India’s rural healthcare system continues to be plagued by shortfall on two critical fronts — doctors and infrastructure. There is a shortage of 83.2 per cent of surgeons, 74.2 per cent of obstetricians and gynaecologists, 79.1 per cent of physicians and 81.6 per cent of paediatricians, according to the Rural Health Statistics 2021-2022 released last week.

Less than half the Primary Health Centres (PHC), 45.1 per cent, function on a 24×7 basis. Of the 5,480 functioning Community Health Centres (CHC), only 541 have all four specialists, showed the document released by the Union health ministry.

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In the Indian healthcare system, sub-centres (SC) are the first point of contact for a patient, catering to a population of 3,000-5,000. This is succeeded by a PHC, which is required to look after the daily needs of 20,000-30,000 people.

CHCs provide referrals and access to specialists, catering to 80,000-120,000 people. These facilities are overburdened across the board, with SCs currently looking after more than 5,000 people, PHCs catering to 36,049 people and CHCs to 164,027 people. This, coupled with a human resource shortage, plagues access to adequate and quality healthcare.

SCs, PHCs and CHCs had more staff in 2021, at the height of the deadly second wave of COVID-19, as compared to now. The number of auxiliary nurse midwives at SCs has decreased to 207,587 in 2021 from 214,820 in 2022. The shortage was most pronounced in Uttar Pradesh, Gujarat, Himachal Pradesh, Odisha and Uttarakhand.

The number of doctors at PHCs has shrunk to 30,640 in 2022 from 31,716 in 2021. Lab technicians, nursing staff and radiographers at PHCs and CHCs have all recorded a marginal increase between 2021 and 2022. Up from 22,723 to 22,772, from 79,044 to 79,933 and from 2,418 to 2,448, respectively.

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Uttar Pradesh, Rajasthan, Madhya Pradesh, Gujarat and Odisha face the highest shortage in surgeons, obstetricians / gynaecologists, paediatricians and radiographers at CHCs across the country.

Urban PHCs — part of the National Health Mission’s efforts to set up multi-tier health centres catering to a population of 50,000-75,000 — also face severe shortages. These facilities currently face a shortage of 18.8 per cent of doctors, 16.8 per cent of pharmacists, 16.8 per cent of lab technicians and 19.1 per cent of staff nurses.

Urban CHCs — catering to 0.25-0.5 million — face a similar fate. These centres encounter a shortfall of 46.9 per cent of total specialists, 14.7 per cent of General Duty Medical Officers, 49.3 per cent of radiographers, 3.9 per cent of pharmacists, 7.2 per cent of lab technicians and 5.3 per cent of staff nurses.

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While there has been a decline in the past year, a huge improvement has been recorded as compared to 2005, when the government launched the National Rural Health Mission.

“The allopathic doctors at PHCs have increased from 20,308 in 2005 to 30,640 in 2022, which is about 50.9% increase. There is a shortfall of 3.1% of allopathic doctors at PHC, out of the total requirement at all India level. The specialist doctors at Community Health Centers (CHCs) have increased from 3,550 in 2005 to 4,485 in 2022,” the report noted.

Moreover, compared to the requirement for existing infrastructure, there is a shortfall of 83.2 per cent of surgeons, 74.2 per cent of obstetricians and gynaecologists, 79.1 per cent of physicians and 81.6 per cent of paediatricians. Overall, there is a shortfall of 79.5 per cent of specialists at the CHCs as compared to the requirement, the document noted.

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