Healthcare is an essential sector to develop for bettering the standard of living. Primary healthcare is the focus for action since the masses depend on this level for their basic health needs. Health Gaps in Goa are many at the availability, accessibility and administrative level especially in the urban fringe areas and the rural areas in terms of time, cost, comfort, convenience and safety. Higher tertiary order facilities are absent and patients are referred to neighbouring cities, which offer these services. The health facility network shows an ad-hoc growth pattern and does not consider the terrain or geographical restrictions. Health inequalities in the state exist due to the difference in economic standards of the people. Goa's three main income generating sectors are tourism, alcohol distillation and mining. All contribute adversly to the health situation in Goa. The intent of the dissertation is to attempt efficiency in health delivery through better networking, upgrading of facilities and efficient administration.
The system should be responsive to the legitimate expectations of the people. To some degree the users should be made to pay for the services they partake of, in the form of some risk pooling or risk sharing schemes. To realise the benefits of planned development, keeping in mind the spatial and sectoral disparities a set of strategies has been formulated. The basis for infrastructural build up can be founded upon the strategic introduction of mobile facilities for improving the reach of healthcare, creation of new roads, bettering connectivity and modifying the administrative and operational hierarchy of health facilities. Policies oriented to facilitating a multisectoral impetus to health system development, public-private partnership in health delivery, participatory approach in health system development and health tourism are designed to take health care to international standards and also add valuable revenue to the state exchequer. Proposals regarding the responsibility of healthcare professionals, improving the referral system, health education and awareness and financing of the action plan have been sensitively framed to address intangible issues effectively.
Revenue earned by other sectors must be put into the health sector either directly or indirectly. The addition and upgrading of facilities brings the health system to the people rather than forcing them to the system. A participatory approach where a community works towards self-improvement, learning more about itself in the process and developing a sense of belonging within itself has been envisaged within the background of health system development. The plan will benefit the people of Goa vis-à-vis healthcare delivery.
Keywords: Health Systems, Healthcare Delivery Policies, Health Facilities Development, Mobile Health Units, Routing Operations, Inter-Sectoral Development, Healthcare Delivery, Healthcare Planning, Healthcare Management, Health Tourism, Hospitals, Health Centres, Risk Pooling, Risk Sharing, Goa.
1.1 Issues Pertaining to Healthcare Systems and Goa
1.2 Purpose of Health System Development
1.3 Extents of Health Planning
1.4 Procedure for Efficient Plan Formulation
1.5 Sources of Data
2.0 The Existing Healthcare System
2.1 Perceptions of the Prevailing Situation
2.2 Study of the Existing Situation
2.3 Spatial Patterns of the Delivery System
2.4 Economics of the System
3.0 Crisis Identification
3.1 Incidence of Diseases
3.2 Issues Peculiar to Goa
4.0 Sanguem Taluk - a Specific Action Area
4.1 Distinctive Problems of Sanguem
5.0 Health System Plan for Sanguem
5.1 Facility Location
5.2 Transport Network Connections
5.3 Rational Location of Mobile Stations
5.4 Routing for Management of Health Services
6.0 Health Strategy Guidelines for Goa
Appendix I - Questionnaires for Collecting Primary Data
Appendix II a - Census of India, 1991, Plan of Sanguem Taluk
Appendix II b - Census of India, 1991, Series 6, Part XII - A & B (in part)
Appendix III - DALYs for India, 1990
Appendix IV - Resource Persons
I would like to express a deep senseof gratitude, esteem and affection towards my guide Prof. R. N. Chattopadhyay, for his criticism, suggestions and inspiration, without which this dissertation would be seriously wanting.
My indebtedness to Mr. R. N. Ray, CTP of the Town and Country Planning Dept., Goa State, and Prof. Arif Merchant, Prof. S. Sen and Prof. R. N. Dutta of the Department of Architecture and Regional Planning, IIT KGP for their help and encouragement.
Heartfelt appreciation of Ms. Rinea Dourado, of the Sangath Centre for Child Development and Family Guidance, Dr. Abhijit Kamat, Mr. Syed Iqbal, Manager and Ms. Sudha Anavker of the Govt. of India Tourist Office, Dr. Bicaji Ghanekar, Dy. Dir-Med. of the Directorate of Health Services, Goa State for spending the time and effort to help me know Goa and it's health issues better.
I am grateful to Dr. Nihal Singh, of the World Health Organisation, Dr. M. N. Pal, Dean of the Goa Medical College, Dr. Sidhartha Satpathy, of the AIIMS, Mr. Siddhart Saha, of Indraprastha Apollo Hospital, Dr. Sumanta Bhat, Dir. HIB and Dr. Enric d'Souza, CMO of the DHS, Ms. Aparna, of Hosmac and the numerous people who's insights and information are of immense value to this dissertation.
I thank Chinmoy Jana for his assistance with my thesis. Also, my friends and colleagues at IIT KGP for their suggestions, discussions and timely help. Last, but definitely not the least, Bhuwneesh Kumar, for his constant presence when I needed it most.
IIT - Kharagpur, January 2001