Nationwide, India suffers an 82 percent shortage of specialist doctors in its community (CHCs) and primary health centres (PHCs) – the frontline of the nation’s healthcare infrastructure. This is according to data released by the Union Health Ministry, which also revealed a shortfall of laboratory technicians of almost forty percent and dearths of nurses and pharmacists between twelve and sixteen percent.
India has just one allopathic doctor for every 11,082 people, with the deficiencies of specialist doctors highlighting what this means for those attempting to avail healthcare. State by state, the figures vary and, in many examples, are even higher than the national average. Even states ranked highly on healthcare management like Kerala (recently named by Niti Aayog the best-performing state in India on health parameters in recent rankings) fare poorly in terms of staffing levels, with a shortage exceeding ninety percent in the state. The same is true of Uttar Pradesh (which Niti Aayog’s Index named the worst-performing state on health), Gujarat, Haryana, Himachal Pradesh, and West Bengal.
The figures shed fresh light on the poor status of healthcare infrastructure in Bihar, which has seized hold of national and global headlines in the wake of an encephalitis outbreak which has left more than 150 children dead. The aftermath of the tragedy saw poor health infrastructure implicated as a driving factor behind the deaths, with the National Human Rights Commission castigating all the states and the central government alike for the “deplorable” status of public health infrastructure.
The Union Health Ministry identified a specialist shortfall of more than 86 percent in Bihar, revealing a staggering lack of physicians, paediatricians, obstetricians, and gynaecologists, and surgeons. This applies not only to that one state, but manifests as a national crisis impeding efforts to deliver accessible, affordable, and high-quality healthcare to citizens. As stated by Vivek Srivastava, chief executive officer and co-founder of Healthcare at Home, “while Ayushman Bharat is a significant step in the direction of increasing affordability, accessibility of quality healthcare still remains a concern”, particularly “in the wake of shortage of medical infrastructure and skilled manpower”.
As previously reported by Health Issues India, inadequate staffing levels are a major driver of the subpar healthcare crisis which results in the death of 1.6 million Indians annually. By comparison, lack of access to healthcare kills 838,000 people every year – conveying that accessibility must be ensured, but that quality cannot be overlooked. To do so, fixing the specialist doctor shortage is imperative.
Lack of qualified personnel means the mantle is often assumed by those who lack proper training and credentials, so-called ‘quack doctors’ being perhaps the most notable example of this. Government initiatives have also sought to plug the gap have included recruiting dentists and homoeopaths to fill vacancies. As many as 25 percent of healthcare workers in India may be working without proper qualifications. This portion of the manpower is made up of quacks, “traditional birth attendants, faith healers, snakebite curers and bonesetters”.
Rural areas suffer the brunt of healthcare staff shortages. Down to Earth quoted a report by Indian Journal of Public Health stating
“As of March 31, 2017, the country had a shortfall of 10,112 female health workers at primary health centres, 11,712 female health assistants, 15,592 male health assistants and more than 6,1000 female health workers and auxiliary nurse [midwives] at sub-centres.
“In fact, primary health centres across the country are in want of at least 3,000 doctors with 1,974 such centres operating without a single doctor. In community health centres, there is a shortfall of close to 5,000 surgeons.”
Rural India suffers from shortages of public health infrastructure, ranging from health centres themselves to even hospital beds (across 20,000 rural hospitals, there are less than 280,000 beds). “CHCs are few in number and inadequate in health human resource,” former Director General of National Health Services R. K. Srivastava is quoted as stating in The Times of India. “Primary care is incomplete without efficient response capacity of CHCs to timely address referral needs. This is evident in recent deaths in Muzaffarpur in Bihar. Had there been a strong CHC system, many lives would have been saved.”
It is clear that plugging the healthcare workforce and infrastructure gaps must be considered a priority as the Centre seeks to expand healthcare access in the country through its flagship initiative Ayushman Bharat. In its manifesto ahead of this year’s election, the BJP pledged to establish 1.5 lakh health and wellness centres nationwide and create more medical institutes to train new numbers in the healthcare workforce. The Union Health Ministry has also directed the bodies responsible for awarding the Diplomate of National Board (DNB) to individuals upon completion of postdoctoral or postgraduate medical education to aim to create 10,000 specialist medical professionals.
Expanding access to healthcare will not achieve the objective of improving the quality of life and the health of citizens unless steps are taken to ensure that the healthcare citizens receive is of sufficient quality. Fixing the manpower shortages must be at the crux of this.