Shortage of medical personnel in Rural Healthcare

Context

Amid the proposals for a three-year diploma course for medical practitioners, who would then serve in primary health centres (PHCs), concerns surrounds the fact for ethical, safety and Professional challenges. Gaps in Rural Healthcare system:

• More than two-thirds of Indians live in villages, but the healthcare facilities in these areas are yet to show the progress seen in urban areas.

The Data: 43.2 per cent of the primary health centres in Chhattisgarh and 37.7 per cent in West Bengal also do not have a doctor. And in Bihar, 72.12 per cent of Sub Centres has no female health worker who is supposed to manage them.

• The chances of you going to a rural health facility without a doctor or a health professional are still very high in the country.
• The analysis of the data available with the Ministry of Health and Family Welfare tells us that things are way worse than they used to be 17 years ago, in 2005.

About the proposal:

• India’s doctor-patient ratio currently stands at 1:834.
• So, to drive a cadre of doctors who are capable of providing first-level care to the rural countryside, if not of handling critical situations is required.
• To retain MBBS doctors in rural areas is not going to be possible for at least 30-40 years because ultimately, rural doctor shortage is a development problem.
• As, rural area lacks adequate hospital Infrastructure and basic living amenities.
• PHCs are the most essential part of the healthcare infrastructure and should possess doctors who are fully trained.
• The recent National Medical Commission (NMC) Act also makes a provision for community health officers.

Why health facilities in rural India faces workforce crisis?

• Lack of incentives: Lack of incentives may be prompting Doctors to not work in rural health facilities.
• Urban-Rural divide: Health infrastructure is more in urban areas, so medical professionals are interested stay in urban areas.
  • Indian medical education is geared to train Doctors to work only in tertiary care and specialised hospitals, so these medical professionals are not interested to stay in rural areas.
• Lack of incomes: Incomes in rural areas are less as compared to urban areas.
• Low government spending: Government spending on health is not even 2% of GDP. Health facilities are poor in rural areas.
• Lack of basic facilities: Many health facilities are functioning without water or electricity supply.

Possible consequences:

• Maternal mortality and Infant mortality rates high in rural areas due to lack of basic health check-ups.
• Increasing disease burden due to lack of timely services in rural areas.
• Higher cost of treatment: Affordable medical facilities are provided to people living in rural areas, however lack of public intervention will motivate private sector to reach the areas and charge them with high cost.

Government initiative to boost rural healthcare infrastructure:

• Ayushman Bharat Health Infrastructure Mission: It envisages increased investments in public health and other health reforms to provide better access to health in rural areas by:
  • Strengthening of Health and Wellness Centres in villages and cities for early detection of diseases.
  • Addition of new critical care-related beds at district level hospitals.
  • Support for Block Public Health Units (BPHU) in 11 high focus States
  • Integrated district public health laboratories in all districts.
• National Rural Health Mission:
  • Under the NRHM, support is provided to the States for ensuring a range of free services related to maternal health, child health, adolescent health, family planning, universal immunization etc.
• National Ambulance Service:
  • Government of India in implementation of National Ambulance Service under NHM for free transportation to health facilities.
  • This service is extended to remote and rural tribal areas also.
  • States are free to place these Ambulances at a lower population norm or as per time to care approach so that these ambulances are easily accessible to all.
• ASHA workers:
  • One of the key components of the NRH Mission is to provide every village in the country with a trained female community health activist – ASHA (Accredited Social Health Activist).
  • An ASHA acts as the interface between the community and the public health system in rural India.

Way forward:

• Medical institutions should motivate the upcoming doctors to provide their education and services in rural parts of the country as well as remind them that the profession revolves around saving lives.
• The issue of lack of doctors for rural areas can also be addressed to a certain extent by reintroducing “Licentiate Medical Practitioners”.
• The government should create a framework for the right staffing, duration and think about the incentives and career paths of doctors and all levels of staff to work in a rural health centre.
• Union Government and the Medical Council of India should formulate a policy regarding the compulsory service in rural area for certain duration to be rendered by the Doctors who are trained in government institutions.