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Rural India Faces 60% Shortage of Doctors

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Highlights
* Himachal Pradesh has the best infrastructure in rural healthcare
* Madhya Pradesh has the highest number of health centres without doctors
* Rural India is living with an acute shortage of over 60% specialist doctors

 

The Ministry of Health and Family Welfare came out with an official release recently about its ambitious target of achieving universal health coverage during the 12th Plan (2012-2017) period.

 

IndiaSpend’s Sourjya Bhowmick looks at the rural health statistics in India (as on 2011), and the situation is worrying in rural health infrastructure as well.  While Himachal Pradesh, with the highest rural population density, has the best health infrastructure, Madhya Pradesh has the highest number of health centres without doctors.  And rural India has a shortage of over 12,300 specialist doctors (around 64%), vacancy for 3,880 doctors and a shortfall of 9,814 health centres.

 

Incidentally, the National Rural Health Mission (NRHM) has spent around Rs 101,166 crore since its inception but key issues like rural healthcare infrastructure and access to medical advice leave much to be desired. Let us now look at these indicators in states that have high rural population, according to Census 2011.

 

Table 1: Rural States

 

States Rural population as per Census 2001 Rural population as per Census 2011
Himachal Pradesh 90 90
Bihar 89.5 89
Assam 87 86
Orissa 85 83
Uttar Pradesh 79 78
Chhattisgarh 80 77
Jharkhand 78 76
Rajasthan 77 75
Madhya Pradesh 73 72
Uttarakhand 74 69
All India 72 69

 

(Figs in %; Source: Rural Health Statistics, 2011)

 

We can see that the rural population has not declined sharply in the last decade in these states.

 

The report also takes into account only community health centres and primary health centres as they serve more rural population than the sub-centres. Let’s see the definition of CHCs and PHCs:

 

 

So, what is the average rural population served by a community health centre and a primary health centre?

 

Table 2: Serving The Rural Population

 

States* Average rural population covered by primary health centres Average rural population covered by community health centres
Himachal Pradesh 26,456 81,155
Bihar 49,423 1315358
Assam 28,551 247,968
Orissa 28,462 92,709
Uttar Pradesh 42,013 310,186
Chhattisgarh 26,456 132,457
Jharkhand 75,870 133,175
Rajasthan 33,975 137,705
Madhya Pradesh 45,448 157,771
Uttarakhand 29,396 127,738
All India 34,876 173,235

(*Table organised based on states with highest rural population)

 

From Table 2, we can see that primary health centres in states like Jharkhand, Bihar and Madhya Pradesh cover more people than it is designed for.  Even in the case of community health centres, the all-India figure is much higher than the objective that CHCs should cover 120,000 people.

 

Let us now look at the healthcare infrastructure of various states:

 

Table 3: How equipped Are Health Centres?

 

States* Community Health Centres Primary Health Centres
  Required In Position Shortfall Required In Position Shortfall
Himachal Pradesh 52 76 NA 210 453 NA
Bihar 770 70 700 3,083 1,863 1,220
Assam 238 108 130 953 938 15
Orissa 327 377 NA 1,308 1,228 80
Uttar Pradesh 1,293 515 778 5,172 3,692 1,480
Chhattisgarh 194 148 46 776 741 35
Jharkhand 241 188 53 964 330 634
Rajasthan 462 376 86 1,851 1,517 334
Madhya Pradesh 494 333 161 1,977 1,156 821
Uttarakhand 59 55 4 238 239 NA
All India 7,294 4,809 2,766 29,213 23,887 7,048

 

We can see that the all-India shortfall of community health centres and primary health centres works out to 9,814. Uttar Pradesh and Bihar lead when it comes to shortfalls in CHCs and PHCs.  It may also be said that more the rural population, the more it accounts for the shortfalls. Though the shortfall situation is acute, the reasons are not known from published government documents.

 

Where Are The Doctors?

 

Doctors (allopathic) and specialists form an integral component of the healthcare system but a lot remains to be fulfilled.

 

Table 4:  Shortage of Doctors

 

States Total PHCs functioning PHCs without doctors % of PHCs without doctors
Himachal Pradesh 453 30 7
Bihar 1,863 18 1
Assam 938 0 0
Orissa 1,228 182 15
Uttar Pradesh 3,692 0 0
Chhattisgarh 741 243 33
Jharkhand 330 101 31
Rajasthan 1,517 85 6
Madhya Pradesh 1,156 188 17
Uttarakhand 239 72 31
All India 23,887 1,099 5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

It can be seen that around 1,100 PHCs (around 5%) across the country function without doctors in rural areas.  Chhattisgarh has the highest number of PHCs (243) without a doctor. All PHCs in Uttar Pradesh and Assam are shown as functioning with doctors.

 

We also found that many community health centres lack specialists (surgeons, physicians and paediatricians).

 

Table 5: Lack of Specialists Hurting

 

 

States Total CHCs functioning Required (4 specialists per CHC) Sanctioned In Position Vacant (sanctioned-in position) Shortfall (required- in position)
Himachal Pradesh 76 304 NA 9 NA 295
Bihar 70 280 280 151 129 129
Assam 108 432 NA 216 NA 216
Orissa 377 1,508 812 438 374 1,070
Uttar Pradesh 515 2,060 2,060 1,894 166 166
Chhattisgarh 148 592 592 82 510 510
Jharkhand 188 752 124 66 58 686
Rajasthan 376 1504 1068 569 499 935
Madhya Pradesh 333 1,332 778 227 551 1,105
Uttarakhand 55 220 210 78 132 142
All India 4,809 19,236 9,831 6,935 3,880 12,301

 

Rural India needs 19,236 specialists at its community health centres but it has a shortfall of 12,310 doctors, which is around 64%.  Madhya Pradesh, Orissa and Rajasthan have the maximum shortfall in doctors at CHCs.

 

So, gaps in rural healthcare infrastructure need to be addressed.  The expert consensus is that public spending on healthcare should be doubled to more than 2% of GDP from the current 1%.  But the worry is that despite increased spending under NRHM, lack of healthcare infrastructure and access to doctors continue to be big concerns for rural India. And the proposed universal health coverage is truly an ambitious idea if you look at the World Health Organisation’s World Health Statistics 2012:

 

* Around 47% of hospital admission in rural India is financed through loans and sale of assets.

*About 30% of people in rural India did not opt for treatment because of financial constraints; and

* 39 million Indians are pushed to poverty because of ill-health every year.

 

 

  1. laxman rudavath Reply

    September 11, 2015 at 10:44 pm

    Then what about nurse’s ratio in rural area.
    What is the nurse’s % in India

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