The Hindu for IAS Exam: Rural Health System in India
Here in this article, we have analysed the present scenario of the health system in Rural India. How the weak health system has a major impact on various indicators of health in rural India. The topic is very important for IAS Exam and it must be covered before the IAS Mains Exam.
The recent incident at the Baba Raghav Das Medical College in Gorakhpur has exposed the weak system of India’s rural health system. The Baba Raghav Das Medical College in Gorakhpur came into the spotlight after the incident in which more than 70 children died within a short time of 3 to 4 days. This incident doesn’t tell about the condition of the health system in Gorakhpur alone, but it also specifies the status of weak medical infrastructure in several surrounding districts and even neighbouring States where a large number of very sick patients are sent to such apex hospitals as a last resort for the common people.
Comptroller and Auditor General in its report on reproductive and child health under the National Rural Health Mission for the year ended March 2016 also stated the dysfunctional aspects of the country’s medical health system. Even if the audit objections on financial administration were to be ignored, the picture that emerges in several States is one of inability to absorb the funds allocated, shortage of staff at primary health centres (PHCs); community health centres (CHCs) and district hospitals, lack of essential medicines, broken-down equipment and unfilled doctor vacancies.
CAG’s report on Reproductive and Child Health (RCH) under National Rural Health Mission
Financial management: The report specifies the unsatisfactory financial management of the RCH programme under which the substantial unspent balances with the State Health Societies every year.In 27 states, the unspent amount increased from Rs 7,375 crore in 2011-12 to Rs 9,509 crore in 2015-16.
Physical infrastructure: A shortfall ranging between 24%-38% was observed in the availability of Sub-Centres (SCs), Primary Health Centres (PHCs) and Community Health Centres (CHCs) in 28 states/UTs. The shortfall was more than 50% in five states (Bihar, Jharkhand, Sikkim, Uttarakhand and West Bengal).
Availability of Human Resources: A shortage of doctors and the paramedical staff was observed in almost all selected facilities. In the selected CHCs of 27 states, the average shortfall of specialists ranged between 77% - 87%. Further, only 1,303 nurses were posted against the required 2,360. It was also noted that medical equipment in some states was lying unutilised due to non-availability of doctors and manpower to operate them. The CAG recommended that the Ministry of Health and Family Welfare must follow up with states to ensure that sanctioned posts of health care professionals are filled up.
Availability of medical equipment and medicines: It was noted that selected health facilities across 29 states/UTs lacks the basic equipment required for RCH services such as labour tables, normal delivery kits, emergency obstetric care equipment, and X-ray facilities. In 8 states, essential drugs were not available. Further, in 14 states, medicines were being issued to patients without ensuring their prescribed quality checks.
Quality of health care: The National Quality Assurance Programme (NQAP) was set up in 2013 for improving the quality of care in the District Hospitals, CHCs and PHCs across the country. The audit results revealed that the institutional framework for implementation of NQAP was either not in place or was not effective. Further, the Report noted a low number of internal and external assessments of health facilities, inadequate reporting, and non-evaluation of key performance indicators.
Reproductive and child health services and outcomes: Janani Suraksha Yojana (JSY) is a safe motherhood intervention to promote institutional delivery among the poor pregnant women. The CAG noted deficiencies in the implementation of JSY, in terms of non-payment of incentive amounts or delayed payment to beneficiaries.
The Government has finalised the models for an upgraded rural health system long back and also issued the Indian Public Health Standards in the year 2007 and 2012 which covers facilities from health sub-centres upwards. The Government has set ambitious health goals for 2020 and is in the process of deciding the financial outlay for various targets under the National Health Mission, including reduction of the infant mortality rate to 30 per 1,000 live births, from the recent estimate of 40. In order to achieve such health goals by 2020, the Government requires sustained investment and monitoring and ensuring that the prescribed standard of access to a health facility with the requisite medical and nursing resources within a 3-km radius is achieved on priority.
Such a commitment from the Government is vital for scaling up reproductive and child health care in the country to achieve a sharp reduction in its deplorable infant and maternal mortality levels, besides preventing the spread of infectious diseases across the States. It is highly imperative for the government to identify the limitations of a market-led mechanism, as the NITI Aayog has pointed out in its action agenda for 2020, in providing for a pure public good such as health. We need to move to a single- payer system with cost controls that make an efficient strategic purchase of health care from private and public facilities possible. Bringing equity in access to doctors, diagnostics and medicines for the rural population have to be a priority for the National Health Mission.