Primary health care centres around the country caught in staff crunch

Located in a narrow lane in Sahibabad district of Uttar Pradesh is what looks like a modest house. But nobody lives here. You step inside to find only one room where a doctor, a pharmacist, a technician and a nurse share space. There’s not even a board outside to indicate it is a primary health care centre, theoretically the starting point in the country’s rural areas. 

At a time when the government is set to roll out the biggest health care insurance scheme, Business Standard visited a few primary health care centres bordering the capital, in Uttar Pradesh and Haryana, to assess the state of the service.   

At the Sahibabad centre, when the doctor posted there goes on leave, no full-time replacement is sent, people in the know said. A doctor from the nearest primary health care centre comes visiting only when there is an emergency. Usually, the support staff offer treatment and prescribe medicines in the absence of a full-time doctor. While the doctor-nurse-pharmacist team manages to treat the locals on a day-to-day basis, it’s a challenge to implement vaccination programmes. While one vaccine specialist is supposed to handle around 10,000 persons, the number often doubles up, a source pointed out. 

Demand for more

In fact, a letter stating the centre’s requirement has recently been sent to the state government authorities to provide more trained personnel for vaccination. A source connected with the development said, “the state government has also conducted tests but it hasn’t deputed anybody to the field.” 

On the other side of Delhi’s border, a primary health care centre in Fathepuri Tappo, a village in Haryana, presents a similar picture. The centre runs with bare minimum support staff- with only one technician, nurse and pharmacist. The health ministry is aware of the situation, according to a source. 

The demand for pharmacists across the state health care centres is on the rise.  And, Pharmacists’ association in Haryana has asked the health ministry to provide more pharmacists in the primary health care centres through Haryana. There’s no word yet on how the health ministry has responded. 

The guidelines

As per stipulation, a primary health care centre is to be manned by a medical officer supported by 14 paramedical and other staff.

While usually health service providers like doctors and their support staff take the blame for not doing their job diligently, things are different at the centre in Fatehpuri Tappo. The government is not keen to upgrade the centre, a local grudged. The staff is working against the odds, trying to improve things. "We have approached government authorities asking for providing an x-ray machine. However, our request has been declined. We have been told a primary health care centre need not provide such a facility," said another source. 

The numbers 

On average, 30,000 persons are covered by public health centres, as per the 2011 census with most primary health care centres having only one nurse, one technician, one pharmacist and one doctor.

At the All-India level, government data till March 2017 states that lab technicians are short by 12,511. The actual requirement is 31,274. Allopathic doctors are short by 3,000. The actual requirement is a little over 25,000 doctors at primary health care centres. 

Out of the 25,650 PHCs, 1,974 do not have even have one doctor, 15,700 PHCs have only one doctor and 6,305 have two doctors. Around 4,744 of these PHCs have no pharmacist and 9,183 have no lab-technician. An estimated 6,611 PHCs do not have a lady doctor.  

The next stage of providing treatment is the secondary health centre which is also called First Referral Unit (FRU), which typically have more than 30 beds. Out of 3,076 FRUs, 79.9 per cent FRUs have more than 30 beds which essentially means the remaining are short of even basic minimum requirement. 

Given these numbers, the primary and secondary health care system needs more attention than tertiary health care, according to experts. Tertiary health care is largely restricted to big cities and people in small towns often have to travel long distances to get treatment of any consequence.