Gujarat’s rural healthcare: “Sufficient” infrastructure facilities stand in sharp contrast to utter lack of human inputs

phcA recent Union ministry of health and family welfare report suggests Gujarat has concentrated excessively on health infrastructure to the detriment of human input. Counterview.org team takes a look:

A recent report, “Rural Health Statistics in India”, has pointed towards a strange dichotomy about the state of health in Gujarat. While Gujarat’s health infrastructure at the local level, the report says, is quite sufficient and up to the mark, what bogs the present state of affairs is a terrible shortage of human resource input. The report, put out by the Statistics Division of the Ministry of Health and Family Welfare, Government of India, and is part of the Centre’s National Rural Health Mission, has found that there is utter shortage of staff not only at the lower level but also at the higher level, especially specialists, in both community health centres (CHCs) and primary health centres (PHCs).

Referring to the shortage of lower level medical staff, the report states, “The availability of manpower is one of the important prerequisites for the efficient functioning of the rural health services. In 2012, the overall shortfall for the posts of female health workers in India, attached with PHCs, was 3.8 per cent of the total requirement. The situation has turned bad, the report states, because certain states have failed to fill up vacancies. “The overall shortfall is mainly due to shortfall in states namely, Chhattisgarh, Gujarat, Himachal Pradesh, Kerala and Tamil Nadu”, it says, adding, the situation was worse with regard to male health workers, with an “overall shortfall of 65.2 per cent of the requirement”.

As for the allopathic doctors at PHC, the report states, “There was a shortfall of 10.3 per cent of the total requirement. This is again mainly due to significant shortfall in doctors at PHCs in the states of Chhattisgarh, Gujarat, Haryana, Himachal Pradesh, Karnataka, Madhya Pradesh, Nagaland, Odisha, Uttarakhand and Uttar Pradesh.” These states suffer from shortfall despite the fact that there has been a “significant increase” in the number of doctors at PHCs in some states such as “Andhra Pradesh, Jammu & Kashmir, Karnataka, Kerala, Manipur, Mizoram, Nagaland, Punjab, Rajasthan and Uttarakhand.” This apart, the report adds, the states saw an “appreciable increase” in specialists in CHCs in certain states alone, which are  “Andhra Pradesh, Chhattisgarh, Jammu & Kashmir, Kerala, Madhya Pradesh, Nagaland, Punjab and West Bengal”.

Specialists at Community Health Centres in India
Specialists at Community Health Centres in India

While there is extreme shortage of human input in Gujarat, the report suggests, the state has, ironically, been doing well on health infrastructure in 2012. Thus, it finds “significant increase in the number of PHCs in the states of Andhra Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jammu & Kashmir, Karnataka, Maharashtra, Nagaland, Uttarakhand and Uttar Pradesh.”  Again, Gujarat is one of the states where there has been an increase in the PHCs working from government buildings. The states have done well on this score are “Assam, Chhattisgarh, Gujarat, Haryana, Himachal Pradesh, Karnataka, Madhya Pradesh, Maharashtra, Nagaland, Uttar Pradesh, Rajasthan and Uttar Pradesh”, it says.

Same is the case with CHCs. The states witnessing increase in the number of CHCs are “Andhra Pradesh, Arunachal Pradesh, Chhattisgarh, Gujarat, Haryana, Himachal Pradesh, Jammu & Kashmir, Jharkhand, Kerala, Madhya Pradesh, Odisha, Punjab, Rajasthan, Tamil Nadu, Uttarakhand, Uttar Pradesh and West Bengal.” PHCs are the lowest unit state-owned rural health care facilities in India.  They are essentially single-physician clinics usually with facilities for minor surgeries. They are part of the government-funded public health system in India and are the most basic units of this system. Also state funded, the CHCs are designed to provide referral health care for cases from the PHCs, and for cases in need of specialist care approaching the centre directly.

Doctors at PHCs
Doctors at PHCs

Data go to suggest what exactly has gone wrong with Gujarat’s rural health facilities. In 2005, the required strength of the PHCs in Gujarat was 1,070 doctors, and the Gujarat government sanctioned all of them. As against this, 838 posts were filled up and there was a shortfall was 222. Things worsened seven years later. In 2012, as against the required strength of doctors in PHCs of 1,156, the state government sanctioned 1,123 posts, but just about 778 doctors posts were filled up and there was a shortfall of 380.  Gujarat’s shortfall in doctors of 31 per cent was higher than all major Indian states, except Uttar Pradesh (37 per cent) and Madhya Pradesh (35 per cent).

Ironically, the poor state of human resources in Gujarat stands in sharp contrast to sufficient infrastructure facilities. In 2012, 97 per cent of the 1,158 PHCs had labour rooms and operation theatres. Further, all the state’s PHCs were equipped with at least four beds. Gujarat was not alone to have such good infrastructure, however. The states that equaled Gujarat’s performance on the infrastructure front were Andhra Pradesh, Maharashtra and Rajasthan. The national average for PHCs with labour room was quite poor — 66 per cent. As for operation theatre it was 34 per cent, and 67 per cent PHCs had at least four bed facility. But such good infrastructure was of no use as there were no doctors to carry out operations or treat patients in Gujarat’s rural areas.

The report finds the situation with regard to community health centres (CHCs) worse. In 2005, Gujarat’s CHCs required 1,088 specialists (including gynecologists, obstetricians, physicians and pediatricians). As against this, the state government sanctioned a mere 321 posts, of which 92 posts were filled up and 229 were vacant. There was a shortfall of 996 specialists, the highest in India. Things aggravated in 2012, when the required strength of specialists was estimated at 1,272. As against this, the state government sanctioned 346 posts, out of which only 76 were filled up, and 270 posts were vacant, and there was a shortfall of a whopping 1,196, next to Rajasthan, Tamil Nadu and West Bengal.

A further breakup suggests how in 2012 the state government remained indifferent towards appointing different branches of doctors in CHCs. It did not care to sanction any physicians’ posts for any of the 318 CHCs.  As against the required strength of 318 gynecologists and obstetricians, it sanctioned 34, of which just nine were appointed, 25 were vacant, and there was a shortfall of 209. As for pediatricians, as against the required strength was 318, 34 posts were sanctioned, appointments were made for three, 31 remained vacant, and there was a shortfall of 315. Coming to surgeons, against the requirement of 318, 278 posts were sanctioned, 64 were appointed, 214 were vacant, and there was a shortfall of 254. Interestingly, all this happened when CHCs were quite equipped – in 2012 of 318 functioning CHCs, all had laboratories, and 305 had operation theatres and labour rooms.

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