A woman leans against a stretcher in a corridor Jawahar Lal Nehru Medical College and Hospital, Bhagalpur, Bihar, July 2020. Photo: Reuters/Danish Siddiqui
The year 2021 is coming to an end, and the whole world, including India, has witnessed the impact of the COVID-19 outbreak and is still struggling to cope with the challenges of COVID-19. The last two years have shown the major healthcare crises and could have been taken as an indicator that India’s healthcare system and policy need to be transformed.
There is no doubt that India has made some remarkable progress in health indicators. However, India’s health sector still faces critical challenges such as low government expenditure, inadequate infrastructure, unavailability of healthcare providers or vacant positions, supply-side problems of medicines, equipment, and quality of healthcare services. The pandemic has highlighted existing gaps in healthcare services, especially the accessibility of healthcare services among rural poor.
The recently released Rural Health Statistics (RHS) 2019-2020 paints a bleak picture of India’s rural healthcare sector. These statistics point towards a major healthcare crisis in India, such as lack of infrastructure, huge vacancies and shortages of doctors, specialists, and other staff.
IPHS norms
RHS (2019-20) reveals a consistent rise in the number of sub-centres (SCs), primary health centres (PHCs) and community health centres (CHCs) at the national level. However, the current numbers of these health centres are not sufficient as per the average rural population requirement prescribed by Indian Public Health Standards (IPHS) norms. Figure 1 shows a consistent increase in all SCs, PHCs, and CHCs from 2005 to 2020. However, figure 2 shows a significant shortfall of health centres based on the mid-year rural population against IPHS norms, and the shortfall of SCs, PHCs, and CHCs is 24%, 29.46%, and 38.39%, respectively.
Infrastructure at SCs, PHCs and CHCs
Figure 3 reveals that only 61% of SCs have an ANM quarter, but the RHS 2019-20 report doesn’t talk about how many ANM are living in those quarters. This might seem just a simple data, but it has great significance because the probability that a patient will receive healthcare facility (even at midnight) increases if ANMs are living in SCs quarters. Further, as of 2020, almost 28% and 14.7% of SCs in rural India are without regular water and electric supplies.
Similarly, figure 4 shows current infrastructural facilities at PHCs in rural India, where almost 84% of PHCs have referral transport services, 72% have labour rooms, around 70% have at least 4 beds, and only 35% have OTs. Additionally, only 34% of the PHCs function 24×7, and 6.90% and 4.30% of PHCs are without regular water and electricity supply.
Figure 5 shows the current infrastructural facilities at CHCs, where it is clear CHCs have most of the basic infrastructural facilities. More than 94% of the CHCs have functioning labs, 94% have regular drug supply, 93% have referral transport facilities, 87% of CHCs have functioning OTs, 78% have functional labour rooms, and almost 77% of CHCs have at least 30 beds. Other points that need to be noted are that only 3.45% of SCs, 15.56% of PHCs, and 8.47% of CHCs, are working according to IPHS norms.
Buildings without doctors and staff
Regretfully, the focus of all successive governments and policymakers was restricted to upgrading the building of these health centres and failed to ensure the availability of human resources in respective healthcare centres. They completely forgot to ensure whether these buildings have sufficient numbers of ANMs, doctors, specialists, and other staff or not.
There are considerable vacant positions and a shortfall of ANMs or female health workers in SCs and PHCs where the vacancies have increased significantly from 4.75% to around 14% from 2005 to 2020. However, the shortfall has declined for the same period but still remains more than 2%.
More than 37% of the health assistant positions are vacant in PHCs, and the shortfall is also very huge i.e., 71.88%. Similarly, there is 19% and 25% vacancy and shortfall of pharmacists at PHCs, whereas the position of laboratory staff and nurses are also vacant by 34% and 21%, respectively. On the other hand, there is a shortage of laboratory technicians and nurses by around 48% and 23%, respectively, in PHCs of rural India.
Figure 7 shows the current status of human resources at CHCs in rural India for the year 2020. The CHCs have four specialists: surgeon, physician, gynaecologist, and paediatrician. And according to the RHS (2019-20), India is facing a significant shortage of these specialists. Around 68% and 66% of the posts of surgeons and physicians are vacant. There is also a significant shortfall of Surgeons (78%), obstetricians and gynaecologists (69%), physicians (78%), and paediatricians (78%). More than 17% of nursing staff’s posts are vacant, and there is also a 9% shortfall.
Missing doctors
All the health centres are ill-equipped in terms of infrastructure facilities; however, CHCs somewhat have better infrastructural facilities than SCs and PHCs, but the tragedy is that there is a lack of specialists and staff to provide healthcare services. As per the RHS, less than 6% of the CHCs in rural India work with all four specialists.
Infrastructure status reveals that around 67% of CHCs have a newborn care corner, but unfortunately, 63% of posts of paediatricians are vacant. More than 86% of the CHCs have functioning operation theatres, but more than 68% of surgeons’ positions are vacant. Unavailability/inadequacy of staff and infrastructure at SCs and PHCs forces people to reach out to the CHCs to seek specialist consultations and treatment. At the same time, CHCs are themselves struggling with a shortfall of specialists and other staff that further exaggerate the problem.
Hence, India’s rural population is stuck and struggling between the inadequacy of SCs and PHCs and the unavailability of specialist doctors and staff at the CHCs level. The benefit of having infrastructural facilities is defeated because of this shortage of doctors and other staff at healthcare centres. It is a clear case of poor design of healthcare policies because these positions of doctors and specialists remain unfilled against the sanctioned posts.
Shabnam is a PhD research scholar at IIT Delhi. Mohammed Faheem Khan is an independent researcher and holds a master’s degree from the department of geography, Delhi School of Economics, University of Delhi. The views expressed here are personal.