Q Rural health care in India faces significant challenges. Elaborate. What can be done to deal
with these challenges?
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• Give a brief introduction about the rural healthcare sector.
• Write about challenges of the rural health care sector and substantiate them briefly.
• Suggest measures to tackle these challenges.
• Conclude appropriately.
Rural healthcare in India is a tiered structure – sub-centres catering to 3000-5000 people, primary health centres (PHCs) as a referral unit for 5-6 sub-centres, followed by community health centres (CHCs) as a referral unit typically for 4 PHCs. These flow into sub-district and district hospitals, which are further succeeded by medical colleges and research institutes.
Despite systematization in structure, rural health care sector is fragmented for a large section of the population with its own set of challenges, such as:
• Poor access: Only about 25% of the total healthcare infrastructure is concentrated in rural areas. People find it difficult to avail services due to remote locations and increased costs of travelling.
• Lack of Infrastructure & Supplies: Rural healthcare facilities are ill-equipped to support diagnosis and accurate investigations of disease. Medicines are often unavailable due to irregular supplies in rural areas and contribute towards 70% of the out-of-pocket expenditure.
• Shortage of healthcare professionals: 60% of PHCs in India have only one doctor while about 5% have none. There is an 82% shortfall in total surgeons, obstetricians and gynaecologists, physicians, and paediatricians across CHCs in India. Further, there is also a lack of adequate number of paramedical and support staff.
• Quality of healthcare: As per Economic Survey 2018-19, only 11% sub-centers, 13% PHCs and 16% CHCs in rural India meet the Indian Public Health Standards (IPHS).
• Low Health Literacy: Lack of awareness aboutchronic diseases and symptoms, patient’s inability to comprehend health information and instructions from their healthcare providers etc. leads to delays in timely intervention.
Rural healthcare system holds immense importance for our country by virtue of the fact that 69% of the population resides in rural areas. Following steps need to be taken:
• Budgetary expenditure on healthcare should be increased to at least 3% from existing 1.2% of GDP with special focus on expenditure in rural healthcare.
• Physical access to healthcare infrastructure should be improved by upgrading existing facilities and improving transportation capacity.
• Training and provisions of medical staff and support staff should be taken on priority. A certification programme for ASHAs could be brought for their preferential selection into ANM, nursing and paramedical courses.
• Providing subsidised insurance cover will not only encourage people to seek early healthcare but also incentivise private healthcare providers.
• Assisted telemedicine-based systems in conjunction with PHCs and CHCs should be adopted for faster and accessible healthcare and early diagnosis.
• Incentives and adequate amenities should be given to doctors to work in rural areas.
• AYUSH and preventive healthcare systems should also be promoted in rural areas.
Though the rural healthcare system has improved a lot in India since independence, still there are gaps, which need to be taken care of through holistic policies and strong political will power. In this direction, policies such as National Health Policy 2017, Ayushman Bharat, upgradation of 1,50,000 existing facilities into Health and Wellness Centres are steps in the right direction.