Abstract
BackgroundThe onus of providing affordable access to specialist services in rural India primarily lies with publicly funded rural hospitals, also known as community health centres (CHCs). However, no studies have attempted to measure the change in the shortage and distributional inequalities of specialists in the publicly funded rural hospitals of Uttar Pradesh (India). This study attempts to fill that gap.MethodsThe study uses data from the three latest rounds of the District-Level Household Survey, covering a period of 10 years spanning from 2002 to 2012. Shortages were measured against the Indian Public Health Standards for CHCs, and inequalities were measured using Gini and Theil indices, with the latter decomposed to reveal the source of the inequalities. Negative binomial regression was applied to examine the association between facility characteristics and the availability of specialists in CHCs.ResultsThe current shortage of specialists stands at 80.7% of the total requirement. Currently, 62.1% of CHCs are functioning without a specialist. The distribution of specialists across CHCs has become progressively uneven over the study period, as shown by the rise in the Gini index (from 0.41 in 2002–2004 to 0.74 in 2012–2013). Decomposition analysis reveals that the contribution of within-district inequalities to overall inequality remains high (85.4% of total inequality). About 50% of within-district inequality is contributed by only 20 districts, most of which belong to eastern and central Uttar Pradesh. The analysis of factors affecting the distribution of the current specialist workforce revealed that the number of available specialists at a CHC is positively associated with the availability of residences for doctors and regular electricity supply, and negatively associated with CHC location and the distance of the CHC from the district headquarters.ConclusionThe findings suggest that Uttar Pradesh not only needs to recruit more specialists, but it also requires proper implementation of deployment and retention policies to ensure equitable access to specialist care for rural populations. Ensuring the availability of quality accommodations and basic amenities at all CHCs, as well as adequate transport and rural allowance, could help increase the chances of specialists staying in rural and far-off CHCs.
Highlights
The onus of providing affordable access to specialist services in rural India primarily lies with publicly funded rural hospitals, known as community health centres (CHCs)
The availability of specialists at the CHCs increased by about 50% during the study period, the overall shortage of specialists, which was about 54% of the total requirement in 2002–2004, had shot up to 81% in 2012–2013; overall, the shortage of all the different specialists grew to reach above 80%
Since the state government does not provide any transportation or rural allowance [70] to travel to those CHCs located in rural and far-off areas, it is not difficult to understand why rural CHCs have fewer specialists when compared to their urban counterparts, which are well connected to district headquarters or major cities through major district roads and state highways
Summary
The onus of providing affordable access to specialist services in rural India primarily lies with publicly funded rural hospitals, known as community health centres (CHCs). No studies have attempted to measure the change in the shortage and distributional inequalities of specialists in the publicly funded rural hospitals of Uttar Pradesh (India). Since private health facilities that offer specialists services are mostly found in urban areas, the onus of providing access to specialist services in rural areas primarily lies with CHCs [3]. Since the rural poor mostly rely on publicly funded facilities for their healthcare needs, the lack of specialists at the CHCs often forces them to either forgo treatment or avail specialist services from the private sector, which is infamous for its exorbitant fees [5, 6]. The lack of CHC specialists may cause higher disease burden and mortality for the rural population, and it could trap rural households into a vicious poverty cycle due to the high out-of-pocket expenditures faced when seeking medical care [5]
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