Stop
blaming doctors and paramedical personnel
Improve Infrastructure Immediately
Nearly
17.5% of the world’s population resides in India. But, the country is
responsible for 20% of the global burden of diseases, 27% of all neonatal
deaths and 21% of all child deaths (younger than five years), drawing reference
from Lancet. India’s miserable healthcare infrastructure network
attributes to this. Both Central and State Governments are responsible for not
fulfilling their Constitutional obligations.
BJP’s
sweeping victory in the Assembly polls in Uttar Pradesh and Uttarakhand
cannot hide the fact that in states like Gujarat; Jharkhand and Chattishgarh,
where the party is ruling for quite some time, majority of the Primary Health
Centres (PHCs) do not have even a single doctor. The situation in Uttar Pradesh
is also very much unhealthy. Out of a total number of 3,497 PHCs in Uttar
Pradesh, 1,288 don't have a single doctor. The number of doctors for each PHC in
Chhattisgarh (0.46 doctors per PHC); Gujarat (0.71); Madhya Pradesh (0.85); Odisha
(0.77); and in West Bengal (0.79), which hit the bottom of the list. (See
Table-1)
No.
of PHCs vis-Ã -vis doctors
Table-1
State
|
No. of PHCs
(2015)
|
Doctors for
PHCs
(2015)
|
Doctor
per
PHC
|
Gujarat
|
1247
|
889
|
0.71
|
Madhya
Pradesh
|
1171
|
999
|
0.85
|
Odisha
|
1305
|
1008
|
0.77
|
West Bengal
|
909
|
723
|
0.79
|
Jharkhand
|
327
|
372
|
1.13
|
Rajasthan
|
2083
|
2412
|
1.15
|
Chhattisgarh
|
792
|
368
|
0.46
|
Kerala
|
827
|
1169
|
1.41
|
Tripura
|
91
|
158
|
1.73
|
Source: Rural Health Statistics, Ministry of
Health and Family Welfare, Government of India
To
take care of 1.3 billion Indian’s health, the country has only 938,861 registered
doctors, which accounts for seven doctors per 10,000 people. According to the Central
Bureau for Health Intelligence (CBHI) statistics, released in March 2015,
states like Bihar and Maharashtra have the worst doctor to patient ratios; with
one doctor treating 28,391 and 27,790 patients respectively. Chhattisgarh stands
third with a doctor to patient ratio of 1 : 25,032. This shortage of number
of doctors is further compounded by unfair distribution across rural health
centres. In community health centres in rural areas of many states, ranging
from Gujarat to West Bengal, the shortfall of specialists exceeds 80%. This
also holds true for other healthcare professionals. (See Table -2)
Table-2 (Source:
Lancet)
Desired Density
|
%
Shortfall
|
|
per 100,000 population
|
||
(as per 12th five year plan)
|
||
Doctors
|
85
|
49.1
|
AYUSH Practitioners
|
49
|
11.3
|
Dentists
|
15
|
106.0
|
Pharmacists
|
70
|
72.3
|
Nurses
|
170
|
177.5
|
Auxiliary Nurse Midwives
|
85
|
185.0
|
AYUSH = Ayurveda; Yoga and naturopathy;
Siddha;
Unani; Homoeopathy practitioner
According
to the Rural Health Statistics (RHS), published by the Statistics Division of
the Ministry of Helth and Family Welfare (2014-15), there are 153,655 Sub
Centres, 25,308 Primary Health Centres (PHCs), 5,396 Community Health Centres
(CHCs), 1,022 sub divisional hospitals, 763 district hospitals and 1,253 mobile
medical units across the country. Does this infrastructure network suffice the
need of 1.3 billion Indians? Using the prescribed norms on the basis of rural
population from Census-2011, there are shortfall in health infrastructure by
20% in Sub Centres; 22% in case of PHCs and 32% for CHCs (all India shortfalls
are derived by adding state-wise figures of shortfall).
As
on 31 March, 2015, out of 153,566 functioning Sub Centres, 71,433 had no male
and 8,138 had no female health workers. 5,053 Sub Centres did not have either
male or female health workers. The Sub Centres across India had 18,226
vacancies for the posts of female health workers; 20,492 for Auxiliary Nurse
Midwives (ANMs) and 37,888 for male health workers.
PHCs
had a shortfall of 12,448 female and 15,513 male health assistants. Out of
total 25,308 PHCs, 14,189 were managed by only one doctor and 2,041 PHCs had no
doctor at all. 9,649 PHCs had no laboratory technicians and 5,553 had no
pharmacists. Only 6,436 PHCs had lady doctors. Number of ANMs in PHCs was
decreased from 213,400 in 2014 to 212,185 in 2015 and major contributory states
were Tamil Nadu, Maharashtra, Jammu Kashmir, Rajasthan, Madhya Pradesh etc.
Vacancies in sanctioned posts of medical specialists also increased from 2014
to 2015. (See Chart-1)
%
of sanctioned posts of specialists remained vacant in PHCs
Chart-1
In
CHCs, out of required 21,584 specialists, only 4,078 doctors were in position
as on 31 March, 2015 leaving a shortfall of 17,525 doctors. The number of
doctors, in position, in CHCs was declined from 4,091 in 2014. Major decrease
came from Rajasthan and Punjab. The number of sanctioned posts for General Duty
Medical Officers was 13,066 out of which 11,822 were in position leaving vacancies
for 1,244 posts. The number of shortfall of doctors in CHCs can be seen across
all specialties. (See Table-3)
Shortfall
of number of doctors in CHCs
Table-3
Specialist
|
Required
(2015)
|
In position
(2015)
|
Surgeons
|
5,396
|
896
|
Obs &
Gyna
|
5,396
|
1,296
|
Physicians
|
5,396
|
918
|
Paed
|
5,396
|
968
|
Total
|
21,584
|
4,078
|
According
to the statistics provided by the Union Health Ministry as on 31 March 2015, there
was a requirement of 29,337 PHCs across India but it had 6,556 PHCs less
attributing a shortfall by 22%. Similarly, there
was a deficit of 2,316 CHCs which amounts to a massive shortfall of 32%. The
CBHI data suggests that there were 20,306 hospitals in India with 675,779 beds;
the rural and urban allocations were 183,602 and 492,177 beds respectively. One
government hospital bed serves 1.923 people on an average. The worst ratios are
in Bihar (8,789) and Jharkhand (6,052). For every 10,000 people, India has the
least numbers of physicians and hospital beds in compare to many countries. (See
Chart-2)
Physician
and Hospital Bed per 10,000 people
Chart-2
With minimal government funding and
poor health infrastructure network, there is a large unregulated private sector
in healthcare business. Despite high cost of treatment, people in general
prefer to visit private hospitals more frequently. The National Sample
Survey Office (NSSO) data shows a declining trend in the use of public
hospitals over the past two decades (See Chart-3). As on March 2015, only 32%
of urban Indians use public hospitals which were 43% in 1995-96. Ironically, a large
section of these private practitioners may not be qualified or may be
under-qualified as pointed out by Lancet. A study in rural Madhya
Pradesh found that only 11% of the sampled healthcare providers had a medical
degree, and only 53% had completed high school.
%
of population treated their ailment at different outfits
Chart-3
Another astonishing fact reveals that
public healthcare system in India benefits higher income class more than the
poorer section. The poorest income class is the least benefited from such
facilities. According to World Health Organization statistics, the proportion
of lower income classes in India with access to free healthcare is 17.33 in
compare to the proportion of higher income class which remains as 22. This
situation is undoubtedly alarming and exposes the fact that the policymakers at
different levels are not so “pro-poor”. (See Chart-4)
Country wise % population in different income
groups
having
access to free healthcare
Chart-4
This
anarchic situation in healthcare system has pushed India far behind. India has
the third highest child mortality rate among SAARC countries with 48 deaths
reported per 1,000 live births. Nearly five women die every hour in India from
complications developed during childbirth. Nearly 45,000 mothers in India die
every year due to causes related to childbirth which accounts for 17 per cent
of such deaths globally. According to World Health
Organisation, the major cause of maternal deaths in India is post-partum
haemorrhage which is often defined as the loss of more than 500-1,000 ml of
blood within the first 24 hours following child birth. Majority
of these deaths are among women in the 15-29 age groups. For every maternal
death in India, 20 more women suffer from lifelong health impairments that
result from complications during their pregnancies. Almost 90% of women in
Maharashtra and Gujarat, the most prosperous states in India, are anemic due to
inadequate nutrition. Only 23.1% of mothers, just one in five pregnant women,
receive iron and folic acid during pregnancy. More than half the women in the child
bearing age group (56.2 percent) are anemic. Only 4% of expectant mothers take
a de-worming drug during pregnancy. Many women are unable to attend
prenatal visits throughout pregnancy. 70% of patients who face an emergency
situation do not have a means of transportation readily available. They had not
planned for it earlier. 40% of deaths occur at home, mainly from severe
infection (sepsis) and bleeding. Delays occur while trying to find money or
while transporting the patient. Even if a mother gets to a hospital in time,
there is no guarantee that her life is safe because the right medical
facilities, trained professionals, medicines and other critical inputs like
blood are not available.
To conclude:
healthcare infrastructure of India needs immediate overhaul. Indian states also
cannot overpass their responsibilities. People’s lives must be saved as
priority. Only chanting slogans through media advertisement won’t help the
hapless. Our policy-makers across the states and at the Centre must realize
that.
@pradipsinterpretations
