India's Rural Health System

What is the issue?

Despite the Centre's efforts towards the ambitious health goals for 2020, the recent Gorakhpur health tragedy calls for an assessment of rural India’s health system.

What are the problems in this regard?

• Recent CAG’s report on reproductive and child health highlights the dysfunctional aspects of the medical system in rural areas.
• CAG found that in certain states about 50% of the PHCs (Primary Health Centres) did not have a doctor, while others had significant levels of vacancies.
• It also brings out a range of other issues such as:

1. inability of States to absorb the funds allocated.
2. poor financial administration of hospitals.
3. shortage of staff at PHCs, community health centres (CHCs) and district hospitals.
4. lack of essential medicines.
5. broken-down equipments.
6. unfilled doctor vacancies.
7. extraordinary patient load on a few referral hospitals.

• Basic facilities in the form of health sub-centres, PHCs and CHCs in some states met only half the need.
• This puts the pressure on a handful of referral institutions on the top as in the case of the Gorakhpur hospital.
• As a result a large number of very sick patients are sent to such apex hospitals only as a last resort and not for immediate remedies.

What is the way forward?

• Sustained investment in and monitoring of India's health system is of prime importance.
• Ensuring access to a health facility with the requisite medical and nursing resources within a 3-km radius is of priority.
• Moving to a single payer system with cost controls for efficient, strategic purchase of health care from private and public facilities is essential.
• As the NITI Aayog has pointed out in its action agenda for 2020, the government has to recognise the limitations of a market-led mechanism.
• It is thus high time that the government takes up the idea of providing health as pure public good.
• Bringing equity in access to doctors, diagnostics and medicines for the rural population has to be a priority for the National Health Mission.

Source: The Hindu