Problems in rural health delivery and remedies

One of the biggest challenges in the delivery of rural health care is ensuring availability of doctors in primary health centres (PHCs) and community health centres (CHCs) due to recruitment delays, improper recruitment policies and lack of basic amenities and incentives. An important reason for the appalling health scenario has been the lack of accountability in our public health services. While the health infrastructure is inadequate and there is shortage of personnel, even what is available is not put to good use. Many surveys reiterate the common perceptions such as low satisfaction levels, inadequate access, poor usage, perception of high level of mistrust and corrupt ion, neglect, lack of community participation and ownership, and ineffective monitoring.

It is precisely to address these maladies that the Union government has launched the National Rural Health Mission (2005-2012), as a part of which, the local governments will have large public health institutions under their jurisdictions as the NRHM aims to operationalize 3222 existing CHCs (30-50 beds) as 24 hour First Referral Units, including posting of anesthetists.

The Ministry has suggested decentralisation of recruitment at the district level and even holding walk-in interviews for contractual appointment of doctors, besides enhancing the salary for rural postings. Since health is a State subject, the implementation of these initiatives will depend on the State Governments. They can opt for innovative models to increase the availability of doctors. It has also been proposed to keep PHCs open all 24 hours. The States have been asked to hire private practitioners to enable this. Some States have already made rural or difficult area posting compulsory for admission to postgraduate courses, promotion, foreign assignments or training abroad but the problem has not been solved.

In addition, the Union Health and Family Welfare Ministry has written to all State Governments recommending an increase in the retirement age of doctors to 65, with a compulsory stint in rural areas and the last posting preferably near their home towns.

It is hoped that these steps will bring about a paradigm shift in the health delivery system in the country.