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Poor infrastructure, staff crunch continues to plague healthcare in rural India: Centre

GS Paper 2

Syllabus: Issues Relating to Development and Management of Social Sector/Services relating to Health


Source: DTE

 Direction: The article highlights the recent data related to rural healthcare in India and government initiatives to transform rural healthcare.

 Context: According to the Union Ministry of Health & Family Welfare’s Rural Health Statistics 2021-2022, India’s rural healthcare system continues to be plagued by a shortfall on two critical fronts – doctors and infrastructure.


The Indian healthcare system is divided into:

  • Sub-centres (SC): These are the first point of contact for a patient, catering to a population of 3,000-5,000.
  • Primary Health Centres (PHC): SC is succeeded by a PHC, which is required to look after the daily needs of 20,000-30,000 people (50,000-75,000 in urban areas).
  • Community Health Centres (CHC): They provide referrals and access to specialists, catering to 80,000-120,000 people (0.25-0.5 million in urban areas). 


Key highlights of the Rural Health Statistics 2021-2022:

  • There is a shortage of 83.2% of surgeons, 74.2% of obstetricians and gynaecologists, 79.1% of physicians and 81.6% of paediatricians.
  • Less than half the PHC (45%) function on a 24×7 basis.
  • Of the 5,480 functioning CHCs, only 541 have all four specialists.
  • SC, PHC and CHC 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 (like auxiliary nurse midwives – ANM), plagues access to adequate and quality healthcare.
    • The shortage was most pronounced in Uttar Pradesh, Gujarat, Himachal Pradesh, Odisha and Uttarakhand.
    • SCs, PHCs and CHCs had more staff in 2021, at the height of the deadly second wave of COVID-19, as compared to now.


Other challenges faced by the Indian rural healthcare sector and additional statistics:

  • Low quality of care
  • Poor accountability
  • Absenteeism: “Even if the personnel are present, their level of participation in providing health services, may not be at desirable levels due to lack of supplies, inadequate infrastructure facilities, poor monitoring of the staff, and so on.”-Economic Survey 2018-19
  • Lack of awareness
  • Limited access to facilities
  • According to the National Health Profile (NHP) 2019, there are only 5 government hospitals per 100,000 population in rural India, compared to 3.5 in urban areas


Some of the government initiatives to transform rural healthcare:

  • Under Ayushman Bharat, the existing SCs and PHCs are being transformed into AB-Health and Wellness Centres (HWCs) to deliver preventive, curative, palliative and rehabilitative services which are universal, free and close to the community.
  • PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) envisages increased investments in public health to provide better access to health in rural areas by:
    • Strengthening of HWCs in villages and cities for early detection of diseases
    • Support for Block Public Health Units (BPHU) in 11 high-focus States
    • Integrated district public health laboratories in all districts, etc.
  • National Ambulance Service under National Health Mission (NHM) for free transportation to health facilities.


Contribution of the National Rural Health Mission (NRHM):

  • 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 NRHM (now subsumed under NHM).
  • For example, the number of allopathic doctors at PHCs has increased from 20,308 in 2005 to 30,640 in 2022, which is about a 51% increase.



  • The focus should be placed on improving rural healthcare infrastructure and human resources. This will ensure that Indians living in even the most remote areas have access to effective healthcare.
  • This would be in line with India’s commitments as a welfare state and would also aid in the achievement of SDG 3 – Health for All.



Human Resources for Health (HRH)

As per WHO, Human Resources for Health (HRH) are defined as “the stock of all individuals engaged in the promotion, protection or improvement of population health”. This includes both public and private sectors and different domains of health systems, such as personal curative and preventive care, non-personal public health interventions, disease prevention, health promotion services, research, management and support services


Health systems require human resources for health (HRH) to ensure healthcare for all. According to the World Health Organisation (WHO), HRH scarcity primarily affects low- and lower-middle-income countries (LICs and LMICs) like India



Dr Devi Shetty, one of India’s most renowned doctors, remarked, “Beds do not treat people. Doctors, nurses, and paramedics are the ones who do it.”


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Q. Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All’ in India. Explain. (UPSC 2018)