Health does not simply mean freedom from diseases. A healthy life is everyone person's right.
For any health system to function well, it is not only important to have resources but also to maintain a comprehensive database for it. Rural Health Statistics data provides an overview of functional health facilities and available health resources (personnel) and their quality in the country. The data is useful in multiples ways to plan out policies, for academicians, researchers and other stakeholders in building a more refine health system. The report is released on a yearly basis by the Ministry of Health and Family Welfare (MoHFW). This report covers more than two lakh public health facilities in the country. The data provided in the report is till March 2021. (Rural Health Statistics, 2020-2021)
As many of you are aware about the classification of India's public health facilities namely Sub Centres, Primary Health Centres, Community Health Centres, Sub District Hospitals and District Hospitals. Report says, since 2005 (introduction of National Rural health Mission) there has been a 6.9% increase in number of Sub Centres, about 8.2% in number of PHCs and about 63.8% in number of CHCs in 2021 as compared to 2005.
Sub Centres (SCs):
Subcentres are the first point of contact between the primary health care and the people living in a community. Subcentres address not only the health needs but also tries to answer and nudge people to take their health more seriously through various awareness programs, behavioral interventions programs, checkup camps, addressing nutrition challenges, immunization, family planning and sterilizations programs. States which have shown the maximum increase in SCs are Rajasthan (3019), Gujarat (1888), Madhya Pradesh (1315) and Chhattisgarh (1297). Auxiliary Nurse and Midwife/Healthcare worker (both male and female) are the key point personnels in a SC.
Primary Health Centres (PHCs)
Primary Health Centres are the first point of contact between village community and a medical officer. They are maintained and established by State Governments under the minimum needs programme (MNP)/Basic Minimum Services (BMS) programme. PHCs offer preventive, promotive and curative healthcare services to community. Medical officer in a PHC is supported by paramedical and other staff. The increase in PHCs was observed in the states of Jammu and Kashmir, Karnataka, Rajasthan, Gujarat and Assam.
Community Health Centres (CHCs)
CHCs are established and maintained under MNP and BMS programme. Every CHC is supposed to run by four medical specialists (Surgeon, Physician, Obstetrician/Gynecologist) and Pediatrician supported by Paramedical and other staff. The increase in number of PHCs was observed in the states of Uttarpradesh, Tamil Nadu, Rajasthan, West Bengal and Bihar.
As of March 31, 2021 number of health facilities and their distribution is as follows:
Average Rural Population Covered under various public health facilities
It is very important to note that for rural population (as on July 1, 2021) covered by a SC should not be more than 5000 and for tribal population it should not be more than 3000. However, in 2021 these figures were 5734 and 3839. Below Map (1) shows the average rural population (mid-year population as on 1st July 2021) covered per Sub Centre as on 31st March 2021:
Map (2) shows the average Rural Population (mid-year Population as on 1st July 2021) Covered per PHC as on 31st March, 2021
Map (3) the average Rural Population (mid-year Population as on 1st July 2021) Covered per CHC as on 31st March, 2021
Shortfall of manpower
Availability of manpower is a prerequisite for efficient functioning of rural health services. Doctors and Para medical staff available at sub district hospitals and district hospitals in the year 2021 were (15272; 42,073) and (26,929;90,435). In 2020, the figures were (13,399;29,937) and (22,827; 80,920).
As of 31st March 2021, the overall shortfall in the posts of Healthcare worker (Female)/Auxiliary Nurse and Midwife is 2.9% of the total requirement, mainly due to shortfall in States namely, Gujarat (1073), Himachal Pradesh (992), Rajasthan (657), Tripura (389) and Kerala (277). For Health care worker Males the shortfall has increased from 65.5% in 2020 to 66.1% in 2021. The shortfall of doctors in PHC has decreased from 6.8% in 2020 to 4.3% in 2021.
In CHCs, shortfall of specialists in 2021 was surgeons (83.2%), Obstetrician and Gynecologists (74.2%), Physicians (82.2%), Pediatricians (80.6%).
As the data compares 2005 and 2021 scenarios, in 2005 1.49% of the PHCs and SCs were operating without doctors. However, the proportion has reached to 21.83% by 2021. On the other hand, less than half of the community health centres had no medical specialists in 2005, the vacancy rate was 67.96% in 2021. (Hindu Business Line, 2022)
The question now to be asked as to why so many public health facilities in India lacks manpower? Reasons lies from lack of incentives, lack of resources, pressure to pursue their PG courses, delay in payments, lack of facilities in hospitals, etc.
Health care infrastructure and resources are the backbone of a strong health care system. Absence and presence of these resources can play a huge role in smooth functioning of a health facility. In a study published by CEEW in 2017 shows that one in every two PHCs in India, and one in every three in Chhattisgarh, is either un-electrified or suffers from irregular power supply (Council on energy, environment, and water, 2007). This is one such scenario which could impact health care services in a great way. As India ranks, 184 out of 191 countries (WHO) in health spending, there is a long way to go in making our country known for its best, effective, equitable, and affordable healthcare system.
- rhs20-21_2.pdf (mohfw.gov.in)
- Rural India is struggling with shortage of doctors, paramedical staff - The Hindu BusinessLine
- Wake-up call for India’s healthcare infrastructure | Mint (livemint.com)
- sub-centers.pdf (nhm.gov.in)
- Is quality and availability of facilities at Primary Health Centers (PHCs) associated with healthcare-seeking from PHCs in rural India: An exploratory cross-sectional analysis - ScienceDirect
- Electricity Access for PHCs in Chhattisgarh.indd (ceew.in)