Ailing rural healthcare
The National Rural Health Mission (NRHM) was launched in April 2005 with the aim of providing ‘accessible, affordable and quality healthcare’ to the rural population. The thrust was supposed to be on establishing ‘a fully functional, community-owned, decentralised health delivery system’. Later, the NHRM was subsumed as a sub-mission under the National Health Mission. Almost 18 years after its inception, the initiative remains a work in progress and has a long way to go. According to the Rural Health Statistics report 2021-22, there is a shortfall of 79.5 per cent of specialists at Community Health Centres (CHCs) in India’s rural areas. Each centre needs four medical specialists — surgeon, physician, obstetrician/gynaecologist and paediatrician — along with paramedical staff. With one specialist being available against the requirement of five, many CHCs might be functioning without even one. Overall, 67.8 per cent of the sanctioned posts of specialists at these health centres are vacant. Successive governments have performed dismally: the number of specialist doctors at rural CHCs increased from 3,550 in 2005 to 4,485 in 2022 — an addition of just 935 in 17 years.
The shortage or absence of specialists forces villagers to rush to nearby towns or cities, thus overburdening the urban healthcare system. The reluctance of graduates of government medical colleges to serve in rural areas is too well known. Even as the Health Ministry is finalising guidelines to do away with the contentious bond policy for doctors, based on the National Medical Commission’s recommendations, an action plan has to be prepared to fill vacancies of specialists at rural CHCs on priority, backed by the offer of incentives in the form of stipends or education loan waiver, as is being done in the US and Canada. The laggard states must be told to get their act together.
Such efforts should go hand in hand with the upgradation of infrastructure at CHCs. Doctors can’t perform their job efficiently if they have to grapple with a paucity of beds, machines and medicines on a daily basis. Ensuring an uninterrupted flow of funds and regular monitoring of healthcare standards can also make a vital difference on the ground.
