“Last year my elder brother met with an accident. We immediately took him to the nearest Community Health Centre. But there were no doctors. Nurses and ward boys were treating patients. So, we took him to a private hospital. The doctor there said my brother could have died as he had lost lot of blood,” said Amit Kumar, 35, who lives in Gorakhpur, Uttar Pradesh.
“That was the last time I went to a government hospital,” he added.
The Gaon Connection had conducted a nation-wide survey in the month of May in 19 states. It was the biggest rural India survey. We asked more than 18,000 people to comment on issues that are plaguing people living in rural India.
One of the important aspects of this survey was condition of healthcare facilities in rural India.
While 44% said they go to the nearest government hospital when they fall sick, but every third person living in rural India (36%) prefers going to a private doctor. When we asked people if doctors are present at government hospitals, 42.34% said doctors are present, 18.33% said doctors are not present, while 3.46% people said doctors are only sometimes present.
The Primary Health Centres (PHCs) and Community Health Centres (CHCs) are first rung in any state’s healthcare system, but they are in miserable condition. The buildings are dilapidated, there are very few doctors and people often complain that the facilities are below par and they never get medicines here.
When we visited the Jalalnagar PHC in Maholi block in Uttar Pradesh, the PHC was dirty as noone had bothered to clean it in months.
Arjun from nearby Manikpur village, who was there for treatment, said: “There are no doctors here and very few patients come to this PHC as the approach road is so bad.”
Kuldip Kumar, 40, who lives in Murena, Madhya Pradesh, said: “The PHCs and CHCs in India are in terrible condition. There are no doctors, no beds, no facilities and no medicines.”
According toRural Healthcare Department’s 2016 data, in Uttar Pradesh, 84% posts of specialists are yet to be filled and combined staff at both PHCs and CHCs is running at only 50% strength.
According to the World Health Organisation, there is a dearth of 14 lakh doctors in India. Despite this, only 5,500 posts get filled every year. The WHO data adds that number of specialists in India is less than 50%. In rural India, this number stands at 82%.
More than 5 lakh doctors are needed in India. Five decades back there were 23 medical colleges in India. Though in 2014, there were 398 medical colleges, but the number should have been 1,000, the report said.
Dr Tedros Adhanom Ghebreyesus, the WHO director-general, had said in a press release: “In India, many people are still dying of diseases that are completely curable now. Many people have to spend their entire savings on treatments which makes them poorer. There are so many people who don’t even get to avail healthcare facilities.”
According to a report published in medical journal ‘The Lancet’ in 2016, India stands at 145 of the 195 countries in terms of reach and medical facilities. In 1990, India stood at 153th position. In 2.5 decades, India had improved its score by only 16.5 points, whereas the world average was 54.4 that year.
Prof Rajendra Prasad, ex-director of Patel Chest Institute, New Delhi, said: “We keep talking about pathetic healthcare facilities in India, we even make polices, but we lack when it comes to implementation. A large part of our population gets affected by this. If we talk about TB, it’s completely curable now, but people are still dying of TB.”
Anupriya Patel, Minister of State in the Ministry of Health and Family Welfare, had informed the Lok Sabha that in the past three years, we have used only 1.2-1.5% of our GDP on healthcare facilities. In 2016-17, we had used 1.5 of our GDP on healthcare. In 2015-2015, this figure stood at 1.4% and in 2014-15, it stood at 1.2%.
Health expert Dr Abhay Shukla said: “There is a gap between what we suggest to the government and what the government does. We are demanding better healthcare facilities for all. In foreign countries, primary and secondary healthcare facilities are free for people. But in our country, only 50 crore people are covered under the Pradhan Mantri Jan Arogya Yojna, rest of the 80 crore people are not covered.”
In 2013-14, we spent only 1.2% of the GDP on healthcare facilities, whereas in 2016-17 it was increased to 1.4%. In 2017-18, the government allotted Rs 48,878 crore on healthcare, which in 2013-14 stood at Rs 37,330 crore.
Malini Aisola, co-convener of All India Drug Action Network, said: “It’s a good thing that people are getting benefited by the Ayushman Bharat scheme. But under this scheme, enough attention is not given to primary health facilities, which is important for countries like India. Till the time we strengthen our primary healthcare system, such schemes will not reach 100% of the population.”
The WHO report mentions that 3.9% of our population — 5.1 crore Indians — spend one-fourth of their household spending on healthcare. In Sri Lanka, this number stands at 0.1%, in America, 0.8% and in China it stands at 4.8%.
According to the health Department’s Central Bureau of Health Intelligence, in India, there is one doctor for 11,082 people. As per the world average there should be one doctor for 1,000 people. In Bihar, there is one allopathic doctor for 28,391 people. The situation is grim in states like Uttar Pradesh, Jharkhand, Madhya Pradesh and Chhattisgarh.
Paan Singh, 60, who lives in Champavat district, in Uttarakhand,said: “We have a government hospital, but we don’t get medicines. Doctors come only sometimes. Those who are seriously unwell, we have to take them to Haldwani, which is 128 kms from here.”
Ravindra Kumar, 30, who lives in Baddi, Himachal Pradesh, said: “The government is spending a lot on healthcare, but the money is not being utilised properly.”
