Nearly 80% shortfall in specialist docs in rural community health centres

Situation in 2021 has worsened over the previous year, shows government data

There has been a worsening of the shortage of specialists at community health centres in rural areas.

The total shortage widened to 79.9 per cent in 2021, from 76.1 per cent a year earlier, according to data from the Rural Health Statistics 2020-21 report. There is a shortage in every specialization including surgeons, physicians, paediatricians as well as obstetricians and gynaecologists. The shortages range from 74-84 per cent.

A community health centre is the third tier of the rural health infrastructure system. The first is a sub centre which caters to a population of between 3,000 and 5,000. The second is the primary health centre which covers a population of 20,000 to 30,000. The community health centre is a larger establishment to cater to a rural population of between 80,000 and 120,000 where they can access specialist care. Around 80 per cent of the requirement for specialists at such centres is currently not being met.

Absence of infrastructure and financial disincentives play a role according to a 2009 note entitled ‘Revitalizing Rural Health Care Delivery: Can Rural Health Practitioners be the Answer?’ from authors Kapil Yadav, Prashant Jarhyan, Vivek Gupta, Chandrakant S Pandav at New Delhi’s Centre for Community Medicine.

“Often it is argued that the financial rewards in the public health sector are too low to attract the graduate doctors to the scattered rural areas. Another reason cited is that the absence of minimal physical and social infrastructure makes it impossible for young medical graduates to serve in the rural areas… We have to be realistic and accept that trained doctors who have put in 10 years or so in training and are predominantly from urban areas are unlikely to want to go to villages,” said the note which advocated creating a tier of rural healthcare practitioners with some training and accreditation.

 Some states and union territories suffer worse than others from the absence of specialists. They include many places in the north east (see chart 2). Meghalaya, Mizoram and Sikkim are among those who figure in the list. Puducherry, Himachal Pradesh and Bihar are also included in the places with over 90 per cent shortfall.

Better incentives for rural postings was suggested in a paper by S Garg of the Department of Community Medicine in New Delhi along with fellow authors R Singh and M Grover in a 2012 note entitled, ‘India's health workforce: current status and the way forward’.

“These incentives could be financial, housing-related, including interest-free loans for housing, admission of children to schools and even to professional schools, out-of-turn promotions, subsidized rations, etc,” it said.

There are currently 5,481 functioning community health centres as of March 2021. This is an increase of 2,135 from 2005. Each community health centre serves as a referral point for four primary health centres and has 30 indoor beds, besides X-ray, labour room and laboratory facilities. The increase has come from centres in Uttar Pradesh (367), Tamil Nadu (350),  Rajasthan (263), West Bengal (253), and Bihar (205).  

The number of specialists operating in such centres is up from 3,550 in 2005 to 4,405 in 2021, according to the report.