AVAILABILITY ASPECT OF HEALTHCARE ACCESS IN HUNSUR TALUK, MYSURU DISTRICT- A SPATIAL ANALYSIS

This paper aims to attempt the study of availability, accessibility and Infrastructure of public healthcare Facilities in Hunsur taluk, Mysuru District. It also tries to find out the gap between existing public health care facilities and normative requirement of public health care facilities as set by the government of India. The base map of study area has been geo-referenced and digitized using ARC GIS software. The Global positioning system (GPS) was adopted to take the coordinate of all the existing Public health centers in the study area. Data is analyzed though simple quantitative techniques like ratios, percentage and the spatial disparity of health centers were measured with the help of Nearest Neighbour Techniques. The results show that the availability of Public healthcare center is unequally distributed and there is scarcity in the availability of infrastructure and workforce among the study area. A large proportion of the residents have to travel a long way to access the health care facilities. There is a high inequality in the distribution of public Health centers, Health infrastructure facilities and Health Workforce in the hoblis of Hunsur taluk, Mysuru District. The Public Healthcare centers are not increasing with the population so there we can identify the gap between them. To reduce the imbalance in the health centres, the establishment of new health care centres should be based on structured criteria and geographical aspects, and there is need to improve the infrastructure of existing healthcare centers and increase the number of staffs in the study area for balanced regional development.


Introduction
Access can be described as the 'degree of fit' between users and a service. The 'degree of fit' might be influenced by the availability, accessibility, accommodation, affordability and acceptability of a service (1) . The accessibility of healthcare centers is one of the most important indi-cators for measuring the efficiency of a healthcare system. Accessibility is a complex indicator that reflects the number of health care institutions, their geographical distribution and the impact of different types of barriers social, Economic and culture (2) . Geographers are mainly concerned with geographical accessibility for the calculation. The concern for equitable healthcare access to people is a basic element of many health policies. Governments have been committed to ensuring access to healthcare and success is highly dependent on the nature of existing inequality and in the healthcare needs of the people (3) . Thus, access to healthcare is a multidimensional concept that is subject to the influences of both the geographical, social and economic factors (4) . The service availability is another influencing factor for the geographical accessibility of healthcare (5) . Healthcare is concerned with all the issues that are related to the location and facilities. These issues include the optimal location of healthcare centers. GIS is a technique which provide a set of tools for describing and understanding the spatial distribution of healthcare facilities, evaluating accessibility and barriers to health care delivery of health facilities and Creating a map of health infrastructure. With this background this paper attempts to study, the Spatial distribution of public healthcare centers and their services in Hunsur taluk, to find out the gap between existing public health care facilities and normative requirement of public health care facilities as set by the government of India

Study Area
Hunsur taluk it is one one of the seven taluk of Mysuru District in Karnataka. The study area geographically lies between latitude 12 • 31' North and longitude 76 • 29' east. The Taluk

Database and Methodology
The present study is based on both Primary and Secondary source data. The study was conducted hobliwise in Hunsur taluk of Mysuru district. The secondary related to public healthcare centres are collected from various offices like District Health Office and Taluk Health Office. The Spatial Data Such as, Toposheets of the study area at a scale of 1:50,000 are collect from Survey of India and to generate the spatial village maps involves the extraction of taluk and Hobli boundaries from topographical map. The base map of the study areas has been geo-referenced and digitized using ARCGIS software 10.3, to show the spatial distribution and accessibility of Public healthcare centers. The primary sources of data have been collected from field survey through the questionnaire related to infrastructure and health workforce facilities in the hospital and personal observation. The Global positioning system (GPS) was adopted to take the coordinate of all Public health centers in the study area. The collected information has been compiled and put in the form of maps and tables for further analysis. Data is analyzed though simple quantitative techniques like ratios, percentage and the spatial disparity of health centers were measured with the help of Nearest Neighbour Techniques. Various Maps have been generated to show the health care services in the study area.

Availability and Accessibility of Public HealthCare Centres
The distribution of public healthcare facilities varies not only in rural and urban areas but also within rural and urban areas. Public Healthcare centers are providing health services to the people for promoting good health for all, but it depends on accessibility of healthcare centers. Therefore, Availability of the health centers are primarily effect on utilize of healthcare facilities. The Hunsur taluk had 4 hoblis encompasses 95 public health centers, which includes One Taluk Hospital, 21 Primary Healthcare centers,73 Health sub centers and 1 mobile health units. The Hobliwise distribution of Public healthcare centres and Ratios of Population has been shown in (Table 1 and Figure 2).

Health Care Centres and Population Ratio
As per Government of India, National Rural Health Mission (NRHM), the public health institutions in rural areas are to be upgraded from its present level of a set of standards called Indian Public Health Standards (IPHS). According to NRHM policy the population norms for the provision of Sub-Centres, PHC's and Community Health Centres in plain areas are suggested 5000, 30,000, 1, 20,000 people respectively, where as in the Hilly/Tribal regions it is 3,000, 20,000, 80,000 respectively. The (Table 1) shows the Hobliwise Distribution of Public HealthCare Centers and Ratios of Health Centers to the population. In the study area, 2, 82,963 populations are served by One Taluk Hospital, 21 Primary Health Centers and 73 Health Sub Centers. The Community Health Centre is not located in Hunsur taluks, as the city has got general hospital, which can cover all the facilities of community health centre. The High concentration of PHCs are located in Hanagodu Hobli (8), serving the population ratio of 1:8397, followed by Bilikere hobli (6), serving the population ratio of 1: 11432. The lowest concentration of PHC's is located in Gavadagere Hobli (4) and Hunsur Hoblis (3) with serving population ratio is 1:10275 and 1:35365 respectively. PHC's it acts as a referral unit for 6 Sub-Centres, it reveals that, the each PHC is serving to a population ratio of 1:13474 persons. The highest and lowest numbers of Sub Centers are located in Hunsur Hobli (21) and Bilikere Hoblis (20) with serving population ratio of 1:5052 and 1: 3429 respectively. Followed by Hanagodu Hobli (17) with serving population ratio of 1:3951 and the lowest concentration of HSC's is located in Gavadeagere hobli (15) with serving population ratio is 1:2740, it reveals that, the each HSC's is serving to a population ratio of 1:3876 persons. Though it shows there is regional imbalance in the distribution of Public healthcare centres among hoblis of the Hunsur taluk.

Health Infrastructure and Workforce Ratio
As per National Rural Health Mission (NRHM) highlights the healthcare facilities available at different levels namely, Primary and Sub health centers levels in terms of health services, workforce and infrasturucture facilities. The Responsibility of healthcare centers is in two folds, providing skilled medical staff in the healthcare centers and Realization of Millnnimum Developed Goals of improving healthcare facilities to reduce the different kinds of diseases. By primary survey and observation in context of availability of workforce and health infrastructure facilities of 21 Primary Health Centers and 73 Health Sub Centers of the study area are discussed here. In this survey availability of health workforce and health infrastructure like weighing machine, Blood Pressure instrument, steam sterilizer, labour room, wards, OPD, laboratory facility and with their own building, having public utilities like (electricity, drinking water, vehicle and toilets) are included to identify the shortcoming of physical infrastructure facilities with regards to recommended norms have been discussed under the following subheads.
The below ( Table 2) shows the of availability of health workforce and health infrastructure facilties of PHCs of the study area are discussed here. In this survey availability of workforce like doctors, nurse, Asha and infrastructure facilities like beds wards, Equipments etc., are included.
The Primary Health Centres are the first contact point of medical persons with the community. It acts as a referral unit for 6 Sub-Centres and refers out cases to CHC and higher order public hospitals located at taluk and district level. But, CHCs are not available in the study area. However, as the population density in the country is not uniform, the number of PHCs would depend upon the case load (6) . The PHC essential of health workforce is one medical officer, 3 staff nurses, one paramedical and four other staffs. The above (Table 2)  It can be observe in the above (Table 2), though there is high population but the availability of Health workforce are less according to IPHS norms. The essential physical infrastructure facilities at PHCs should have 6 beds, with adult weighing machine, Blood Pressure instrument, steam sterilizer, labour room, wards, OPD, laboratory facility and with their own building, having public utilities like (electricity, drinking water, vehicle and toilets). The Table 3 (Table 3), though there is high population in the study area but the availability of Health Infrastructure facilities are less according to IPHS norms.
Health sub-centres are basic or pre-primary health and medical care service centres at the grassroots level. The staffs of the unit are managed by a male health worker and an auxiliary nurse and mid-waves in each sub-centre to provide curative health/medical services and join the national programmes. The work of these staff members consists of house to house visits for collecting vital statistics of all families and to communicate the health related programmes under the direction of medical officers of the concerned primary health centre-unit. In addition to that they give the treatment for minor ailments, health education in respect of common communicable diseases, family welfare, immunization, vaccination etc. with adequate field staff. These sub-centres are expected to show progress in each month in programmes that are envisaged by each sub-centre. Totally, Study area comprises 73 Health Sub Centre among In the present study Nearest Neighbour Technique has been used to observe how these health centers are distributed in Hunsur Taluk. The 'Nearest Neighbour method, was firstly developed by two botanists, Clark and evens 1954, they have used this techniques to measures the pattern of incidence of different species of plants in a region. Later on, geographers have widely used this technique in order to study the distributional pattern of the places and other phenomena in different geographical regions of the world. As a result, this technique has been used in research to study the Geographical distribution of health centers in the study area. The following formula is as: Where: Rn = The description of the distribution n = The number of points (Health Centers) in the study area By using this formula, Rn values for Four Hoblies of the taluks have been calculated.
The Nearest Neighbour analysis statistics for all four hoblies of Hunsur taluk were derived from the distance between nearest health centers. The Rn Value of the study area is 1.1929, it shows that these health centers are randomly distributed, these can be observed in the Map no 3. Since

Conclusion
This study investigated spatial accessibility to Public health care facilities in Hunsur Taluk of Mysuru District. The Study reveals that, the spatial distribution of public Health centers, which were not evenly distributed across the study area. The hobliwise distributions of Public healthcare centers are vary from one hobli to another. Public Healthcare centers are not increasing with the population so there we can identify the gap between them. In the study area the Public health care centers are randomly distributed (Table 4), the Rn value of the health centers in the taluk is 1.1929. To reduce the imbalance in the distribution of public health centers, the establishment of new health care centers should be based on structured criteria and geographical aspects. These health centers are the mirror of the rural mass in the study area. Availability and affordability of means of transport is important factor for utilizing the health services. So, there is a need to give more importance on the development of transport network in Hunsur taluk. Since south western part of the taluk is forest region, a large proportion of the residents have to travel a long way to access the health care facilities. So there is need to establish more mobile health units to provide service to its people in their region at doorstep. In addition to this there is scarcity in the availability of Health Workforce and Health infrastructure in the study area. The proportionate ratio between health workforce and population is in imbalance, because the rate of increase in population is greater than that of increasing rate of health workforce. Thus there is need to improve the infrastructure of existing healthcare centers and increase the number of staffs in the study area for balanced regional development. Majority of the government health centers are not having clean portable water. So, the study recommends that, to provide clean water for health seekers.
In fact, health's institutions are dissemination of education of cleanliness but the institutions itself are not having the facility of portable drinking water. The use of advance GIS tools has proved to be boon to the researchers and planner to visualize and conceptualize the health plans and policy. And also the public health administrators are at the advantage of saving time and resources by application of such tools.