Belagavi, Affiliated to AICTE, Accredited by NAAC)
Yeramarus Camp, Raichur-584135, Karnataka
2022 -2023
 DEPARTMENT OF COMPUTER SCIENCE & ENGINEERING
H.K.E Society’s S.L.N. COLLEGE OF ENGINEERING
(Affiliated to VTU - Belagavi, Affiliated to AICTE, Accredited by NAAC)
Yeramarus Camp, Raichur-584135, Karnataka

CERTIFICATE

Certified that the AICTE activity point programme on topic “Improve Health
Parameters Of Rural Women” has been successfully completed by Nazmeen
Begum(3SL19CS027) of the 8th Semester of Bachelor of Engineering in Computer Science &
Engineering of Visvesvaraya Technological University, 2022 - 23 . It is certified that all
corrections/suggestions indicate for Internal Evaluation have been incorporated in the report.

Signature of Mentor Signature of HOD

 AICTE

AICTE is an abbreviated form of the All-India Council for Technical Education. AICTE is the
statutory body and the national-level council for technical education in the country. AICTE
was formed in November 1945 with the vision to promote development of the education
system in India. Till 1987, it was acting as an advisory body under the Department of
Education, Ministry of HRD. In 1987, it was given a statutory status by an Act of Parliament,
enabling it to exercise in a more effective manner. AICTE as a body is responsible for
accrediting all postgraduate and graduate programs, under specific categories of technology for
Indian institutions. This is its major point of difference with UGC (University Grants
Commission) as UGC only accredits non-technical education in India.

AICTE provides a coordinated effort for development and planning of technical education in
India. It is primarily the accrediting authority for institutions, including schools and colleges
giving diplomas, undergraduate and postgraduate education. Apart from the accreditation,
AICTE also has major involvement in training, research and development of technical
education in the country, which includes the variety of study areas like commerce and industry
trade, science and engineering, medicine and healthcare, arts, environment, architecture,
vocational studies, management, hospitality, food science and many more.

To provide for establishment of an All-India council for Technical Education with a view to
the proper planning and coordinated development of the technical education system throughout
the country, the promotion of qualitative improvement of such education in relation to planned
quantitative growth and the regulation and proper maintenance of norms and standards in the
technical education system and for matters connected therewith.
Introduction:

India has made significant advances in health of its populations over more
than a decade, reducing the gap between rural and urban areas and
between the rich and the poor. Huge disparities, however, still remain, and
access to healthcare in rural areas remains a huge challenge. A one-day
National Consultation, nested within the World Rural Health Conference,
was held to share learnings from experiences and evidence of rural
primary healthcare within India and from across the world, to identify
elements that may guide improvements in healthcare in rural India. From
discussions, this article summarizes the evidence on what works for rural
primary care, and then provides recommendations for strengthening
healthcare in rural India.

Evidence on What Works for Rural Primary Care

Family-centered healthcare

There is overwhelming evidence that family-centered care that takes a

population health approach and that delivers comprehensive and
continuing care helps improve healthcare of rural populations.

Such a care integrates preventive and promotive care and is delivered by

health providers (doctors, nurses and other health professionals) who are
trained to manage a range of conditions: from safe childbirths to
cardiovascular conditions and respiratory conditions. They are further
trained to work in teams, understand community needs, and engage them
actively.
Higher investments in healthcare

India spends a small proportion of its budget on healthcare. Increased

budgetary allocations to National Rural Health Mission led to significantly
improved health outcomes: most of this improvement occurred in rural
areas, reducing health inequalities. However, overall budgetary allocations
to healthcare remain low, around 1% of gross domestic product (GDP),
restricting optimal improvements.

Within India, there is a clear evidence that states that spend higher
proportions of their budgets on healthcare have better health outcomes
than those who spend smaller lesser. There are concerns in South Africa
and Brazil that reduced public expenditures in primary healthcare will
inhibit provision of healthcare to the most marginalized populations.

State-funded health insurance and implications for primary healthcare

There are concerns that India's investments in the Pradhan Mantri – Jan
Arogya Yojna (PMJAY) will promote secondary and tertiary healthcare, at
the expense of primary healthcare. The consultation brought about
evidence and experience that will be helpful for India to turn this around:
helping the PMJAY strengthen rather than weaken primary healthcare.

First, PMJAY could include primary healthcare services. There are several
examples: in high-income countries such as Australia and in low-middle-
income countries such as Thailand, where state-funded health insurance
covers primary healthcare in rural areas. Second, PHCs should retain the
gatekeeping functions: patients should first present at PHCs, and only
when referred by PHCs, should they be entitled for insurance cover under
PMJAY for secondary or tertiary care. Such an arrangement would help in
increasing utilization of PHCs and maintain the primacy of primary
healthcare. It would also help in ensuring efficiency by reducing
unnecessary referrals.

Building and empowering primary healthcare teams

Most presentations highlighted the need for comprehensiveness of

healthcare: ability to prevent and treat maternal and child health
conditions, and communicable and noncommunicable diseases and
injuries.

Because of shortage of physicians to work in rural areas, various

government and non-governmental organizations have engaged
nonphysician providers to deliver healthcare in rural areas. For example,
in Chhattisgarh, a new cadre of rural medical assistants helped in
significantly improving the utilization of PHCs in some of the remotest
areas of Chhattisgarh. A review of global evidence, shared by WHO India
Country Office, concluded that nonphysician providers, when well-skilled,
supported, and supervised, can deliver good quality healthcare for a range
of conditions.

It was, however, contested that India has a shortage of physicians: their

nonavailability reflects inadequate living and working conditions, low
wages, and poor training opportunities (see next section). Although the
role of nonphysician or mid-level providers was considered important to
improve access, many experiences shared in the consultation, such as that
from South Africa, Rajasthan, and Chhattisgarh, highlighted a team
approach. The team includes a physician (a family physician or a
generalist) and nonphysicians: nurses, other healthcare providers, and
community health workers. Such a team appears to be critical to
provide comprehensive primary healthcare through improved access,
quality of care, culturally sensitive care, and equity.
Training of rural healthcare professionals

Global evidence suggests that such a care is effectively provided by

workforce (especially doctors and nurses) who are trained to practice
comprehensive healthcare and are mentally prepared to offer a full scope
of services to the rural constituency. To be effective, such a training should
take place in rural health facilities, and the trainees should be embedded
in rural communities.

Primary healthcare or a generalist approach

In rural areas, the health professionals need to provide a range of care, for
a range of conditions to people across the life cycle. They therefore need to
have a range of clinical skills, social skills, and leadership skills. Current
medical and nursing education is conducted in specialized tertiary care
settings and is geared toward providing care in such settings only.

In Queensland, medical education is geared toward a generalist approach

that includes training in community-based primary medical practice,
health facility–based secondary medical practice, and hospital- and
community-based public health practice. In CMC Vellore, during the
mandatory rural service, the medical graduates are offered a long-distance
training in Family Medicine that equips them to provide primary
healthcare in rural settings.
Social accountability mandate of medical and nursing schools

Social accountability of medical schools has been defined as “the

obligation to direct their education, research, and service activities
towards addressing the priority health concerns of the communities they
serve.” Similar definition is relevant for nursing schools.

In the context of rural primary care, socially accountable medical or a

nursing school would direct education, research, and services to address
priority concerns of rural communities. A socially accountable rural
medical school helped in addressing health needs of the populations of
North Ontorio.
Availability of rural training sites

CMC Vellore has an affiliated group of about 200 secondary hospitals,

largely in rural and remote areas that act as training sites for physicians
and nurses. Training large numbers of doctors and nurses will require
community-based rural training sites, public or private, where they can
practice and learn primary and secondary healthcare, such as Bayalpata
Hospital in Nepal. Experiences suggest that it is extremely helpful if the
doctors and nurses in these facilities are accorded a faculty position.
Post-training support and placement

Evidence suggests that improved living and working conditions, better

salaries, use of disruptive technology, co-operative arrangements with
other rural health facilities, and continued training help the doctors and
nurses to provide high-quality care in rural areas. In Nepal, the staff of the
rural hospital at Bayalpata receive continued training and exchanges.

In the absence of adequate training, improvement in living and working

conditions, and career progression, merely making it mandatory for
nurses and doctors to work in rural areas does not work.

Recommendations for strengthening primary healthcare in rural India

Various experts and practitioners, based on their own experience and

global evidence, made the following recommendations that would have
relevance for strengthening primary healthcare in rural India.

Investments in primary healthcare

1. The policy commitment to invest 2.5% of GDP on healthcare and
70% of this expenditure on primary healthcare should be tracked
periodically.
2. States that provide lower allocations on healthcare should be
encouraged and supported to provide higher allocations.

Primary healthcare and PMJAY

1. PHCs and H and WCs should retain the gatekeeping function:

Patients should first present at PHCs, and only when referred by

PHCs, should they be entitled for insurance cover under PMJAY for
secondary or tertiary care. Such an arrangement would help in
increasing utilization of PHCs and maintain the primacy of primary
healthcare. It would also help in reducing expenditure by reducing
unnecessary referrals

2. PMJAY should cover primary healthcare, in addition to the

secondary and tertiary care:

It would help in promoting access to primary healthcare and also

reduce the overall expenditure on healthcare, by reducing
 unnecessary referrals, by preventing illnesses, and by treating
diseases at an earlier stage.

PHC team for health and wellness

1. Responsibility (and accountability) for care of a defined population
should be entrusted to the entire primary healthcare team:

The team would consist of the PHC staff (including the primary care
physician), and H and WC staff (consisting of the mid-level provider,
auxiliary nurse midwife (ANMs), multipurpose worker (MPWs), and
accredited social health activists (ASHAs)). Such a team is likely to
provide comprehensive and continued care

2. Primary care physician should be trained in family medicine, and

nurses (and other mid-level providers) should be trained in
equivalent generalist care
3. Primary care team should be adequately supported through regular
skilling, incentives, and supervision. Appropriate technological
solutions should be provided to help them deliver quality healthcare
 4. These teams should have functional linkages with higher levels of
healthcare.

Creating and retaining healthcare professionals for rural primary healthcare

(PHCs and H and WCs)
1. Revise undergraduate medical and nursing curriculum to align with
rural priorities:

The training of MBBS should be aligned toward producing rural

family physicians, and of nursing graduates, to produce rural
primary care nurses

Currently, the graduate training of nurses and doctors has a heavy

urban and tertiary healthcare bias

2. Allocate a large proportion of postgraduate seats for family-centered

care with rural immersion:

In recent years, there has been a huge increase in postgraduate seats

(MD/MS) for medical graduates. Allocating them to family medicine,
with appropriate training in rural health care settings, will bring
 about the change in focus from tertiary care to primary care, and
from urban bias to rural focus. It would require setting up family
medicine programs in medical colleges, with strong rural focus

A similar shift can happen if large numbers of postgraduate seats for

nurses are allocated to community health nursing, or nurse-
practitioner program.

3. Make newly setup rural medical colleges responsible for district

healthcare:

A large number of state-funded medical colleges are being set up in

district hospitals, most of which are rural. Entrusting them with
healthcare of their respective districts, focusing on sourcing rural
students, adapting their training curricula to meet local needs, and
helping them place within the districts would help them fulfil their
social accountability. In such colleges, focus should be on primary
and secondary care rather than tertiary care

4. Identify and accredit rural training sites for rural health

professionals:

It would ensure sustained and high-quality training of a large

number of professionals required for managing PHCs and H and
WCs. The staff of these training sites should be accorded a faculty
status.

5. Set up an empowered group to define improvements in training,

living, and working conditions for rural healthcare professionals:

Such a group should be constituted of medical and nursing

educationists from institutes that have a long experience of training
doctors and nurses for rural areas, and practicing rural physicians
and nurses.
 How are Health Services provided to the people of rural areas?
The health care infrastructure in rural areas has been developed as a three
tier system as follows.

1. Sub Centre : Most peripheral contact point between Primary Health Care
System & Community manned with one HW(F)/ANM & one HW(M)
2. Primary Health Centre (PHC) : A Referral Unit for 6 Sub Centres 4-6
bedded manned with a Medical Officer Incharge and 14 subordinate
paramedical staff
3. Community Health Centre (CHC) : A 30 bedded Hospital/Referral Unit for
4 PHCs with Specialized services

How can government improve health facilities?

ROLE OF GOVERNMENT IN ENABLING INTERSECTORAL
COORDINATION TOWARD PUBLIC HEALTH ISSUES
 Living conditions.
 Urban planning.
 Revival of rural infrastructure and livelihood.
 Education.
 Nutrition and early child development.
 Social security measures.
 Food security measures.
 Other social assistance programs.
How can we improve health care system in India?
6 Ways in Which India's Public Healthcare Can Change for the..

1. Quantum increase in budget allocations.

2. Rebuilding trust between doctors and patients.
3. Reclaiming peace and harmony.
4. Introducing eggs in anganwadi centres.
5. Making workplaces safe.
6. A stronger push against tuberculosis.