The rural health sector in India poses several challenges despite numerous policies and programmes adopted by the government. One of the problems is accessibility of healthcare services. The first landmark in the official health policy of independent India was the acceptance of the Bhore Committee recommendations of 1946. This laid the foundation of comprehensive rural health services through the concept of primary healthcare.
The recent release of Rural Health Statistics shows that there has been a significant increase in the number of sub-centres, primary health centres (PHCs) and community health centres (CHCs). Since the end of the 10th Five-Year-Plan in 2007, there has been an addition of 1,797 sub-centres, 1,303 PHCs and 490 CHCs. Even as there has been a significant increase in the number of PHCs, many of these lack the basic amenities required for functioning.
To begin with, there is the issue of accessibility to health services, assessed by the average radial distance covered by PHCs. In India, on average a PHC covers 6.47 km. In three Union Territories – Lakshadweep, Puducherry and Daman & Diu – there is at least one PHC in the range of 1 to 3 km. Among the big states, Kerala and Bihar have a PHC within an area of 3-4 km.
At the other end of the table, in Jammu & Kashmir, Andaman & Nicobar islands and Mizoram, a PHC covers an average distance of 10 to 13 km. States like Madhya Pradesh, Jharkhand and Rajasthan – which are grappling with problems of high infant mortality and low life expectancy at birth – have inadequate coverage of PHCs, with one centre for an area of 8-9 km. This is much above the all-India average. (click here for graph)
However, the mere presence of PHCs is not reflective of better health services. For instance, Bihar is among the top two states in the country with respect to the distance covered by a PHC, but 71 per cent of PHCs in the state function without electric supply.
The figures of Bihar are not only startling because of the sheer size but also because the next state with large proportion of PHCs functioning without electric supply is Arunachal Pradesh, at least 39 percentage points behind Bihar. There are 16 states in which all PHCs reportedly have electric supply, but in Chattisgarh and Uttar Pradesh, around a quarter of PHCs function without electric supply.
There are, of course, other parameters of basic infrastructure that need to be analysed — regular water supply, all-weather motor road, adequate doctors, presence of a lady doctor, health workers, lab facilities, beds, operation theatres, medicine supply and so on.
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For instance, as of March 2010, there were more than 6,000 vacancies for medical officers in PHCs to be filled. Apart from the numbers, there are issues regarding the quality of healthcare being provided at these centres. All in all, primary health infrastructure is one of the very basic necessities in rural areas and the disparity across states points to the existing unequal access for citizens.
| VIGOROUS GROWTH | ||||||
| India | 1981-85 | 1985-90 | 1992-97 | 1997-02 | 2002-07 | 2007-12 |
| No. of sub-centres | 84,376 | 130,165 | 136,258 | 137,311 | 145,272 | 147,069 |
| No. of primary health centres | 9,115 | 18,671 | 22,149 | 22,875 | 22,370 | 23,673 |
| No. of community health centres | 761 | 1,910 | 2,633 | 3,054 | 4,045 | 4,535 |
Indian States Development Scorecard is a weekly feature by Indicus Analytics that focuses on the progress in India and the states across various socio-economic parameters