Community Health Centres are the backbone of the rural health care system of India. The shortfall of doctors in these centres is a serious issue
According to the recent Rural Health Statistics Report, released by The Ministry of Health and Family Welfare, there is a shortage of 83.2% of surgeons, 74.2% of obstetricians and gynaecologists, 79.1% of physicians and 81.6% of paediatricians. Less than half the PHC (45%) function on a 24×7 basis. Of the 5,480 functioning CHCs, only 541 have all four specialists. The requirement of physicians in the CHCS is 5,183. However, there is a shortfall of 4,087. This has grown from a 3,881 shortfall in 2019. The shortfall has increased by 27.7% in one year. Under the category of Surgeons, the five states with a maximum shortfall of physicians in CHC are Rajasthan, Uttar Pradesh, Gujarat, Odisha and Madhya Pradesh. Under the category of Gynaecologists, the five states with a maximum shortfall of physicians in CHC are Rajasthan, Uttar Pradesh, Gujarat, Madhya Pradesh and Tamil Nadu.
The number of doctors required in Primary Health Centres in rural areas is 24,918, And Chhattisgarh positions are vacant. The shortfall of doctors in PHCS was the highest in Odisha, Rajasthan, Chhattisgarh, Uttar Pradesh and Karnataka. The shortfall in the posts of health workers was 2%. SC, PHC and CHC facilities are overburdened across the board. Community Health Centres are considered the backbone of the rural health care system of India. These Centres should have at least thirty beds. They should cover at least four primary health centres with specialized services. Every Community Health Centre should be manned by four medical specialists: a physician, a surgeon, a gynaecologist and a paediatrician.
The RHS estimates as of 31 March 2022, have revealed that each Community Health Center (CHC) caters to 164027 people, against a norm of 80,000-1,20,000. The Primary Health Centre should consist of four to six beds and 14 subordinate paramedical staff. The RHS estimates as of 31 March 2022, have revealed that each Primary Health Centre (PHC) caters to 36049 people, against a norm of 20,000-30,000. Sub Centres are the most peripheral contact point between the primary health care system and the community. It should consist of one HW (Female) or ANM and one HW (male). HW is Health Worker and ANM is Auxiliary Nurse Midwife. The RHS estimates as of 31 March 2022, have revealed that each sub-centre (SC) catered to an average of 5691 people, against a norm of 3,000-5,000. This, coupled with a human resource shortage (like auxiliary nurse midwives – ANM), plagues access to adequate and quality healthcare.
The shortage was most pronounced in Uttar Pradesh, Gujarat, Himachal Pradesh, Odisha and Uttarakhand. SCs, PHCs and CHCs had more staff in 2021, at the height of the deadly second wave of COVID-19, as compared to now. CHCs are 30-bed block-level health facilities that are supposed to provide basic care related to surgery, gynaecology, paediatrics, and general medicine.
There are 6,064 CHCs across India, and the Health Ministry has been unsuccessful in meeting the requirement for specialist doctors in most of these centres. Apart from specialist doctors, there is also a shortage of female health workers and auxiliary nursing midwives, with up to 14.4% of these posts lying vacant in PHCs and SCs. There has been an over 50% rise in the number of allopathy doctors in primary health centres since the launch of the National Rural Health Mission in 2005. The number of allopathic doctors at PHCs has increased from 20,308 in 2005 to 30,640 in 2022.
NRHM’s focus on expanding institutional deliveries did lead to a significant increase in the share of deliveries in health facilities. The Quality of delivery services in the public sector remains a concern, including difficulties in handling birth complications, shortfalls in emergency obstetric care facilities, shortages of key essential medicines, diagnostics, etc.
(Prof. Sunil Goyal is the Dean and Chairman of – the Board of Studies, Dr BR. Ambedkar University of Social Sciences, Dr Ambedkar Nagar and Dimple Khokhar is a PhD Research Scholar)
