After 10 yrs of rural health mission, doctor shortfall up
Subodh Varma
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Samarin Bai, a 50-year-old Baiga tribal woman from Mahamai village lives in the dense Achanakmar forests of Bilaspur district, Chhattisgarh. A few days back, she decided to see a doctor for the big lump that had developed at the base of her neck and various other problems. Although there is a government sub-centre 6km away , she knew that there was only one auxiliary nurse cum midwife (ANM) who wouldn't be able to help.So she trudged through 14km t of rain-soaked forest to a health centre in Bamhani vill lage set up by a local NGO, Jan i Swasthya Sahyog (JSS). A doctor visits this centre every week and he diagnosed a dangerous thyroid enlargement which needed quick surgery . i Samarin Bai waded across a monsoon swollen river and was transported by the JSS f van to their hospital at Ganiyari, some 70km away .Yogesh Jain of JSS narrates this story as an example of what is routine in the area.Healthcare delivery is so patchy and deficient that peo ple travel dozens of kilome ers to get treatment. “In the 10 years since the NRHM was aunched, some improvement s there, but doctors and key healthcare personnel are still deficient,“ he told TOI.
Recently released government data on the rural health nfrastructure and personnel confirms that Samarin Bai's problem is not a rare example rom some inaccessible forest.At the country level, there is a staggering shortfall of 81% of specialist doctors, 12% of general physicians, 21% of nurses and 5% of auxiliary nurse cum midwives. Among technical support staff, shortfalls range from 29% for pharmacists to 45%for laboratory technicians and 63% for radiographers.But since a decade ago, many of these shortfalls have increased except for nurses and ANMs.
A bizarre aspect of this data put out annually by the ministry of health is that in many categories of health personnel, some states have surplus appointments while others have shortfalls. For example, at the country level, 25,308 doctors are required going by the Indian Public Health Standards (IPHS), which says that one doctor is needed for every primary health centre (PHC).But actually , there are 34,750 doctors sanctioned. 25 states have surplus doctors, the total surplus working out to 5,115.On the other hand, the remaining states have a combined shortfall of 3,002 doctors.
T Sundararaman, professor at the Tata Institute for Social Sciences and former executive director of the National Health Systems Resource Centre says, “IPHS recommended two doctors and one ayush doctor per PHC. In 2011, the doctors per PHC was revised downwards. But doctors are -unlike ANMs -paid only by the states. So many states, like Tamil Nadu, have two doctors per PHC as sanctioned. The `required' number is the statistics department's interpretation of IPHS to mean that only one doctor is required per PHC. They have no basis to do this, and one doctor per PHC is not viable. The short falls are genuine -the over appointments are not,“ he told TOI.
The surpluses in healthcare personnel arise because goal posts are shifted by lowering requirements. In reality the shortages are all round.
For the full report, log on to http:www.timesofindia.com
Recently released government data on the rural health nfrastructure and personnel confirms that Samarin Bai's problem is not a rare example rom some inaccessible forest.At the country level, there is a staggering shortfall of 81% of specialist doctors, 12% of general physicians, 21% of nurses and 5% of auxiliary nurse cum midwives. Among technical support staff, shortfalls range from 29% for pharmacists to 45%for laboratory technicians and 63% for radiographers.But since a decade ago, many of these shortfalls have increased except for nurses and ANMs.
A bizarre aspect of this data put out annually by the ministry of health is that in many categories of health personnel, some states have surplus appointments while others have shortfalls. For example, at the country level, 25,308 doctors are required going by the Indian Public Health Standards (IPHS), which says that one doctor is needed for every primary health centre (PHC).But actually , there are 34,750 doctors sanctioned. 25 states have surplus doctors, the total surplus working out to 5,115.On the other hand, the remaining states have a combined shortfall of 3,002 doctors.
T Sundararaman, professor at the Tata Institute for Social Sciences and former executive director of the National Health Systems Resource Centre says, “IPHS recommended two doctors and one ayush doctor per PHC. In 2011, the doctors per PHC was revised downwards. But doctors are -unlike ANMs -paid only by the states. So many states, like Tamil Nadu, have two doctors per PHC as sanctioned. The `required' number is the statistics department's interpretation of IPHS to mean that only one doctor is required per PHC. They have no basis to do this, and one doctor per PHC is not viable. The short falls are genuine -the over appointments are not,“ he told TOI.
The surpluses in healthcare personnel arise because goal posts are shifted by lowering requirements. In reality the shortages are all round.
For the full report, log on to http:www.timesofindia.com
