INTRODUCTION:

Health geography provide a spatial understanding of people’s health, the distribution prevalence and occurrence of diseases in an area and the environment‘s effect on health and diseases. This study is considered a sub-discipline of human geography; however, it requires an understanding of other fields like epidemiology and climatology. The Geography of Health: An essay in welfare geography by John Eyles examined on the topic of health, care, resources, health and illness in Britain in a systematic manner. His central theme of study was to focus on the welfare of the people.

By questioning who gets what, where and how? It also regards the spatial basis of policy initiative to tackle problems, geographical perspective is, therefore, a necessary framework of reference for any analysis of health and health care. Although health care is a public good, it is not pure. In other words, it is not equally available to all individuals. In a ‘planned’ health care system, one should expect the distribution of facilities to reasonably closely match the distribution of demand.

Health is defined by many scholars but the most widely accepted definition is given by World Health Organization (1984) in the preamble to its constitution, which is as follows: “Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity and also includes the ability to lead a socially and economically productive life”. Health care is an expression of concern for fellow human beings. It is defined as a “multitude of services rendered to individuals, families or communities by the agents of the health services or professions, for the purpose of promoting, maintaining, monitoring or restoring health”. In many countries health care is completely or largely a governmental function. The main focus of health care is ‘serve’ or ‘service to others’. Therefore, it is so pathetic to left alone to health practitioner rather it would be concerned of social scientists in general and health geographers in particular.

The provision of high quality, affordable, economic and social development of the country is closely related with the health care of the people. Development of any country is highly depends on the health care of the people and Siaha District is no exception in this regard. With a total population of 0.56 lakhs, health care of the people in general is still very far from satisfactory. Due to ignorance, religious beliefs and traditional thoughts and thinking especially in the rural and outskirts of the main towns, the health condition of the people on average is fragile and pathetic. Many people especially in urban areas are now aware of their health status and many young citizens are becoming aware of taking good care of their health. Yet there is still a towering requirement of medical attendants such as nurses, doctors and lab-technicians besides the presence of health workers.

Study Area:

The study area Siaha District which comprises of 52 villages is located in the southern corner of Mizoram bordering Myanmar, the location lies within 92°30’ – 92°58’ East longitude and 21°9’ – 22°47’ North latitudes. The district was bounded by Lawngtlai District in west and north while the eastern and southern side is bounded by Myanmar, therefore the location has a strategic significance as it share an international boundary with Myanmar. Due to the administrative changes of Mizoram in 1996, the then Chhimtuipui District was bifurcation into Siaha district and Lawngtlai District, the former capital of Chhimtuipui District i.e Siaha continue to be the capital of Siaha District.

Many of the villages in this district is well known for its economic backwardness due to its remoteness, especially those villages in the southern part bordering Myanmar, rural inhabitants are scattered along the international boundary comprising of few houses ranging from 20-50 with a population of less than 300 people. These villages are connected by seasonal road which are sometimes cut off from the rest of the district during rainy season. It is also true to mentioned that there are no medical facility and even for treatment of minor illness and they have to go the nearest Sub-Centres, in many cases the villagers could not afford to do so and sometimes it results in a very bad and awful situation.

STUDY AREA MAP (SIAHA DISTRICT):

The study area has a hilly landscape and the altitude ranges between 900 m and 1200 m. The area is largely constituted by Tertiary rocks of Bhuban sub group. The highest point of the area is 6470 feet from mean sea level. The rocks are covered by an uneven layer of soil which is composed mainly of alternate thinly bedding shale. Many of the villages in this district is well known for its age old practices i.e. shifting cultivation where majority of its population depend for their livelihood. Despite its drawbacks and low returns in terms of output, no viable alternative has been found so far. Efforts have been undoubtedly channelized to improve through infusion of technology and capital. In many areas, these efforts have been complemented by extensive introduction of horticulture.

The location of the study area falls within monsoon type of climate, the study area also experience the same climate with a marked dry season from November to April during which about 10% of the annual rainfall is recorded and a wet season from May to October with and average annual rainfall of 250 cm (accounting for 90% of annual rainfall). The temperature in the study area sometimes fluctuates between 17°C in winter and 27°C in summer. As a result the climate is pleasant throughout the year.

OBJECTIVES:

The objectives of the present study are as follows:

1 To examine the distribution of health care facilities in the study area.

2 To analyze the availability and spatial variation of health care facilities and medical staff/personal.

METHODOLOGY:

The main objectives of this study is to investigate the distribution and availability of health care facilities such as hospitals, health sub-centers, dispensaries, community health centers, public health centers etc, the investigation is mainly done on the basis of field observations and relevant and reliable data obtained from both primary and secondary sources. Availability and distribution of health care facilities such as hospitals, public health centers, community health centers, dispensaries, health sub-centers etc in the rural areas had been examined.

In order to bring out a detail and an indepth study of the availability and distribution of medical personal/staff in the study area, availability of doctors, pharmacists, nurses and health workers in rural areas had also been examined, in order to assess the spatial variations of health care faculties in the study area, the extent of availability and distribution of health care facilities and medical personal/staff village level data and information was used as the unit of study, at present there are 52 villages and two Rural Development Blocks in the study area.

Distribution of Population:

The present study examines the spatial distribution and availability of health care facility in the study area. An important dimension in health care facility in any region refers to its distribution and concentration of population. Therefore it is necessary to examine the distribution of population in the study area. The total population of Siaha District was 56,574 (Census of India, 2011), of which male and female were 28,594 and 27,890 respectively. The density of population was 44 person sq/km. Siaha town is the capital and it is the only urban center within the district having a total population of 10,421, while the rural population constitutes 31,464. There are two rural development blocks namely Siaha R.D. Block and Tuipang R.D. Block, the total number of inhabited villages in the whole district was 52, of which 33 villages falls under Tuipang R.D. Block and the remaining 19 villages falls under Siaha R.D. Block. The above figure shows that about 55 % of the total population lives in the rural areas. A micro level examination reveals that the spatial distribution of population and the size of village within the district are highly uneven. The distribution of rural population including male and female are shown in the table given below:

Table 1: Distribution of Rural Population in Siaha District-2018

	Name of Village	Household	Male	Female	Total
1	Tuisih	196	445	433	878
2	Theiri	131	311	315	626
3	Serkawr	258	500	477	977
4	New serkawr	37	67	77	144
5	New Latawh	123	312	291	603
6	Tuipang L	140	322	330	652
7	Tuipang V	306	849	806	1655
8	Tuipang Diary	238	561	559	1120
9	Siatlai	74	161	174	335
10	Zawngling	302	803	827	1630
11	Chheihlu	101	280	250	530
12	Chakhang	285	651	682	1333
13	Siasi	74	172	172	344
14	Mawhre	98	255	285	540
15	Chapui	205	501	544	1045
16	Khopai	137	296	355	631
17	Ahmypi	42	112	135	247
18	Kaisih	96	245	197	442
19	Maisa	52	130	114	244
20	Lohry	55	132	137	269
21	Lawngban	119	296	311	607
22	Lodaw	60	143	116	259
23	Phura	231	553	515	1068
24	Vahai	148	414	412	826
25	Tongkalong	107	243	235	478
26	Miepu	95	221	202	423
27	Laki	182	508	504	1012
28	Supha	15	28	30	58
29	Lomasu	82	170	159	329
30	Bymari	113	245	210	455
31	Lope	15	29	29	58
32	Lungpuk	223	551	523	1074
33	Khaikhy	36	73	78	151
34	Phalhrang	73	188	189	377
35	Romibawk	103	229	221	450
36	Riasikah	36	72	61	133
37	Tuipuiferry	58	125	111	236
38	Zeropoint	155	399	360	759
39	Maubawk L	122	285	314	599
40	Maubawk Ch	56	135	117	252
41	Kawlchaw E	239	548	523	1071
42	Lower Theiva	135	290	261	551
43	Lungbun	167	396	403	799
44	Ainak	132	285	274	559
45	Siata	179	438	429	867
46	Tuisumpui	34	98	102	200
47	Old Tuisumpui	69	193	202	395
48	Thingsen	57	174	154	328
49	Niawhtlang-I	151	368	404	772
50	Niawhtlang-II	169	466	443	909
51	Chhuarlung-I	174	430	421	851
52	Chhuarlung-II	56	155	158	313
	Total	6541	15853	15631	31464

Source: Census of India (District Census Handbook) 2018

With an average population of 605, there are 9 villages in Siaha District where the total population exceeds above 1000, the largest concentration of population is found at Tuipang ‘V’ village having a total population of 1655, this is followed by Zawngling (1630), Chakhang (1333) Tuipang Diary (1120) respectively. On the other hand, there are 5 villages where the total population is below 200 and 2 villages namely Supha and Lope recorded the lowest population with 58 only. Apart from this, there are 23 villages having a total population of above the average and the remaining 29 villages’ falls below the average.

It is quite apparent that the size of village population shows a sharp contrast in terms of its absolute number throughout the whole district. This unequal distribution of population within the district may be attributed to different factors such as location, agricultural activities, migration, accessibility, and means of livelihood and so on.

Table 2: Size of Population and No. of Villages in Siaha District

Size of population	Above 1000	1000-800	800-600	600-400	400-200	Below 200
No. of Villages	9	6	8	10	14	5

Fig 1: Size of Poplation and No. of Villges in Saiha District-2018

Table 3: Distribution of Health Care Facility in Rural Areas of Siaha District-2018

	Name of Village	Community Health Centre	Public Health Centre	Health Sub-Centre	Total
1	Tuisih	-	-	1	1
2	Theiri	-	-	-	-
3	Serkawr		-	1	-
4	New Serkawr	-	-	-	-
5	New Latawh	-	-	1	1
6	Tuipang ‘L’	-	-	-	-
7	Tuipang ‘V’	-	1	1	2
8	Tuipang Diary	-	-	-	-
9	Siatlai	-	-	-	-
10	Zawngling	-	-	1	1
11	Chheihlu	-	-	1	-
12	Chakhang		1	2	3
13	Siasi	-	-	-	-
14	Mawhre	-	-	1	1
15	Chapui	-	-	1	1
16	Khopai	-	-	1	-
17	Ahmypi	-	-	-	-
18	Kaisih	-	-	-	-
19	Maisa	-	-	-	-
20	Lohry	-	-	-	-
21	Lawngban	-	-	1	1
22	Lodaw	-	-	-	-
23	Phura	-	1	1	2
24	Vahai	-	-	1	2
25	Tongkalong	-	-	1	2
26	Miepu	-	-	-	1
27	Laki	-	-	1	1
28	Supha	-	-	-	-
29	Lomasu	-	-	-	-
30	Bymari	-	-	-	-
31	Lope	-	-	-	-
32	Lungpuk	-	-	-	-
33	Khaikhy	-	-	-	-
34	Phalhrang	-	-	1	1
35	Romibawk	-	-	1	1
36	Riasikah	-	-	-	1
37	Tuipuiferry	-	-	1	1
38	Zeropoint	-	-	-	2
39	Maubawk L’	-	-	1	1
40	Maubawk ‘Ch’	-	-	-	-
41	Kawlchaw ‘E’	-	-	-	-
42	Lower Theiva	-	-	-	1
43	Lungbun	-	-	1	1
44	Ainak	-	-	-	-
45	Siata		-	1	2
46	Tuisumpui	-	-	-	-
47	Old Tuisumpui	-	-	1	1
48	Thingsen	-	-	-	-
49	Niawhtlang-I	-	-	1	1
50	Niawhtlang-II	-	-	-	-
51	Chhuarlung-I	-	1	1	2
52	Chhuarlung-II	-	-	-	-
	Total		4	26	35

Source: Census of India (District Census Handbook) 2018

Distribution of Health Care Facility:

The distribution of health care facility depends on many factors such size of the village, total population, location of the village and policy of the Government towards rural health and so on. The distribution of heath care facility especially in rural areas of Siaha District is far from satisfactory particularly in the southern and western part. The absence of health care facility in the remote and inaccessible areas bordering Myanmar continues to remain one of the greatest challenges faced by the rural inhabitants till today.

It is important to note that the availability of health care facility is extremely important for every person as the availability and location of heath care facilities is a basic prerequisite for treatment in case of emergency. It is also important to examine the number of existing health care facility such as OPD (Out Patient Department), clinic, laboratory, hospital beds, operation theatre etc, besides, the number and availability of existing doctors, nurses, health workers, pharmacists etc which indicates the quality of services and availability of care for the patients in particular and public in general.

Community Health Centres:

Community Health Centres (CHC) which constitute the secondary level of health care were design to provide referral as well as specialist health care to the rural population. These centres are however, fulfilling the tasks entrusted to them by only to a limited extend. The launched of National Rural Health Mission (NHM) gives the opportunity to have a fresh look at their functioning. In order to provide quality care in these Community Health Centres (CHC) Indian Public Health Standards are being prescribed to provide optimal expert care to the community and achieve and maintain an acceptable standard of quality of care. In general Community Health Centres (CHC) is also one of the agents in providing health care system in the rural areas. Generally, Community Health Centres (CHC) is manned by doctors, nurses, health workers and pharmacists. So far as the availability of health care facility is concerned there is no Community Health Centres in Siaha District.

Primary Health Centres (PHC):

Primary Health Centres are the corner stone of rural health care. Sometimes it is referred to as public health centre; they are state owned rural health care facilities. They are the most vital and important agent of rural health service-a first port of call to a qualified doctor of the public sector in the rural areas for the sick and those who directly report or referred from the Sub-centres for curative, preventive and promotive health care. The overall objective of Primary Health Centres is to provide health care that is quality oriented and sensitive to the needs of the community. These standards would also help monitor and improve the functioning of the Primary Health Centres and they are a part of the government funded health system. Primary Health Centres and their sub-centres are supposed to meet the health care needs of rural population. A medical officer, Block Extension Educator, one female health assistant and laboratory technicians look after the Primary Health Centres. It is equipped with vehicle and necessary facilities to carry out small surgeries.

As stated above Primary Health Centres are provided to meet the health care needs of the rural areas, therefore; the availability of Public Health Centres is very crucial. So far as the availability of Primary Health Centres is concerned there are four Primary Health Centres in the entire Siaha District, one Primary Health Centres under Siaha R.D. Block, the location of this Primary Health Centres is at Chhuarlung-I village, the remaining three Primary Health Centres under Tuipang R.D. Block are located at Tuipang ‘V’, Phura and Serkawr. Each of these PHC is manned by one doctor, six nurses, two health supervisors and one pharmacist. This Primary Health Centres caters the health care needs of the rural areas in the district which include 52 villages comprising a total population of 31,464 in 2018.

Health Sub-Centre:

Sub-Centres are mainly peripheral health institutions catering to the health care needs of the rural population. One Sub-Centre caters to the health care needs of 5,000 population in general and 3,000 population in hilly, tribal and backward areas. The Sub-Centres are provided with basic drugs for minor ailments needed for taking care centre of essential health needs of men, women and children. It is the most peripheral contact point between the primary health care system and the community. Generally; sub-centre is manned by two health workers (one male and one female) and one fourth-grade depending upon the availability of medical staff.

In 2018 as per the information obtained the concerned office, there are 26 Health Sub-Centres in the Siaha District, 9 Sub-Centres under Siaha R.D. Block and 17 Sub-Centres under Tuipang R.D. Block. The distribution of Health Sub-Centres showed that 52% of the villages in Siaha District had been covered by Health Sub-Centre, 9 villages (47.63%) out of 19 in Siaha R.D. Block and 17 villages (51.51%) out of 33 in Tuipang R.D. Block. The above analysis shows that the spatial coverage of villages by Health Sub-Centres clearly reveals that 26 villages in the whole district had not yet been provided by this basic health amenity.

As stated above Health Sub-Centres in rural areas are generally manned by two health workers one male and one female. Considering the availability of health sub-centre in rural areas of Siaha District as compared from the national scenario; the coverage it quite remarkable. On an average the coverage of rural areas by health sub centre showed that one sub-centre cater the needs of 1210 person as against 3000-5000 person for all India average.

Availability of Medical Staffs/personal:

Health care facilities such as Community Health Centres, Primary Health Centres, Health Sub-Centre in rural areas of Siaha District are looked after by State Government, these health care centers are manned by medical staffs such as doctors, nurses; health workers and pharmacists. The total number of medical staffs are 84, 24 nurses, 52 health workers, 4 pharmacists and 4 doctors respectively. Out of the total medical staffs; nurse accounted for 28.57% while health workers comprises 61.90%, pharmacists and doctors comprises 4.76% and 4.76% respectively. These 84 medical staffs/personals look after the care of health care needs of the rural population.

Table 4: Existing Strength of Medical personal/Staff-2018

Doctor	Nurse	Health Worker	Pharmacist	Total
4	24	52	4	84

Fig: 2. Existing Strength of Medical Personsal/Staff-2018

Table 5: Proportion of Rural Population and Medical Stagg/Personals-2018

1	Doctor-Population Ratio	7866
2	Nurse-Population Ratio	1311
3	Health Worker-Population Ratio	605
4	Pharmacist-Population Ratio	7866

Fig: 3. Proportion of Rural Population and Medical Personals-2018

The above table clearly suggests that the availability of medical staff such as doctors, nurses; health workers and pharmacists in rural areas of Siaha District are highly uneven. The availability of medical staffs/personals is very important especially medical doctors because in case emergency and serious illness their presence is highly indispensable. Taking the district as whole medical doctors are available only in those villages where Primary Health Centres are located and there are only four Primary Health Centres in the whole district suggesting a heavy dependency of rural population on these medical doctors. On an average in rural areas of Siaha District the ratio of doctor-population was 7866, apart from this the ratio of other medical personal/staff are 7866 pharmacist, 1311nurse and 605 health workers respectively.

CONCLUSION:

From the ongoing investigation with reference to the availability of health care facility in Siaha District it is quite obvious that there is certain degree of imbalance with regards to distribution of health care facilities, moreover, with the increasing population and number vulnerable and critical illness is concerned there is an urgent need to strengthen the existing health care facilities. Out of 52 villages with a total population of 31,464, there are 34 health care facility such as four Primary Health Centres and 26 Sub-Centres distributed in 26 different villages, these health care facility are looked after by 84 medical personal/staff such as 4 doctors, 4 pharmacists, 24 nurses and 52 health works while the remaining 26 villages had no such facility.

The overall analysis pertaining to health care facility in Siaha District reveals that there are a certain degree of imbalances in the availability of health care facilities with an ever increasing population demand and nevertheless the rapid rise in critical and serious illness. It would not be an exaggeration to say that there is hardly any improvement in the health care-population ratio. It is an urgent need to pay serious concern for the concern government to upgrade the current health care facility in the study area. It is an imperative assignment for the government to equip the health care facility in order to cope with the rising needs of the people. Needless to say that it is also quite disturbing that some villages with a population of nearly 1000 had been devoid of both health care facility and medical personal which suggests that in times of emergency and critical situation problem may arise for the concerned village. It is also desirable that if provided with at least a minimum requirement which will be immensely helpful for the rural health in general and for the local people in particular.

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Received on 17.11.2018 Modified on 10.12.2018

Int. J. Rev. and Res. Social Sci. 2019; 7(1):10-16.

DOI: 10.5958/2454-2687.2019.00002.9