Illness is mostly a subjective awareness of an individual, the relief of which may be sought within or outside medical or health facilities. Perception of illness vary from people to people depending upon cultural, ethnic and socio-economic differences. Perception of symptoms by persons suffering from tuberculosis is very high yet only half of them approach modern medical facility for alleviation of their suffering. A survey was carried out in rural area of Hoskote taluk, Bangalore district to determine perceived morbidity and accessible medical relief in 1433 households belonging to 18 villages; of them, 1393 (97%) were successfully interviewed. Selected households belonged to three types of villages i.e., those being within 3 kms of a i)PHC, ii)taluk headquarters hospital and non- Governmental health centre.

Of the 9286 individual belonging to 1393 households satisfactorily interviewed regarding health, 1201 (12.9%) were found to be ill at some point of time during the reference period of one month. No differences were observed in the perception of morbidity or in the health seeking behaviour in the three groups of villages. Persons with symptoms/disease accounted for 88.8% of the total sickness, 3.4% for injuries and 9.3% for disabilities, while action taking was 61.6%, 90% and 13.5% respectively. Age sex distribution showed no difference in illness occurrence. Sputum was collected from 147 chest symptomatics and seven were found to be sputum positive. Government health facilities were utilized by 37.6% of the sick persons, private doctors by 36.4%, nature medicine by 10.6% and home remedies by only 9.9%. In conclusion, the services at the government health facilities were acceptable and were utilized if accessible. Prompt and adequate relief for injuries and acute indispositions ensures confidence of the people and better utilization.

National tuberculosis programme reaches people through PHCs and sub centres. A study was conducted to find out the perception of illness and utilisation of health facilities by the community. This study was conducted in a random sample of 48 villages selected according to Probability Proportioned to Size within 5 Kms of the selected PHIs in Kolar District using a Multi stage sampling technique. Information on socio economic status, availability of health services and their utilisation was collected. 13,323 individuals were interviewed. 706 were ill in a period of two months prior to survey. 71.3% had taken allopathic system of treatment. 69.1% had approached government hospital or PHC. 34 patients reported to have TB. All had attended either DTC or PHC.

The study indicated that morbidity was perceived much early and also followed by an action. Data indicates a high percentage of preferring allopathic system in general and from peripheral health centres and other Government hospitals in particular. Data indicates that in spite of overall backwardness of the study area and very limited economic resources people have utilised the PHC to the maximum. The reason could be either high acceptance of PHC or inevitability. But, there is an evidence of higher utilisation of family welfare and MCH services. The data shows all tuberculosis patients have had exposure to standard regimens, all of them have approached either PHC or DTC for treatment. This confirms the felt need oriented concept of National Tuberculosis Programme. Also high level morbidity among children below 4 years of age and action taken indicate an enhanced level of demand for health services.

This paper highlights some of the Technical, Economical and Operational problems encountered in 1955 60 when the National Tuberculosis Programme was being evolved wherein considerable importance was laid on diagnosis of patients using mass miniature radiography. Technological imperfections seen were: 1) High breakdown rates of X-ray units 2) Though power supply was available, the quality of powerline was such that X-ray could not work satisfactorily in 75% of them. Moreover, running cost of X-ray unit when using petrol generator was very high. This can be reduced by connecting the unit to power supply. Reduced sensitivity and specificity of the X-ray is another operational deficiency. The number of suspects diagnosed was 7 times the actual number of cases and probably 60% of cases were being missed also.

In order to solve these problems, the suggestions given were 1) X-ray equipment capable of working from low capacity powerlines without loss in standard of performance is desirable. 2) Flouroscopic image intensifiers using solid state panels which are easy to operate and maintain can probably improve the reliability of flouroscopic examinations without increasing the radiation dose. 3) Electronic contrast enhancement of films are possible and this could improve the diagnostic reliability. Research is needed to improve contrast perceptibility without increase in radiation.