Rural Healthcare – UPSC GS2

Utility: A direct question can be asked on Rural Healthcare due to COVID. Also, content can be used in Essays/Answers related to health.
Facts:
  • Out of 139 crore population of India, at least 91 crore people are living in 649,481 villages.
  • There is a growing incidence of non-communicable diseases (NCDs) such as hypertension, diabetes, cancer and cardiovascular diseases in rural India. As per WHO, NCDs cause nearly about 5.87 million (60%) of all deaths in India.
  • India is facing a shortage of about 5 lakh doctors.
Healthcare structure in India: (#diagram)
  • Primary Level in villages: Primary Healthcare Centres (PHCs). No MBBS doctors; Multi-purpose health workers (MPWs like ASHA, ANM, Anganwadi) who administer primary health care along with other efforts like vaccination etc. These MPWs are not properly trained.
  • Secondary level: Community Healthcare Centres (CHCs). In blocks. 2/3 MBBS doctors who do uncomplicated treatment.
  • Tertiary level: District hospitals
  • Quaternary level: Medical colleges
Inadequate and poor health infrastructure in the rural areas
According to the fact shared by the Union Minister of State for Health and Family Welfare in the Rajya Sabha. India is having inadequate PHCs, CHCs, specialists, etc.
  • Inadequate primary health centres (PHCs):  India has only 25,743 primary health centres (PHCs) though the estimated requirement of PHC’s in rural India is 29,337. (Shortfall of 3,594 units).
  • Inadequate community health centres (CHCs): Against the requirement of 7,322 CHC’s, rural India has only 5,624 community health centres (CHCs).
  • Inadequate specialists in CHC’s: Data on CHCs, show that, overall, there is a shortfall of 81.8% specialists as compared to the requirement for existing CHCs.
  • Inadequate infrastructure: According to the Human Development Report 2020, India has eight hospital beds for a population of 10,000 people, while China has 40 beds for the same number of people.
Significance of rural health infrastructure in effective delivery of health Services
  • Rural health networks will help to treat the diseases at the primary level. Further, it will also help us save a lot of money and the resources being spent at tertiary level health care.
  • For instance, if our Sub-HCs work effectively, there will be less pressure on PHCs. If the PHCs function well, then there will be minimal pressure on CHCs and so on.
  • It will enable people’s participation in ensuring better functioning of rural health services.
  • For example, in case of Haryana, Swasthya Kalyan Samitis, or SKSs were constituted for all CHCs, PHCs.
  • It helped health providers  to engage with all kinds of rural community organisations (panchayats, gram Sabha, notified area committees, municipal bodies and non-governmental organisations) in minimising the adverse impact of the pandemic on rural life.
Suggestions to improve rural health infrastructure:
  • Rural health networks should have access to the health data of people in their respective areas. It will enable them to identify those likely to slip into the secondary or tertiary care zone.
  • Need to conduct Regular health camps. It will help us to identify those on the verge of developing tuberculosis, hypertension, diabetes or any diseases owing to their socio and economic conditions.
  • A CHC or referral centre should be modernized with effective and adequate health infrastructure. For example, A single CHC should have least 30 beds for indoor patients, operation theatre, labour room, X-ray machine, pathological laboratory, standby generators’ etc.
Can Licentiate Medical Practitioners be a solution?
  • In the 1940s, primary care physicians were trained under short-term courses, and were called Licentiate Medical Practitioners (LMPs).
  • LMPs worked and delivered quality health services in the rural sector.
  • The Bhore Committee (1946) recommended the abolition of LMPs as India produced sufficient MBBS doctors.
  • Arguments against LPMs:
    • Poor quality doctors.
    • By appointing lower tier doctors the people in rural areas would be made to feel like low class citizens.
  • Arguments for reintroduction of LMPs:
    • A short-term course in medicine will help design a medical curriculum that is more relevant to the country’s requirements.
    • Can work on low salaries.
    • Willingness to work in rural areas.
    • LMPs can be adequately trained and have a well-defined role in health care.
    • MBBS curriculum has many subject which are not needed for all.
WHO states that ensuring accessibility, affordability and Quality are Key to achieve Universal Health Coverage. The government should strive to provide regular and comprehensive healthcare needs in rural areas guided by the World Health Organization (WHO)’s principle of Universal Health Coverage.
Related Questions:
Critically comment on India‘s attitude towards health care in rural areas since independence and its consequences. (200 Words)