Facing a shortfall of 2,277 doctors — against the required strength of 3,621 — and with 942 primary health centres (PHCs) working without electricity, regular water supply and all-weather motorable approach road, Uttar Pradesh’s PHCs have the worst patient:doctor ratio and infrastructure in the country to cater to the poorest patients.
This according to a reply given by the Union Health Ministry in the Lok Sabha, earlier this week, on the question of shortage of doctors in PHCs and the state of infrastructure.
The other States that have shown poor PHC ratings — the backbone of the health delivery system — include Chhattisgarh, Odisha, Karnataka and Bihar as per the Rural Health Statistics-2018, quoted by the Ministry.
The data note that while Uttar Pradesh requires 3,621 doctors for its PHCs, it has a sanctioned strength of 4,509 but has only in position strength of 1,344 with 3,165 seats being vacant and showing a clear deficit of 2,277.
No power, water
The State also has the worst infrastructure PHC-wise with 213 centres not having electricity supply, 270 without regular water supply and 459 without all-weather motorable approach road. The other States that have poor infrastructure based on the same parameters include Jammu and Kashmir, Chhattisgarh, Odisha, Assam and Uttarakhand.
The Ministry in its reply noted that public health and hospitals being a State subject, all the administrative and personnel matters, including that of recruitment of doctors at PHCs, lie with the State governments. The shortage of doctors in public health facilities varies from State to State depending upon their policies and context.
Financial support
Union Health Minister Harsh Vardhan said that under the National Health Mission (NHM), financial and technical support is provided to States/Union Territories to strengthen their healthcare systems, including support for recruitment of doctors on contractual basis, based on the requirements posed by them in their Programme Implementation Plans (PIPs) within their overall resource envelope.
The Ministry noted that measures to improve the availability of doctors through establishment of new government colleges and increase of seats at existing government medical colleges under a Centrally sponsored scheme and rationalisation of norms for government medical colleges in terms of faculty, land etc have been done.
More than 29,000 MBBS seats have been increased in the last 5 years.
Flexible norms
“In order to meet the shortage of doctors in PHCs and to improve the doctor-patient ratio, the States are encouraged to adopt flexible norms for engaging doctors for public health facilities. Financial support is also provided to States for providing performance-based incentives, hard area allowance, providing accommodation and transport facilities in rural and remote areas, etc., for engaging doctors in the public health facilities. Also, States are advised to put in place transparent policies of posting and transfer, and ensure rational deployment of healthcare professionals. State/Union Territory governments are impressed upon from time to time to fill the vacant posts including those of doctors,” the Ministry noted.
Dr. Vardhan added that as per the budget announcement of 2017-18, 1.5 lakh Sub-Health Centres and Primary Health Centres are being transformed into Health and Wellness Centres under Ayushman Bharat (AB-HWCs) for provision of comprehensive primary care that includes preventive healthcare and health promotion at the community level with continuum of care approach.
