Thursday, 16 August 2012

Unhealthy At 65: India Has 76% Shortfall In Government Doctors

After spending around 1% of gross domestic product (GDP) on health in the past five years, the government is proposing an increase in public spending by half a percentage point to make it 1.58% for the coming five years (2012-17) under the 12th Plan.

This is what the draft chapter on health in the Plan document says. Health experts and activists are up in arms at this meagre increase because even the Planning Commission's high-level expert group and the steering committee on drafting the Plan had suggested at least 2.5% of GDP as the public health spend.

But, what happens with low spending? The Planning Commission's own analysis of the state of the country's healthcare system reveals the rot within.

The latest available rural health statistics for 2011 show a shocking shortfall of human resources, be it doctors, nurses or other healthcare personnel . According to the Planning Commission's draft, the country's government-run healthcare system is hamstrung because the number of doctors is short of the target by a jaw-dropping 76%, there are 53% fewer nurses , specialist doctors are short by 88%, radiographers are short by 85% and laboratory technicians are short by 80%.

What the shortage of personnel means is that in many states where infrastructure is largely present, the absence of doctors and nurses renders the whole facility meaningless. Thus, Gujarat has only a 5% shortfall of community health centres but only 76 out of 1,220 specialists required are available. In Odisha, there are 377 CHCs although only 327 are required as per norms. But of 1,570 specialists required , only 438 are at work.

Health infrastructure poor in states

The shortfall of medical personnel in several states tells a sorry state of affairs of the health machinery. This is the situation after the Centre spent Rs 33,390 crore, that is 52% of its total NRHM budget, on human resources.

The picture is grim on physical infrastructure too, consisting of the gigantic network of health sub-centres (SC), primary health centres (PHC), community health centres (CHC) and district hospitals (DH). There are supposed to be 1,78,267 SCs in the country on the basis of about one per 1,000 population. In reality, there are only 1,48,124 — about 17% short. Even among the functional ones, more than 40,000 are working out of rented buildings ; buildings for 13,000 sub-centres are still being made. A quarter of them don't have water and a similar proportion has no electricity.

The situation is no different as one goes up the ladder. There is an 18% shortfall in PHCs, and an alarming 34% shortfall in CHCs. District hospitals are only 4% short of the target but since all lower centres are short and ill-equipped , the rush to district hospitals causes massive crowding. This is the result after the government spent Rs 17,380 crore or about 27% of its total NRHM budget on setting up infrastructure in the last five years.

Even the physical infrastructure available is unevenly spread across the country. In states like Tamil Nadu, Kerala, Odisha, J&K, Himachal Pradesh and many states in the northeast, there is no shortfall of CHCs. But in states like Assam, Bihar, Karnataka, MP, Maharashtra , UP and Bengal, the shortfall ranges between 33% and 91%. This clearly shows that as much as finances , political will at the state government level is also a key determining factor in the fate of public healthcare.

So, by under-investing in key areas like infrastructure and deployment of qualified personnel, the government appears to have constrained the spread of health facilities for all — and apathy at the state governments' level has further worsened the situation.

Times View

The figures make it quite clear how abysmally successive governments have performed in putting in place a working public healthcare system. No wonder then that Indians spend more out of their pockets for illnesses than almost any other nation. This is a shame for 65-year-old independent India. More needs to be done to beef up the infrastructure. Much more importantly, the infrastructure that does exist must be adequately staffed. This is what our government must focus on urgently. If we do not provide for this very basic need for our citizens, we would have failed to keep the tryst with destiny that Nehru so eloquently spoke about 65 years ago.


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