Rural healthcare is in shambles

The revelation that about 68 per cent of posts of specialist doctors at the government’s community health centres (CHC) in rural areas are lying vacant does not create any surprise. This is according to the latest statistics put out by the Union health ministry. The inability of the CHCs to attract and retain specialists has been known for a long time. Never have these centres of rural healthcare had sufficient number of medical personnel with specialised expertise. In fact, they have experienced a severe shortage of doctors with even the basic MBBS qualification. Primary health centres (PHCs) have 25 per cent shortage of such doctors. They also don’t have enough numbers of para-medical personnel like nurses and pharmacists. Medical students who have to do one year’s mandatory rural service are unwilling to go to villages and try to evade this obligation.

Community health centres are meant to be referral centres for primary health centres. Patients needing specialised medical care are sent there from the PHCs. Four PHCs have one referral centre. Each CHC should have four specialists – in medicine, surgery, paediatrics  and gynaecology – and necessary physical and technical infrastructure to give expert, and if necessary, inpatient medical care to patients. But a study of their working conducted by the Planning Commission as early as 1999 had found that the CHCs did not have the required staff and facilities. Even then, the shortage of specialists was as high as 70 per cent. In 2005, new quality guidelines were evolved for the CHCs. These also laid down norms for  personnel and other requirements. But the condition of the CHCs has not improved. It is unrealistic to imagine that many medical specialists, except those who are driven by the missionary and altruistic spirit, would be willing to work in villages. Even ordinary hospitals in big cities and those in small towns find it difficult to get them.

The Planning Commission’s study hoped that corrective steps would be taken and the services delivery system would be improved. But not many effective steps have been taken, in spite of the launching of initiatives like the National Rural Health Mission. Attracting sufficient numbers of specialists to over 5,000 CHCs in the country is near impossible, now and in future. A more sensible alternative is to improve the road infrastructure in rural areas and to set up an efficient and speedy ambulance fleet which could shift patients needing specialised care to the nearest towns and cities. A better road network has other advantages too.