Friday, August 17, 2012

India has 76% shortfall in govt docs - Times of India

After spending around 1% of its gross domestic product (GDP) on health in the past five years, the government is proposing an increase in public spending by half a percentage point to make it 1.58% for the coming five years (2012-17) under the 12th Plan. This is what the draft chapter on health in the Plan document says. Health experts and activists are up in arms at this meagre increase because even the Planning Commission’s high-level expert group and the steering committee on drafting the Plan had suggested at least 2.5% of the GDP as the public health spend.  But what happens with low spending? The Planning Commission’s own analysis of the state of the country’s healthcare system reveals the rot within. 
Quoting from the latest available rural health statistics for 2011, the draft chapter gives details of two key areas — physical infrastructure and human resources. 
The statistics show a shocking shortfall of human resources, be it doctors, nurses or other healthcare personnel. According to the Planning
Commission’s draft, the country’s government-run healthcare system is hamstrung because the number of doctors is short of the target by a jaw-dropping 76%, there are 53% fewer nurses, specialist doctors are short by 88%, radiographers are short by 85% and laboratory technicians are short by 80%. 
What the shortage of personnel means is that in many states where infrastructure is largely present, the absence of doctors and nurses renders the whole facility meaningless. Thus, 
Gujarat has only a 5% shortfall of community health centres (CHC) but only 76 out of the 1,220 specialists required are available. In Odisha, there are 377 CHCs although only 327 are required as per norms. But of the 1,570 specialists required to man these CHCs, only 438 are at work. 
This is the situation after the government spent . 33,390 crore, that is 52% of its total National Rural Health Mission (NRHM) budget on human resources. 
The picture is grim on physical infrastructure too, consisting of the gigantic network of health sub-centres (SC), primary health centres (PHC), community health centres (CHC) and district hospitals (DH). There are supposed to be 1,78,267 SCs in the country on the basis of about one per 1,000 population. In reality, there are only 1,48,124 — about 17% short. 
Politics plays a key role in public healthcare 
There are supposed to be 1,78,267 SCs in the country on the basis of about one per 1,000 population. In reality, there are only 1,48,124 — about 17% short. Even among the functional ones, more than 40,000 are working out of rented buildings; buildings for 13,000 sub-centres are still being made. A quarter of them don’t have water and a similar proportion has no electricity. 
The situation is no different as one goes up the ladder. There is an 18% shortfall in PHCs, and an alarming 34% shortfall in CHCs. District hospitals are only 4% short of the target but since all lower centres are short and illequipped, the rush to district hospitals causes massive crowding. 
This is the result after the government spent Rs17,380 crore or about 27% of its total National Rural Health Mission budget on setting up infrastructure in the last five years. 
The physical infrastructure available is unevenly spread across the country. In states like Tamil Nadu, Kerala, Odisha, Jammu and Kashmir, Himachal Pradesh and many states in the northeast, there is no shortfall of community health centres. But in states like Assam, Bihar, Karnataka, MP, Maharashtra, UP and West Bengal, the shortfall ranges between 33% and 91%. This clearly shows that as much as finances, political will at the state government level is also a key determining factor in the fate of public healthcare. 
 So, by under-investing in key areas like infrastructure and deployment of qualified personnel, the government appears to have constrained the spread of health facilities for all — and apathy at the state government level has further worsened the situation. Will another half a percentage point increase solve this colossal problem? TNN

Subodh Varma TNN 

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