Rural health care in India faces a crisis unmatched by any other sector of the economy. To mention just one dramatic fact, rural medical practitioners (RMPs), who provide 80% of outpatient care, have no formal qualifications for it. They sometimes lack even a high school diploma.
In 2005, the central government launched the National Rural Health Mission (NRHM) under which it proposed to increase public expenditure on health as a proportion of the GDP to 3% from 1%. But increased expenditure without appropriate policy reform is unlikely to suffice. The main aim of NRHM is to provide accessible, affordable, accountable, effective and reliable primary health care, especially to poor and vulnerable sections of the population. It also aims at bridging the gap in Rural Health Care. Experience to-date inspires little confidence in the ability of the government to turn the expenditures into effective service.
Rural India consists of approximately 638,000 villages inhabited by more than 740 million individuals. A network of government-owned and -operated sub-centres, primary health centres (PHCs) and community health centres (CHCs) is designed to deliver primary health care to rural folks. Current norms require one sub-centre per 5,000 persons, one PHC per 30,000 people and one CHC per 120,000 people in the plains.
Despite this elaborate network of facilities, only 20% of those seeking outpatient services and 45% of those seeking indoor treatment avail of public services. While the dilapidated state of infrastructure and poor supply of drugs and equipment are partly to blame, the primary culprit is the rampant employee absenteeism. Nation-wide average absentee rate is 40%. The employees are paid by the state, with the local officials having no authority over them. Not surprisingly, many medical officers visit the PHCs infrequently and run parallel private practice in the nearby town. auxiliary nurse midwife(ANMs) are frequently unavailable for childbirths even if the mother is willing to come to the PHC.
Urgent bold measures need to be taken by the Government to bring about desired improvements in rural health services. These may include public-private partnership, provision for health insurance of the poor, one or two years of compulsory service in rural areas by the graduating doctors and a vastly increased trained manpower for manning health services at various levels.
