The Need of the Social Worker in Primary Health Care Centres

Special Articles / A.K. Praveenbabu / Scientific Writing and Publishing in Social Work

Abstract
Primary health is essential health care based on practical, scientifically sound and socially acceptable methods. It includes technology made universally accessible to individuals and families in the community through their full participation.  It involves a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self–determination. It forms an integral part— both of the country’s health system, of which it is the central function and main focus, and the overall social and economic development of the community. It is the first level of contact for individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process. Later this became the basis for the upcoming of government hospitals. 

In 1977, the Government of India launched a Rural Health Scheme, based on the principle of “placing people’s health in people’s hands”. It is a three tier system of health care delivery in rural areas based on the recommendation of the Shrivastav Committee in 1975. The health planners in India have visualized the primary health centre (PHC) and its sub-centres as the proper infrastructure to provide health services to the rural population. This paper is an attempt to study the significance of the PHCs and how it has not been successful in recruiting social workers as part of this team despite social workers being recognised an integral part of the healthcare systems.The Government has recommended the following staffing pattern in PHCs.

At present in each community development block; there are one or more PHCs and each block has a rural population of around 30,000. In the new set-up, each PHC will have the following staff. At  the PHC level :1 x Medical officer, 1x Pharmacist, 1 x Nurse mid-wife, 1 x Health worker (female)/ANM, 1x Block Extension Educator, 1x Health assistant (male), 1 x Health assistant (female) LHV, U.D.C. 1, L.D.C., 1x Lab. Technician, 1x Driver(subject to availability of vehicle), 1x Class IV 4, Total 15.

It is regrettable to note that the Government has not thought of recruiting a social worker/counselor. This analysis asks why social workers are not included in the hospitals multi-disciplinary team, considering they are very important to a hospital environment. The role of social worker /counselor is to act as a bridge between the staff, patients, and people. Social workers are the people who integrate all the activities of the hospital and serve as link between the patients, nurses, doctors and the other staff. In a way they are also great healers. Social workers have and provide specific skills such as counseling that provide tremendous benefit to hospitals.This analysis recommends the appointment of a social worker/ counselor be mad ein government hospital staffing arrangements as soon as possible. 

Keywords: primary Health Centre, Staffing, Alma-Ata, Integral Healer

Introduction:
Primary health is essential health care based on practical, scientifically sound and socially acceptable methods.It includes technology made universally accessible to individuals and families in the community through their full participation.  It involves a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part— both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process. Later this became the basis for the upcoming of government hospitals. 

In 1977, the Government of India launched a Rural Health Scheme, based on the principle of “placing people’s health in people’s hands”. It is a three tier system of health care delivery in rural areas based on the recommendation of the Shrivastav Committee in 1975. The health planners in India have visualized the primary health and its sub-centres as the proper infrastructure to provide health services to the rural population. This paper is an attempt to study the significance of primary health care centres and how it has not been successful in recruiting social workers as part of this team despite social workers being recognised an integral part of the healthcare systems.

The Central Council of Health, at its first meeting held in January 1953 had recommended the establishment of primary health centres (PHC) in community development blocks to provide comprehensive health care to rural population. The number of primary health centres established since then had increased from 725 during the First Five Plan to 5484 by the end of the Fifth Plan (1975-1980)-each PHC covering a population of 100,000 or more spread over some 100 villages in each community development block.

These centres were functioning as peripheral health service institutions with little or no community involvement. Increasingly, these centres came under criticism as they were not able to provide adequate health coverage, partly because they were poorly staffed and equipped, and partly because they had to cover a large population of one lakh or more. The Mudaliar Committee in 1962 had recommended that the existing PHCs should be strengthened and the population to be served by them to be scaled down to 40,000. In fact the Government of India appointed the Mudaliar Committee to review the progress made in medical relief and public health since the submission of the Bhore Committee’s report to formulate guidelines and proposals for inclusion in the subsequent Five Year Plans. Mudaliar Committee thereafter went into the problems of public health in great depth and their recommendations were meant to serve as guidelines for the development health services, both curative and preventive. In India, as also all over the world, relief against sickness is made available to patients mostly through hospitals and dispensaries. Hospitals, in fact, are temporary homes for patients, and both the hospital authorities and the government have to create conducive conditions. It advised strict adherence to the recommendations of the Bhore Committee regarding implementation of the programme of PHCs. This was followed by the Declaration of the Alma – Ata conference.
 The Declaration of Alma-Ata Conference in 1978:  ‘setting the goal of Health for All by 2000 AD’, ushered in a new philosophy of equity, and a new approach:the primary health care approach. The National Health Plan (1983).This approach proposes the reorganization of PHCs which will see one PHC for every 30,000 rural population in the plains, and one PHC for every 20,000 population in hilly, tribal and backward areas for more effective coverage. As of the 30th sept. 2005, 23236 PHCs have been established in the country.As a signatory to the Alma-Ata Declaration, the Government of India is committed to achieving the goal of health for all, through primary health care approach which seeks to provide universal comprehensive healthcare at a cost which is affordable. 

In the establishment of the PHCs, the Government has recommended the following staffing patterns. At present in each community development block; there are one or more PHCs and each block has a rural population of around 30,000. In the new set-up, each PHC will have the following staff. At  the PHC level : 1 x Medical officer, 1x Pharmacist, 1 x Nurse mid-wife, 1 x Health worker (female)/ANM , 1x Block Extension Educator, 1x Health assistant (male), 1 x Health assistant (female) LHV, U.D.C. 1, L.D.C., 1x Lab. Technician, 1x Driver (subject to availability of vehicle), 1x Class IV 4, Total 15. This is what is called a multi-disciplinary team.

It is regrettable to note that the Government has not thought of recruiting a social worker /counsellor. This analysis asks why social workers are not included in the hospitals multi-disciplinary team, considering they are very important to a hospital environment.  The role of social worker /counsellor is to act as a bridge between the staff, patients, and people. Social workers are the people who integrate all the activities of the hospital and serve as link between the patients, nurses, doctors and the other staff. In a way they are also great healers. Social workers have and provide specific skills such as counselling that provide tremendous benefit to hospitals. 

The social workers role in a PHC is immense. The social workers help to educate the public about the physical illness in a manner that is understandable to them. They sensitize the voluntary agency personnel about the issues related to health problems and health services available in the District in order to enlist their active participation. They facilitate, coordinate and collaborate with District Health programmers along with welfare and development Departments in Governmental and non-governmental sectors for effective delivery of Health Services.  They help and participate in the training programmes conducted for Health Workers and Voluntary Agency personnel as well as assist in the periodical monitoring of their services to the community.

Besides these factors, the social workers help to evaluate the community’s perception about the PHCs and devise ways to improve the quality of services to meet the growing needs of their community. Apart from this they act as an agent of community education and community involvement in various health programmes in media/personnel for this work.  In this they facilitate the quality of psycho social settings for well-being of the physically / mentally ill people. They also educate the attenders and caregivers of the patients about the nature of the disease and how to manage the symptoms. Not only that — the role of social workers is very significant in hospital settings as they are involved in educating the caregivers about the various treatment options available in the PHC/ Hospitals and rehabilitation services offered by the government and the financial assistance that could be acquired for welfare of the physically ill.In short the social worker is knowledgeable, understanding, empathetic and service-oriented and is of great help to each and everyone in the hospital environment.

Frequently doctors in hospitals are extremely busy and invariably may not be in a position to spend quality time with the patients due to their preoccupations with several issues. Similarly the nurses are often attending many patients due to which they are unable to talk freely with the patients. It is at these moments that the role of the social worker as counsellor gains importance and looms large. They can communicate with the patients and their attendants and becomes fully knowledgeable about the patients and their illness and the background from which he hails.They can discuss in detail, the nature of the ailment to the doctor’s and can remind nurses of the patient’s needs. Consequently the social worker is not only helpful to the patients but also to the doctors and the nurses in attendance of the patients. Their role in hospitals is vast.

Conclusion:
As recommended by the Study Team on Social Welfare appointed by the C.O.P.P., counselling through a social worker should be introduced with proper machinery by the Central Welfare Board which is giving grants to voluntary agencies. This should be followed by licensing by the State Governments. But the question arises as to how the State Governments will be able to judge and select institutions which should be granted licenses. In the absence of proper standards and adequately qualified machinery to study various aspects of an applicant agency’s work, the licensing law will not serve any useful purpose. Therefore the State Governments should make use of the machinery for field counselling being set up by the central Social Welfare Board and specialized knowledge of the agencies like the Indian Council for Child Welfare, the All India Women’s Conference, Y.M.C.A., Y.W.C.A. the National Association for Blind, the Indian Red Cross Society, the Bhartiya Grameen Mahila Sangha, etc.Suffice it to say that the social workers/ counsellors are the prime need in the current hour and their holistic involvement in all the activities and all the persons involved make them integrative healers.

References:

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2. Davis, Keith (1977). Human Relations at work, 5thed, McGraw-Hill, New York, P.431.
3. Flipps, Edwin B. (1989). Personnel Management, 5thed, McGraw-Hill, Kogakusha, Tokyo, p.430.
4. Morley, David, et al (1984).practising Health for All, Oxford University Press.
5. WHO (1978).Health for All Sr.No.1.
6. UNDP, Human Development Report 2003, Millennium Development Goals: A compact among nations to end human poverty, Oxford University Press.