Acute shortage of doctors and health workers imperil healthcare delivery in India
Health and wellness centers are part of the Narendra Modi government's big idea in healthcare — Ayushman Bharat, which the BJP manifesto calls 'the world's largest health care programme'. But what about its implementation?
Patralekha Chatterjee 28 May 2019 7:10 AM GMT
Those who have money in this country have the luxury of bypassing the creaky health care system and access world-class treatment in top, private hospitals. But what will change for the men and the women living out their lives away from the glare of prime time?
India's 'festival of democracy' is over. It is no secret that the polls were seen, in one way or the other, as a referendum on Prime Minister Narendra Modi, and a fierce tug-of-war between contesting ideas of India. Verdict 2019 shows an overwhelming mandate for Modi 2.0.
In this polarised ethos, where does healthcare figure?
Predictably, healthcare is also contested terrain in a country with one of the highest out-of-pocket expenditures on health.
As in everything else in India, however, the real story lies not always in the big picture, but in the details, in what is actually happening on the ground, how the big idea impacts the little man – and woman.
Last month, I visited the Salwan primary health center. It is beside a temple, on the edge of Salwan village, one of the largest in Haryana's Karnal district. It has had a new look in the last six months, and is now called a 'health and wellness center.'
For those who don't read budget speeches or manifestos, 'health and wellness centers' (HWC) are part of the Narendra Modi government's big idea in healthcare — Ayushman Bharat, which the BJP manifesto calls 'the world's largest health care programme.'
Ayushman Bharat has two components. The better marketed one is the insurance initiative called Pradhan Mantri Jan Arogya Yojana (PMJAY), launched by Prime Minister Modi himself last September, in Ranchi, and which seeks to provide an annual cover of around five lakh rupees to around 500 million of the poorest Indians for secondary and tertiary care in hospitals.
But the more crucial component which touches a gaonwalla is the plan to create 1,50,000 Health & Wellness Centers (HWCs) by upgrading existing Sub Health Centers and Primary Health Centers. The HWCs are meant to deliver 'comprehensive primary health care' by 2022. According to the BJP manifesto, till date, 17,150 such HWCs have become functional.
The Salwan HWC is one of them, which is what took me to Salwan village.
At first sight, the Salwan health and wellness center is impressive. Unlike many PHCs that I have visited in rural India, this one did not look dirty or decrepit. It was neat and clean; it looked well-maintained. Its walls were a lovely shade of yellow ochre with decorative designs on them. There were potted plants all around. All in all, it makes a good first impression.
I even spotted signage indicating that the new HWC has a colour-coded bed linen schedule. On Mondays, bed linen is supposed to be violet; on Tuesday, it is the turn of indigo and so on. There were boards listing out the expanded services that the HWC is meant to provide. These included a host of new services for which village residents would have had to go elsewhere earlier, like screening, prevention, control and management of non-communicable diseases and basic management of mental health issues.
The problem was that despite all the infrastructural improvements, the HWC did not have a permanent doctor. A doctor from elsewhere was deputed to visit the center once a week, for a few hours. The day I visited, the staff on duty included a multipurpose health worker, a health inspector, a staff nurse. They were clearly doing their best. I was told there was also an auxiliary nurse and midwife (ANM) and another female health worker who were out in the field. I was also told that the supply of medicines had improved in recent months.
But what was disconcerting was that this rush of activities had started only in recent months. Why the last-minuteism, one wondered, if the vision was so grand?
One of the health workers who I spoke to said the staff could do so much more 'if there was a medical officer and if all the sanctioned posts were filled up.' Salwan HWC is among the better-equipped government health facilities in the country. Acute shortage of doctors and health workers imperil healthcare delivery in many parts of the country.
Another recent trip to Haryana took me to another health center. This one was located in the village of Ujina in Haryana's Nuh (earlier called Mewat) district. Less than 60 kms from glitzy Gurugram of malls, multiplexes and multinationals, Nuh, is one of Gurugram (formerly Gurgaon) Lok Sabha constituency's worst-kept secrets. Nuh is one of the most backward pockets of the country. According to the latest National Family Health Survey (NFHS 4), around 84% of the children age 6-59 months in the district are anaaemic. And that's just one among many markers of Nuh's backwardness and deprivation.
In January 2018, the Modi government launched the Aspirational District Programme and Nuh became one of the 101 most 'aspirational districts'.
In the past year, Nuh has seen some improvement in areas like financial inclusion. Nuh town also has a new look bus stand with a night shelter where you can get a bed for 50 rupees.
But in the villages, things are bad. The acute drinking water crisis persists; little girls who should be at school trudge long distances to fetch water.
The good news about the Ujina PHC is that it has a medical officer. The bad news is that though there has been a rush to fill vacancies, especially in the past year, there is still a manpower shortage. The laboratory technician's post has been vacant for 4 years; much of the equipment for the laboratory is lying idle.
Monika Sinha who is in charge of the Ujina PHC said more than 10 vacant posts have been filled up in the past year. Sinha who was put in charge of the Ujina PHC a little over a year ago said if her PHC had a lab technician, many more blood tests could be done right there. Ujina PHC can do malaria tests and is now better-equipped to tackle malaria outbreaks, a chronic problem in the area, but patients who come o the PHC for other tests have to be referred elsewhere because of the lack of a laboratory technician.
The plan to provide comprehensive primary health care is a good idea. But many health experts say the initiative is not backed by sufficient resources. "All the necessary posts for the HWCs have not even been sanctioned. Yes, they do have time till 2022. But the issue is that they do not have the budget, or the human resources policy or the IT support…" says Prof Thiagarajan Sundararaman, Dean of the School of Health System Studies at the Tata Institute of Social Sciences (TISS)
The opposition Congress Party's big idea in health care was the Right to Healthcare Act. Its poll manifesto promised that the party will legally guarantee every Indian citizen the right to healthcare services and enable State Governments to revamp primary health centers, if voted to power.
Those who have money in this country have the luxury of bypassing the creaky health care system and access world-class treatment in top, private hospitals.
But what will change for the men and the women living out their lives away from the glare of prime time? That still remains the big issue now that the season of discussions about who will win how many seats from where is over.
Patralekha Chatterjee is an award-winning journalist/columnist, and photographer focusing on development issues. Currently, her writing focuses on the intersection of politics and public policy on a range of inter-linked development issues for Indian and international media.
(Views are personal)