Introduction-The term "basic health services" is defined by UNICEF and WHO (1965) as a network of co-ordinated, peripheral and intermediate health units capable of performing effectively, a selected group of functions essential to the health of an area and assuring the availability of competent professional personnel to perform these functions. WHO has also proclaimed health as a fundamental right of every individual and society.
India is a developing country with a large and diverse geographical terrain, and a huge population with a great deal of ethnic and cultural variation. It has all kinds of health care providers ranging from well qualified doctors of allopathy, homeopathy, ayurveda, registered medical practitioners to untrained providers of medical aid, herbalists, and magico-religious practitioners. The importance of the involvement of practitioners belonging to different systems of medicine in the health care system has been noted by various committees and in various health related policy documents from time to time. The National Health Policy (2002) advocated expanding the pool of medical practitioners to include a cadre of licentiates of medical practice, practitioners of Indian System of Medicine and Homeopathy. It further recommended that different categories of medical manpower should be permitted medical practice after adequate training. The National Population Policy (2000) recommended the involvement of manpower from different health agencies to expand the body of effective health care providers. Shrivastva Committee (1975) recommended primary health care within the community through trained workers to keep the health in the hands of the people.
The governments of developing countries are unable to deliver free health services as the basic right of the citizen in a holistic manner.Accessibility of health agency is an important aspect of its availability; hence a vital factor affecting treatment seeking behaviour of consumers. To make provision for basic health care to all the people is a difficult task for administrators in a country like India. Thus, eliminating geographical barriers, and to help develop new strategies and services to appeal to consumers' various needs and desires is a big challenge.In spite of a host of national health policies; the health care indices significantly lag behind those of the developed countries. The quantitative and qualitative demographic transition in the population and disease profile along with inadequate health care delivery infrastructure is a fundamental concern for the country. In India, government from time to time declared deadlines for achievement of goals in health and various related areas. At present, in addition to other time bound goals of current eleventh five year plan, some of the important goals to be achieved by 2000-2015 are to increase utilization of public health facilities, and to establish a system of surveillance, national health accounts and health statistics.
Moreover, the increased need for health care has not been matched with a commensurate increase in resource, and the imbalance is growing. In developed countries telenursing applications are available in homes, home care agencies, hospital based telemedicine centres, hospices and rehabilitation centres whereas in Indian scenario, its need for implementation is being considered vis-a-vis telemedicine. The evidence based approach can mobilize application of the knowledge generated through research to meet the consumers' health needs to bridge the gap between what is known and what to be done. Telenursing approach can serve as a new and valuable asset to utilize telecommunications to support the practice of nursing and provision of professional nursing care to the patients, health care professionals, as well as administrators on remote residential or clinical settings. The present paper presents an evidence based challenges for telenursing approach with an attempt to assess and study the trends of utilization of public and private (formal and informal) health agencies available in different communities of the Union Territory, Chandigarh, India.
Further, implementation of a holistic national health programme would require an assessment of the available health systems. In addition there is a nation wide need to find various aspects of the utilization of health services in different populations and geographical areas which may be helpful for finding out some of the reasons why the goal of "health for all" was not achieved and the utilization of public health care services was very low. It will further aid to fulfill the time bound national health goals. Thus, the considerable promise of e-health in addressing issues of quality, efficiency, cost, and access to care should be placed at the forefront of our national effort to reform healthcare.
Need of the study-With an attempt to discover the relationship between the consumer and the health agencies; the present paper intended to investigate and address major bottlenecks that may impede effective implementation of telenursing approach. Further, the need was felt for positive return on investment by targeting the consumers' real needs and to hunt aspects which may be helpful for finding out some of the reasons for slow or non achievement of health goals and low utilization of public health care services.
Methodology-The study was conducted through a cross sectional survey of geographical areas of the urban, the rural, the slum and the rehabilitated sector in the Union Territory of Chandigarh, India. Data about utilization of health care services, and factors affecting treatment seeking behaviour of the consumers was explored through formal and informal interviews of 600 consumers. Observational visits were made to health agencies and study areas.
Results-The study found that majority i.e. 490(81.7%) out of 600 subjects most often used the indigenous health agency at one time or the other.Amongst reasons for utilization of indigenous health agencies and majority consumers perceived cause of diseases to be supernatural powers,bad karma/bad nazar (bad fortune), kala jadu performed by evil people to affect their families, no cure was available in the Allopathic system of medicine, illnesses can be cured through pujas, jharas or animal sacrifices,tying of sacred thread given by sadhus/babas cures illnesses, and the treatment of ailments through yoga and pranayama.
Indigenous health agencies were nearest to majority i.e. 59.9% subjects which included maximum number 87.3% of the slum subjects. As the indigenous agency was the second amongst most often used health care agency; the accessibility and availability of the indigenous agencies, along with other factors, are likely explanations for their high utilization.
On the other hand, it can be seen that in spite of the indigenous health agency being the nearest health agency in the urban and the rural sector (40% and 63.3% subjects respectively) it was not the most often utilized (utilization was by 11.3% of the urban and 20% of the rural subjects). The use of indigenous agencies was significantly higher in less educated people.
It was found that who utilized indigenous health agency most (53.1% respondents) were from lowest monthly income group (Rs.1000-5000). These included 93.3% of the slum, and 100% of the rehabilitated subjects. Chi square value of 110.617 and p value <0.001 indicated a highly significant difference in the use of health agencies in different income groups. Thus, the use of indigenous agencies was significantly higher in lower income group.Majority of people from low income group availed health services from informal health agencies, which also happened to be the cheapest agencies. Thus, from above it was found that services of indigenous health agencies were actively utilized them in the slum and the rehabilitated sector.
Recommendations-Education and documentation will bring better quality of health care services through formal recognition of standardized private indigenous health agencies and health workers as opposed to the reliance on quacks/faith healers. Thus, with greater responsibility in telecare, telenursing has to struggle a long way to replace old challenges with new possibilities in weaning consumers away from untrained private indigenous health providers and faith healers hence safeguarding the interest of the consumers. This will not only save people from being misled by superstitions and unscientific practices, but would also conform to the objective of the national health goals in developing countries like India.
There is a need for collaboration and integration of services of the government health care agencies with private formal and private indigenous (informal) health care providers to achieve national health goals.The right mix of health care professionals can attend to people's most frequent needs up to their satisfaction levels.
Therefore, the investment plans should be intended to meet towards today's evidence based needs and challenges with steady progress toward a longer term vision.
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