COMMUNITY HEALTH CENTRE - HEALTH
News:
80% shortfall of specialist doctors in CHCs: Health Ministry report
What's in the news?
● Specialist doctors, with a shortfall of nearly 80% of the required specialists at Community Health Centres (CHCs), reveals the Rural Health Statistics report published by the Ministry of Health and Family Welfare.
Key takeaways of the report:
● The
Rural Health Statistics report shows that there is a shortfall of more than 80%
of the required surgeons and pediatricians in the 6,064 Community Health
Centres across the country.
● The
report has noted that funds should be
provided for outsourcing and providing support services according to the
need of each centre, and also recommends that nursing orderlies be trained in
the assistive procedures required for surgery.
● There
is also a shortage of female health
workers and auxiliary nursing midwives, with up to 14.4% of these posts
lying vacant in primary health centers and sub-centres.
What is a Community Health Centre?
● CHCs
are 30-bed block-level health facilities
which are ideally supposed to provide basic care related to surgery,
gynecology, pediatrics and general medicine.
Importance
of CHCs:
● It
helps detect diseases early, well
before complications set in.
● It
reduces the need for expensive secondary
and tertiary healthcare.
● Of
the total current expenditure on health classified by healthcare functions, preventive care accounts for 6.7 per
cent, while spending on curing people accounts for 51% of the total expenditure
on health.
● Developed
nations such as the UK, Australia, Canada, Netherlands and Sweden spend a large
share of their federal healthcare budgets on community health care.
● India
has been spending huge amounts in the cure of non-communicable diseases, which can only be won through a
community health system that ensures that chronic diseases are not only
detected early, but also that preventive action is taken to ensure improved
lifestyles.
● Unavailability
of CHC from the government leads to heavy
burden, out of pocket expenses on consultations and drugs.
Problems of CHC in India:
1. Limited services:
● Although
the community health care system exists in India, its scope is limited to
pregnancy care, limited childcare and certain services related to national
health programmes.
2. Training and manpower problems:
● CHCs
are suffering from poor management skills, lack of appropriate training and
supportive supervision for health workers.
3. Conversion in Health and Wellness centres:
● Government
announced the conversion of 150,000 sub centres into HWCs in the 2017 budget
and also in National Health policy 2017, only a few thousand such centres have
been sanctioned.
4. Urban neglect:
● Community
health care for the growing urban population has not been conceptualized. Its
focus is still limited to the rural population of India.
5. Funding:
● Funding
for overall health care is very low, leaving insufficient amounts that require
to be spent on CHCs.
6. Staff shortage:
● CHCs
are also suffering from inadequate skilled and trained manpower.
● There
is a shortfall of about 9,000 doctors in about 25,000 CHCs in the country.
7. Poor facilities:
● Primary
level facilities need complete building reconstruction, as they operate out of
rented apartments and thatched accommodations, and lack basic facilities such
as toilets, drinking water and electricity.
8. Overburdened CHCs:
● India
has a large network of CHCs, each supposed to serve a population of 25,000.
● But
in states such as Madhya Pradesh, Bihar and Jharkhand, however, a CHC covers as
many as 45,000, 49,000 and 76,000 people.
Government measures:
● The National Health
Policy (NHP), 2017 advocated allocating
resources of up to two thirds of total health budget to Primary Health care.
● An
outlay of ₹1,200 crore was proposed to transform
1.5 lakh sub-health centres into health and wellness centres (HWC) by 2022,
which would provide a wider range of primary care services than existing sub
and primary health centres (PHC).
● Each
HWC is to be operated by a well-trained, mid-level health provider (nurse
practitioner or community health officer) who will be supported by a team of
front line health workers to provide an expanded package of services.
Best National and International Practices:
● Cuba
has one of the most effective community healthcare systems in the world, the
system provides community-based polyclinic, each polyclinic serves a catchment
area hosting between 30,000 and 60,000 people.
● Polyclinic facility
is further extended by neighborhood-based family doctor and nurse offices
closer to the communities, one such office for 1,000-2,000 people.
● Prevention
is the cornerstone of these services, complemented by community analysis and
treatment.
● In
a cross-country analysis of governance systems and health outcomes, countries
with higher fiscal decentralization
(Citizens participation) were found to have consistently lower infant
mortality rates that those with more centralized forms.
● In
West Bengal and Kerala in India -
states in which primary healthcare is co-managed by panchayats – health
outcomes are better than in most other states at similar levels of economic development.
WAY FORWARD:
● Government
must fasten the process of conversion of Sub-health canters into health and
wellness centres so that it can achieve its target by 2022-23.
● Digitization of family
records and information from the community to the
facility level, to provide better treatment.
● An
important requirement of community health care is the active participation of
those whom the care serves – akin to citizen
participation in democracy. Such systems are likely to be more responsive
to public needs.
● Government
should delegate the responsibility of managing these health facilities to communities and local self-government
institutions.
● The
specialist doctors and health workers need to be filled on time and in needed
numbers.
● Nursing
staff must be prepared to provide treatment to the patient in case the doctor
is absent from the clinic. Adequate orientation and training must be provided
to nursing staff for that.
● Government
must increase budgetary allocations
to healthcare to at least 3-4% of GDP so that public expenditure on healthcare
is at least 70% of total health expenditure.
● Undertake
a well-funded research programme to
find the best pathways for effective and context-specific scaling up of
community health care.