India still struggles with rural doctor shortages

Abstract

In the last week of November, two siblings aged 5 and 6 years died in a remote village in central India after they were given an injection by a quack who thought they had chickenpox. The village, Khodsanar in Chhattisgarh state, is accessible only by boat and is more than 40 km away from the nearest government hospital. The incident highlights the poor state of rural health care in India, a system blighted by lack of access to health-care facilities, shortages of doctors and paramedic staff , and the predominance of untrained private practitioners as the fi rst point of care. The rural health-care system in India is composed of three tiers. Subcentres are manned by trained health workers and auxiliary nurse midwives, with each centre covering up to 5000 people. Primary health centres, which act as the fi rst point of contact between village communities and a medical offi cer, are supposed to have a doctor supported by 14 paramedics and other staff. Community health centres are meant to have four medical specialists (a surgeon, physician, gynaecologist, and paediatrician) supported by 21 paramedic and other staff as well as 30 beds and facilities such as an operating theatre and radiology room. Although the number of health facilities has risen in the past decade, workforce shortages are substantial. As of March 31, 2015, more than 8% of 25 300 primary health centres in the country were without a doctor, 38% were without a laboratory technician, and 22% had no pharmacist. Nearly 50% of posts for female health assistants and 61% for male health assistants remain vacant. In community health centres, the shortfall is huge—surgeons (83%), obstetricians and gynaecologists (76%), physicians (83%), and paediatricians (82%). Even in health facilities where doctors, specialists, and paramedic staff have been posted, their availability remains in question because of high rates of absenteeism.