en years down the line since the National Rural Health Mission (NRHM)
was put in place, challenges to ensure quality and affordable health services
in large swathes of the country’s rural belts are being tackled with renewed
vigour.
Latest rural health statistics reveal that gaps are to be bridged and much has been accomplished despite a plethora of challenges on the road in the wake of increasing expectations in rural regions.
Latest rural health statistics reveal that gaps are to be bridged and much has been accomplished despite a plethora of challenges on the road in the wake of increasing expectations in rural regions.
Manpower has been increased and infrastructure refurbished for the rural
health set up to match ever increasing aspirations of people who are becoming
more aware of quality health services available in urban stretches and
government endeavours to improve health care delivery in rural regions. At some
places ,more facilities and manpower are required lest it
cast an adverse impact on the services.The NRHM common review commission has
undertaken a close look on the set up to improve services .
The National Democratic Alliance (NDA) government, led by Prime Minister
Narendra Modi, is exploring ways and means to ensure proper utilisation
of public spending on the system, confronted with multiple challenges.
Several state governments are also intensifying efforts to ensure sound
healthcare in rural belts.
The NRHM seeks to provide effective healthcare to rural population
throughout the country with special focus on 18 States, which have weak public
health indicators and infrastructure. The States are Arunachal
Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu &
Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Odisha,
Rajasthan, Sikkim, Tripura, Uttarakhand and Uttar Pradesh.
NRHM aims to undertake architectural correction of the health system to
enable it to effectively handle increased allocations and promote policies that
strengthen public health management and service delivery in the country. It
seeks decentralisation of programmes for district management of health and to
address the inter-State and inter-district disparities, with emphasis on the 18
high focus States, including unmet needs for public health infrastructure. It
also seeks to improve access of rural people, especially poor women and
children, to equitable, affordable, accountable and effective primary
healthcare.
The last common review commission which had met late last year found
some “encouraging facts” like adequate number of health facilities as per population
norms in most states except Uttar Pradesh, Uttarakhand, and Bihar, the
investment in infrastructure responsive to caseloads and increasing trends in
OPD load at every level.
The findings also revealed availability of secondary care at district
hospitals in most states, except districts in Uttarakhand (Tehri), Chhattisgarh
(Jashpur), and Uttar Pradesh (Shravasti);Tamil Nadu and Kerala demonstrate
relatively better availability of services at SDH/Taluka level as compared to
other states.
Other features include laboratory services at sub-district level are
available but not comprehensive; Tamil Nadu has a robust system of diagnostics,
Odisha has taken efforts towards integration of laboratory services across
various programs and optimise HR utilisation; co-location of AYUSH services in
most states;and increased utilisation of 108 ambulances.
The review commission had also highlighted some concerns which
inter alia include availability of radiological investigations only at district
level in most contexts; Range of diagnostic services is limited at
Sub-District level hospital and below and assured OPD care at sub-district
level is still a challenge in most states.
It also found that time to care approach is yet to set in across the
States; Non-Integration of various models of ambulances leading
ineffective utilisation;Under utilisation of Mobile Medical Units; Grievance
redressal mechanisms yet to be established & where available, their
effectiveness is limited. Informatively,
the NRHM is an articulation of the commitment of the government to raise to
2-3% public spending on health from 0.9% of GDP.
After the review commission meeting, another survey was conducted mainly
to collect statistics. The latest rural health figures has highlighted that as
on March 31, this year, 8.1% of the PHCs (primary health centres) were
without a doctor, 38.1% a lab technician and 21.9% a pharmacist. The Community
Health Centres (CHC) provide specialised medical care of surgeons, obstetricians
& gynaecologists, physicians and paediatricians.
The latest survey, which compiled data on various parameters, found that
progress has been made on various fronts but experts feel the limited public
spending is one of the key reasons which hobbled development of the sound rural
health network, and medical crisis spell doom for families running on
shoestring or zero budget as they have no means to afford timely and quality
healthcare.
The survey noted that in India, 1,022 Sub Divisional/ Sub District
Hospitals were functioning till March. At Sub Divisional/Sub District
Hospitals, there are 10,018 doctors available. In addition to the doctors,
about 26,717 paramedical staffs are also available at Sub Divisional/ Sub
District Hospitals.
As many as 763 District Hospitals are functioning with 18,437 doctors
available. In addition, about 55,642 para medical staff were also available at
District Hospitals as on March 31, 2015. Diarrhoea, typhoid, infectious
hepatitis, worm infestations, measles, tuberculosis, whooping cough,
respiratory infections, pneumonia and reproductive tract infections were also
very common in rural pockets. Maternity and child mortality were
high. Almost 50 percent of the rural mothers were said to
experience post partum illnesses six weeks after delivery.
The current position of specialist manpower at CHCs reveals that as on
March, 2015, out of the sanctioned posts, 74.6% of surgeons, 65.4% of
obstetricians & gynaecologists, 68.1% of physicians and 62.8% of
paediatricians were vacant. Overall, 67.6% of the sanctioned posts of
specialists at CHCs were vacant.
Moreover, as compared to requirement for existing infrastructure, there
was a shortfall of 83.4% of surgeons, 76.3% of obstetricians &
gynaecologists, 83.0% of physicians and 82.1% of paediatricians. Overall, there
was a shortfall of 81.2% specialists at the CHCs.
The shortfall of specialists is significantly high in most of the
States. As on March 31, 2015, there were 153,655 Sub Centres (SCs),
25,308 Primary Health Centres (PHCs) and 5,396 Community Health Centres (CHCs)
functioning in the country.
While the Sub Centres, PHCs and CHCs have increased in number in
2014-15, they are not sufficient to meet their population norm, the government
survey had pointed out. Experts say unless public spending was increased on
health, the infrastructure despite having bare minimum staff and facilities, it
would not be able meet needs of patients in remote and inhospitable terrain.
Locals do not have adequate funds to meet expenditure on medical treatment and
the government has to ensure free distribution of generic drugs. Many of them
say that corruption and middle level players had to be bridled to ensure that
every penny spent on health services reaches the needy in time.
Surveillance must be mounted to control the existing staff too and
frequents raids on rural health centres of all types were the need of the hour.
Number of existing Sub Centres increased from 146,026 in 2005 to 153,655 by
March 2015. There is significant increase in the number of Sub Centres in the
States of Chhattisgarh, Gujarat, Jammu & Kashmir, Karnataka, Odisha,
Rajasthan, Tripura and Uttarakhand.
There has been an addition of 1,329 Sub Centres, during the year
2014-15. Significant increases in the number of Sub Centres have been reported
in the States of Gujarat (789) and Madhya Pradesh (428). Percentage of
Sub Centres functioning in Government buildings has increased from 50% in 2005
to 67.5% in 2015.
The increase is mainly due to addition in the number of government
buildings in the States of Assam, Chhattisgarh, Karnataka, Madhya Pradesh,
Maharashtra, Odisha, Punjab, Rajasthan, Tripura, Uttarakhand, Uttar Pradesh and
West Bengal. As on March 31, the overall shortfall in the posts of
HW(F)/ ANM( Auxiliary Nurse Midwife ) at SCs & PHCs was 5.21% of the total
requirement, mainly due to shortfall in the states of Arunachal Pradesh,
Chhattisgarh, Gujarat, Himachal Pradesh, Karnataka, Rajasthan, Tamil Nadu,
Tripura, Uttarakhand and Uttar Pradesh.
Number of PHCs has risen by 2072 during the period 2005-2015.Significant
increase is observed in the number of PHCs in the States of Assam, Bihar,
Chhattisgarh, Jammu & Kashmir, Karnataka and Rajasthan.
The number of PHCs has increased by 288 during the year 2014-15.
Significant increases in the number of PHCs have been observed in the States of
Karnataka (120) and Gujarat (89). Number of ANMs at Sub Centres and PHCs
has increased from 133,194 in 2005 to 212,185 in 2015.
Percentage of PHCs functioning in government buildings has
increased significantly from 78% in 2005 to 89.5% in 2015. This is mainly due
to increase in the government buildings in the States of Assam, Chhattisgarh,
Gujarat, Karnataka, Madhya Pradesh, Maharashtra, and Uttar Pradesh. The
number of allopathic doctors at PHCs has increased from 20,308 in 2005 to
27,421 in 2015, which is about 35.0% increase.
The statistics say shortfall of allopathic doctors in PHCs was 11.9% of
the total requirement for existing infrastructure. Number of Community Health
Centres (CHC ) has increased by 2050 during the period
2005-2015.
Significant increase is observed in the number of CHCs in the States of
Gujarat, Jharkhand, Kerala, Madhya Pradesh, Odisha, Rajasthan, Tamil Nadu,
Uttar Pradesh and West Bengal. There has been an augmentation of 33 CHCs
from the number reported upto March, 2014. Significant increase in the number
of CHCs was observed in the State of Gujarat (20). Number of CHCs
functioning in government buildings has also increased during the period
2005-2015.
The percentage of CHCs in Govt. buildings has increased from 91.6% in
2005 to 95.1% in 2015. Significant increase in the number of
paramedical staff is also observed in 2015 when compared with the position of
2005. In addition to 4,078 Specialists, 11,822 General Duty Medical Officers
(GDMOs) are also available at CHCs. There was huge shortfall of surgeons
(83.4%), obstetricians & gynaecologists (76.3%), physicians (83.0%) and
paediatricians (82.1%).
Overall, there was a shortfall of 81.2% specialists at the CHCs
vis-a-vis the requirement for existing CHCs. While the number of Sub Centres,
PHCs and CHCs have increased during the year 2014-15, the number of ANMs,
Specialists & Radiographers declined, though marginally from the position
in 2013.
The number of ANMs at Sub Centres and PHCs has declined from 2,13,400 in
2014 to 2,12,185 in 2015 (decrease of 1,215). Major reductions are observed in
the States of Maharashtra (466), Tamil Nadu (619), Jammu & Kashmir (292),
Rajasthan (259), Tripura (185) and Madhya Pradesh (168). Similarly, the number
of allopathic doctors at PHCs increased from 27,355 in 2014 to 27,421 in 2015.
There are significant increases in the States of Maharashtra (431),
Rajasthan (301), Tamil Nadu (236) and Haryana (94). Major reduction is observed
in the State of Jammu & Kashmir (390). Regarding the specialist
doctors at CHCs, the number has declined from 4,091 in 2014 to 4,078 in 2015.
Major decreases have been noticed in the States of Rajasthan and Punjab .
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