India’s rural healthcare system

General Studies Paper 2

Context

• Recently, the Rural Health Statistics 2021-2022was released by the Union health ministry.

Document highlights

• According to the document, India’s rural healthcare system continues to be plagued by a shortfall on two critical fronts: Doctors and infrastructure.
  • Doctors: There is a shortage of

• • 83.2 percent of surgeons,
  • 74.2 percent of obstetricians and gynaecologists,
  • 79.1 percent of physicians and
  • 81.6 percent of paediatricians.

• Infrastructure:

• • Less than half the Primary Health Centres (PHC), 45.1 percent, function on a 24×7 basis.
  • Of the 5,480 functioning Community Health Centres (CHC), only 541 have all four specialists.

Sub-centres (SCs), Primary Health Centres (PHC) & Community Health Centres (CHC):

• In the Indian healthcare system, sub-centres (SC) are the first point of contact for a patient, catering to a population of 3,000-5,000.
• This is succeeded by a PHC, which is required to look after the daily needs of 20,000-30,000 people.

CHCs provide referrals and access to specialists, catering to 80,000-120,000 people.

• Situation of SCs, PHC & CHC:
  • According to the document, these facilities are overburdened across the board.
    • SCs are currently looking after more than 5,000 people,
    • PHCs catering to 36,049 people and
    • CHCs to 164,027 people.
  • This, coupled with a human resource shortage, plagues access to adequate and quality healthcare.
• Understaffing of SCs, PHCs and CHCs:
  • SCs, PHCs and CHCs had more staff in 2021,at the height of the deadly second wave of COVID-19, as compared to now.
    • The number of auxiliary nurse midwives at SCs has decreased to 207,587 in 2021 from 214,820 in 2022.
    • Lab technicians, nursing staff and radiographers at PHCs and CHCs have all recorded a marginal increase between 2021 and 2022.
  • State-wise data:
    • The shortage was most pronounced in Uttar Pradesh, Gujarat, Himachal Pradesh, Odisha and Uttarakhand.
  • Doctors of SCs, PHCs and CHCs:
    • The number of doctors at PHCs has shrunk to 30,640 in 2022 from 31,716 in 2021.
    • State-wise data:
      • Uttar Pradesh, Rajasthan, Madhya Pradesh, Gujarat and Odisha face the highest shortage in surgeons, obstetricians / gynaecologists, paediatricians and radiographers at CHCs across the country.
    • Improvements:
      • A huge improvement has been recorded as compared to 2005, when the government launched the National Rural Health Mission.
        • The allopathic doctors at PHCs have increased from 20,308 in 2005 to 30,640 in 2022, which is about 50.9% increase.
        • The specialist doctors at Community Health Centers (CHCs) have increased from 3,550 in 2005 to 4,485 in 2022, according to the report.

Issues & Challenges

• Lack of awareness:
  • Lack of awareness appears to cut across the lifespan in our country.
    • Adequate knowledge regarding breastfeeding practice was found in only one-third of the antenatal mothers in two studies.
    • A study in urban Haryana found that only 11.3% of the adolescent girls studied knew correctly about key reproductive health issues.
    • A review article on geriatric morbidity found that 20.3% of participants were aware of common causes of prevalent illness and their prevention.
  • Poor public health spending:
    • India is one of the countries with the lowest public health spending. 
    • Indian government was estimated to spend over two percent of the country’s GDP on healthcare in financial year 2022
  • Affordability or the cost of healthcare: 
    • 60%+ of the Indian population has to spend Out-Of-Pocket (OOP) to access healthcare services.
    • In India, 65%+ of the population is uninsured, including government and private schemes.
  • Rural Urban disparities:
    • While the rural population in India is higher, as compared to its urban population, rural health status is generally poorer than in most of the urban areas.
      • The healthcare infrastructure in urban areas is comparatively sophisticated and better equipped.

Government initiatives 

• The National Health Mission (NHM): Itwas launched by the government of India in 2005 subsuming the National Rural Health Mission and National Urban Health Mission.
  • Main program components include: 
    • Health System Strengthening (RMNCH+A)in rural and urban areas
    • Reproductive-Maternal- Neonatal-Child and Adolescent Health, and
    • Communicable and Non-Communicable Diseases.
  • Objectives:
    • Improve health status through concerted policy action in all sectors and expand preventive, promotive, curative, palliative and rehabilitative services provided through the public health sector with focus on quality.
  • National Digital Health Mission (NDHM): 
    • Under this, every Indian will get aHealth ID card and this card will contain all the health records of the person.
    • It aims to develop the backbone necessary to support the integrated digital health infrastructure of the country.
  • Ayushman Bharat Digital Mission:
    • The Ministry of Health and Family Welfare formulated the Ayushman Bharat Digital Mission with the aim to provide the necessary support for the integration of digital health infrastructure in the country.
      • It aims to develop the backbone necessary to support the integrated digital health infrastructure of the country.
    • Pradhan Mantri Jan Arogya Yojna (PM-JAY):
      • The scheme was launched and recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
      • PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened.
      • It subsumed the then-existingRashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008.

Suggestions & Way ahead

• There is an urgency to focus on all the three levels of primary, secondary and tertiary healthcare, it is imperative that the government look towards improving primary health care as a public good.
• The government should create a framework for the right staffing, duration and think about the incentives and career paths of doctors and all levels of staff to work in a rural health centre.
• India needs to move beyond the doctor-led system and paramedicalise several functions.
• There is a need for an increase in expenditure on health so that India can improve existing facilities as well as add more of them.