Shortfall of surgeons, gynaecologists and paediatricians in rural India was 80% in 2022
The shortfall of specialist doctors in community healthcare centres (CHCs) in rural areas has increased over the past decade in India. Surgeons, obstetricians, gynaecologists, physicians and paediatricians were considered specialists for this analysis. In 2012, the shortfall of specialists was already high at 69.7%, but it increased further to 79.5% in 2022.
As per the norms of the Indian Public Health Standards, a CHC is required to be manned by four medical specialists: surgeon, physician, obstetrician/gynaecologist, and paediatrician. As on March 31, 2022, according to the 2021-22 Rural Health Statistics, released recently, 21,920 specialist doctors were required in rural areas across India. However, only 4,485 were available, which means that there was a shortfall of 17,435 specialists. This translates into a shortfall of 79.5% (17,435 as a percentage of 21,920), which is nearly 10% points more than a decade ago .
As of today, India has 1,57,935 sub-centres in villages, 24,935 primary health centres and 5,480 CHCs.
One PHC caters to 30,000 people in plains and 20,000 in difficult areas while one sub-centre caters to 5,000 and 3,000 people, respectively.
The health manpower shortage continues at the level of village sub-centres, with shortfall in the posts of female health workers and ANMs (auxiliary nurse midwife) being 3.5 pc and that of male health workers being as high as 66.6 pc.
The overall shortfall of manpower at the national level is mainly due to the low staff situation in Uttar Pradesh, Himachal Pradesh, Gujarat, Uttarakhand, Odisha, and Tripura.
6,064 Community Health Centres in country
5,480 in rural areas, 584 in urban areas
1 CHC caters to 1.2 lakh people in plain areas, 80,000 in hilly and difficult areas.
This deficit is not due to dearth of specialists but it's due to complacency, timidity and peanut salaries offered by the Government.
What are CHCs?
CHCs which constitute the secondary level of health care were designed to provide referral as well as specialist health care to the rural population. Indian Public Health Standards (IPHS) for CHCs were first released under National Rural Health Mission (NRHM) in early 2007 and are mandated to provide specialised medical care of surgeons, obstetricians, gynaecologists, physicians and paediatricians to the village population.
CHCs are being established and maintained by the State government under Minimum Needs Programme (MNP)/ Basic Minimum Services (BMS) Programme.
As per minimum norms, a CHC is required to be manned by four medical specialists i.e. surgeon, physician, gynaecologist and paediatrician supported by 21 paramedical and other staff. It has 30 in-door beds with one Operation Theatre (OT), X-ray, labour room and laboratory facilities. The idea of a CHC is to serve as a referral centre for Primary Health Centres (PHCs) and to also provide facilities for obstetric care and specialist .
The RHS report (published on jan 12th.2023, also recommends that nursing orderlies be trained in the assistive procedures required for surgery and funds be provided for outsourcing and providing support services according to the need of each centre,
“Apart from specialist doctors, there is also a shortage of female health workers and auxiliary nursing midwives, with upto 14.4% of these posts lying vacant in primary health centres and sub-centres,”.
Primary health centres see over 50% increase in doctors .
The allopathic doctors at PHCs have increased from 20,308 in 2005 to 30,640 in 2022, which is about 50.9% increase. There is shortfall of 3.1% of allopathic doctors at PHC, out of the total requirement at all India level.
As per norms, each sub centre (SC) is supposed to cater to a population of 3,000-5,000, each PHC to a population of 20,000-30,000 and each CHC to a population of 80,000-1,20,000. Actually, The RHS estimates as of 31 March, 2022, has revealed that each SC catered to an average of 5691 people, each PHC to 36049 people and each CHC to 164027 people.
Urban health statistics
The RHS also provides an update on the status of implementation of the urban component of the health mission under which multi tier health centres are set up to cater mainly to people living in urban slums. There is a vacancy of 18.8% of doctors, 16.8% of pharmacists, 16.8% of lab technicians and 19.1% of staff nurses at the U-PHCs, the report says. There is a shortfall of 35.5% auxiliary nurse midwives at PHCs. Additionally, there is also a shortfall of 5.0% of doctors, 24.5% of pharmacists, 29.1% of lab technicians and 1.2% of staff nurses
at U-PHCs.There is also a shortfall of 46.9% of total specialists, 14.7% of General Duty Medical Officers (GDMOs), 49.3% of radiographers, 3.9% of pharmacists, 7.2% of lab technicians and 5.3% of staff nurses at Urban Community Health Centres (U-CHCs).
The population covered by a U-PHC may vary from 50,000 for cities with sparse slum population to 75,000 for highly concentrated slums. Urban Community Health Centre U-CHCs is set up as a referral facility for every 4-5 U-PHCs. The U-CHC caters to a population of 2,50,000 to 5 lakhs. For metropolitan the metro cities, UCHCs are to be established for every 5 lakh population with 100 beds.
Shortfall of auxiliary nurse midwives at health sub centres and primary health centres across India
In the following states, the shortfall has increased from 2020-21 to 2021-22.
Shortfall in nursing staff at primary health centres and community health centres in rural areas
Nursing staff are the backbone of healthcare at PHCs and CHCs. Their presence is especially important to make some of the PHCs and CHCs functional all day, everyday.
Shortfall of specialists at CHCs across India: Surgeons
CHCs are mandated to have one surgeon each. Thus, these are the number of CHCs that have zero surgeons in each state.
What is the Rural Health Statistics report?
It is an annual publication of the Ministry of Health and Family Welfare (MoHFW) since the year 1992.
The report provides data on health infrastructure including manpower up to 31st March of every year.
Source: Rural Health Statistics 2021-22 and 2020-21, Humanitarian Data Exchange (Boundaries)
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