Rural Healthcare In Shambles

More than half of the global population remains without access to essential Universal Health Coverage, and a staggering 2 billion people face severe financial hardships when attempting to pay for necessary services and products out-of-pocket. The World Health Organization (WHO) and the World Bank presented this dire situation in the 2023 Universal Health Coverage (UHC) Global Monitoring Report.

According to the Rural Health Statistics report 2021-22, there is a shortfall of 79.5 per cent of specialists at Community Health Centres (CHCs) in India’s rural areas. Each centre needs four medical specialists — surgeon, physician, obstetrician/gynaecologist and paediatrician — along with paramedical staff. With one specialist being available against the requirement of five, many CHCs might be functioning without even one. Overall, 67.8 per cent of the sanctioned posts of specialists at these health centres are vacant.

Successive governments have performed dismally: the number of specialist doctors at rural CHCs increased from 3,550 in 2005 to 4,485 in 2022 — an addition of just 935 in 17 years.

The data is worrisome considering that the CHCs are mandated under the National Health Mission to provide specialised medical care of surgeons, obstetricians, gynaecologists, physicians and paediatricians to village population. The current position of specialists at the CHCs reveals that as on March 31, 2022, of the sanctioned posts, 71.9 per cent surgeons, 63 per cent obstetricians and gynaecologists, 67.5 per cent physicians and 69.7 per cent pediatricians are vacant. Overall 67.8 pc of the sanctioned posts of specialists at the CHCs are vacant. Importantly, there has been no change in the specialist shortfall between 2021 and 2022 with the shortage percentage being almost the same – 79.9 pc in 2021 and 79.5 pc in 2022.The requirement of specialists in CHCs has increased by 63.8 pc between 2005, when the NMH was launched, till now, whereas there has been an increase of only 26.3 pc in the actual number of in-position specialists.

As of today, India has 1,57,935 sub-centres in villages, 24,935 primary health centres and 5,480 CHCs. One PHC caters to 30,000 people in plains and 20,000 in difficult areas while one sub-centre caters to 5,000 and 3,000 people, respectively.

It is a fact that for   the present and past government, primary or secondary care at rural CHCs is not the priority. Also, there is hardly any push from agencies like WHO or UNICEF. But if there is a dedicated manager at the health ministry and the government is serious, then there are models to improve the CHCs.

The  government has failed to pump enough resources into CHCs and did not look for innovative approaches to lure and retain specialists in villages.

Medicos who pay huge capitation fees in private medical colleges, do not join government service after passing out. As they are  unable to pay their loans if they work for the government. They  look for other green pastures  to recover the money .

The health manpower shortage continues at the level of village sub-centres, with shortfall in the posts of female health workers and ANMs (auxiliary nurse midwife) being 3.5 pc and that of male health workers being as high as 66.6 pc.

The overall shortfall of manpower at the national level is mainly due to the low staff situation in Uttar Pradesh, Bihar, Himachal Pradesh, Gujarat, Madhya Pradesh, Chattisgarh, Uttarakhand, Odisha, and Tripura.

It should be noted that the shortage or absence of specialists, forces villagers to rush to nearby towns or cities, thus overburdening the urban healthcare system.

The reluctance of graduates of government medical colleges to serve in rural areas is too well known. Even as the Health Ministry is finalising guidelines to do away with the contentious bond policy for doctors, based on the National Medical Commission’s recommendationsan action plan has to be prepared to fill vacancies of specialists at rural CHCs on priority, backed by the offer of incentives in the form of stipends or education loan waiver, as is being done in the US and Canada.

Such efforts should go hand in hand with the upgradation of infrastructure at CHCs. Doctors can’t perform their job efficiently if they have to grapple with a paucity of beds, machines and medicines on a daily basis. Ensuring an uninterrupted flow of funds and regular monitoring of healthcare standards can also make a vital difference on the ground.

(Dr. Naresh Purohit is Executive  Member- Federation of Hospital Adminstrator

– Advisor , Indian Medical Academy for Preventive Health. The views and opinion expressed in this article are those of the author)


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