Economic Survey 2018-19: Healthcare still inaccessible in rural India

Most primary health centres have only one doctor; out-of-pocket expense still high

By Banjot Kaur
Published: Thursday 04 July 2019

There may be a lot of attention on improving tertiary healthcare in India but, going by the latest Economic Survey, healthcare in rural areas remained a concern.

Sixty per cent of primary health centres (PHCs) in India have only one doctor while about five per cent have none, according to the Economic Survey 2018-19, tabled in the Parliament on July 4, 2019.

Gujarat, emerged the worst performer, with more than 90 per cent PHCs having just one doctor. The state was followed by Kerala and Karnataka (80 per cent each) and Rajasthan, UP and Bihar (70 per cent each).

More than 10 per cent PHCs in Jharkhand and over 20 per cent in Chhattisgarh function without doctors, the Survey stated.

“States with large number of PHCs functioning with just one doctor or without a doctor are indicative of relatively higher rural Infant mortality rates (IMR) and maternal mortality ratio (MMR),” according to the Survey.

Besides the lack of doctors, participation of healthcare staff was also found to be disturbing.

“What this data does not reveal is that 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,” the Survey stated.

Only 20 per cent PHCs complied with Indian Public Health Standards (IPHS), the Survey said. The National Rural Health Mission (NRHM) introduced IPHS in 2007 to improve the quality of healthcare delivery — in terms of infrastructure and human resource. 

Haryana and Uttar Pradesh emerged the worst performers, with less than five per cent PHCs following the norms. In contrast, in Tamil Nadu and Andhra Pradesh 90 and 100 per cent PHCs respectively adhered to the norms. 

High cost 

Adhering to the regulations directly lifted antenatal care facilities in the PHCs and consequently lowered the risk of MMRs in the state, the Survey said.

The allocation on healthcare as a percentage of the gross domestic product (GDP) remained at 1.5 per cent. Out-of-pocket expenditure (OOPE) was still worrisome — one of the highest in the world, despite a decline in the last few years.

The Survey identified cost of medicines as one of the major contributors to OOPE. 

This reveals that despite several schemes of the government to provide free drugs, including the Jan Aushadhi Yojana, the situation has not changed much in reality.  

While there are “various provisions to provide medicines free of cost, but in reality, a majority (more than 60 per cent) of the patients are still forced to pay,” the government conceded. 

AYUSH programmes may help government bring down OOPE, it suggested.

“There are several scalable projects in the areas of infertility treatments, NCDs (Non-Comunicable Diseases) etc, which can be adopted across India by co-locating AYUSH healthcare services under single roof so that people are free to choose, what is appropriate for them, thus making healthcare more accessible, accountable, affordable and customised,” it added.

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