Corona Times 2020-16. Our Rural Health Care System.

I got worried when transport was arranged for the migrant workers who wanted to go home. Sure, they had a miserable time, were hungry, scared and did not enjoy being corralled. I am not sure if they were the poorest of the poor, many of them were dignified skilled workers, who hated being dependent. As usual there was squabbling between Government and Opposition. Was the Government caught napping? I do not know and am beyond caring. 

Anyway the center and the states are footing the bill! I hope the auditors work hard and let us know how many migrant workers went home and how much it cost. They could also calculate cost of the other sorties made to get our citizens back home. Let both BJP and Opposition be billed for the humanitarian gestures made by them both. Either from the party coffers or donations from the well heeled. Let them not get away and make only the tax payers pay. I am serious. May be SC will say the same and help us poor tax payers.

My worries made me look and locate the following  report on Rural Health Care. 

It is my pet theory that it is not enough only the bureaucrats and police face the music. Let all netas ( who are demigods in any case) get acting and go to their constituencies, some of them have already set good examples, make sure the PHC etc., are in good shape. It seems the worst of our fears, the  Covid cases may go up and up! Many more will move out of towns and cities and go home! They would be from the same state and not migrant workers. Villagers who have moved to the cities for economic reasons, but still have roots in their villages.

I believe that our urban health care is in better shape! Many hospitals are not busy, may be the same donors who worried about migrant workers will turn their attention to the poor slum-dwellers in the cities and towns and pay for their treatment.

Rural Health Care System in India (Source Vikaspedia.)

The health care infrastructure in rural areas is a three tier system.(Wonder if these are adequate!!)

Sub Centre : First contact point in the community manned with one HW(F)/ANM & one HW(M). It is planned to cover 5000 people and 3000 in hilly/tribal/difficult area.

Primary Health Centre (PHC) : A Referral Unit for 6 Sub Centres, 4-6 bedded, manned with a Medical Officer and 14 subordinate paramedical staff. Will cover 30,000 normally and 20,000 in hilly/tribal/difficult area.

Community Health Centre (CHC) : A 30 bedded Hospital/Referral Unit for 4 PHCs with Specialized services. To cover 1,20,000 in the plains and 80,000 in hilly/tribal/difficult area.

Sub Centres: brings about behavioral change and provide services. Also take care of maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable diseases programmes.
Each Sub Centre one auxiliary nurse midwife (ANM) / female health worker and one male health worker. Under National Rural Health Mission (NRHM), there is a provision for one additional second ANM on contract basis. One lady health visitor (LHV) is entrusted with the task of supervision of six Sub Centres. Government of India bears the salary of ANM and LHV while the salary of the Male Health Worker is borne by the State governments.
There were 1, 56,231 Sub Centres functioning in the country as on 31st March, 2017. There is significant increase in the number of Sub Centres in the States of Rajasthan (3894), Gujarat (1808), Chhattisgarh (1368), Karnataka (1238), Jammu & Kashmir (1088), Odisha (761), Tripura (448), Madhya Pradesh (318) and Kerala (286)

Primary Health Centre (PHC) PHC is the first contact point between village community and the medical officer. The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the State governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services (BMS) Programme

There were 25,650 PHCs functioning in the country as on 31st March, 2017. At the national level, there is an increase of 2414 PHCs by 2017 as compared to that existed in 2005. Significant increase is observed in the number of PHCs in the States of Karnataka (678), Assam (404), Rajasthan (366), Jammu & Kashmir (303) and Chhattisgarh (268) and Bihar (251).

Percentage of PHCs functioning in government buildings has increased significantly from 78% in 2005 to 90.9% in 2017. This is mainly due to increase in the government buildings in the States of Uttar Pradesh (1681), Karnataka (841), Gujarat (450), Assam (403), Madhya Pradesh (410), Maharashtra (232) and Chhattisgarh (336). The number of allopathic doctors at PHCs has increased from 20308 in 2005 to 27124 in 2017, which is about 33.6% increase. Shortfall of allopathic doctors in PHCs was 11.8% of the total requirement for existing infrastructure.

Community Health Centres (CHCs) CHCs are being established and maintained by the State government under MNP/BMS programme. As per minimum norms, a CHC is required to be manned by four medical specialists i.e. surgeon, physician, gynecologist and pediatrician supported by 21 paramedical and other staff. It has 30 in-door beds with one OT, X-ray, labour room and laboratory facilities. It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations. As on 31st March, 2017, there were 5,624 CHCs functioning in the country. Significant increase is observed in the number of CHCs in the States of Uttar Pradesh (436), Tamil Nadu (350), West Bengal (254), Rajasthan (253), Odisha (139), Jharkhand (141), Kerala (126), Gujarat (91) and Madhya Pradesh (80). Number of CHCs functioning in government buildings has also increased during the period 2005-2017. The percentage of CHCs in Govt. buildings has increased from 91.6% in 2005 to 96.7% in 2017.

In addition to 4156 Specialists, 14350 General Duty Medical Officers (GDMOs) are also available at CHCs as on 31st March, 2017. There was huge shortfall of surgeons (86.5%), obstetricians & gynaecologists (74.1%), physicians (84.6%) and paediatricians (81%). Overall, there was a shortfall of 81.6% specialists at the CHCs vis-a-vis the requirement for existing CHCs.

First Referral Units (FRUs) An existing facility (District Hospital, Sub-divisional Hospital, Community Health Centre etc.) can be declared a fully operational First Referral Unit (FRU) only if it is equipped to provide round-the-clock services for emergency obstetric and New Born Care, in addition to all emergencies that any hospital is required to provide. It should be noted that there are three critical determinants of a facility being declared as a FRU:

• Emergency Obstetric Care including surgical interventions like caesarean sections;
• new-born care; and
• blood storage facility on a 24-hour basis.

• At present there are 3,076 FRUs functioning in the country. Out of these total 94.2% of the FRUs are having Operation Theatre facilities, 96.3% of the FRUs are having functional Labour Room while 68.9% of the FRUs are having Blood Storage/ linkage facility.

Source : Rural Health Survey 2017