Funds fail to draw docs to villages

Despite 42,000Cr Kept Aside For Rural Med Care, Rs 10,000Cr Lying Unspent

   As the country awaits another central government Budget, there is a growing demand for more financial muscle on several fronts. But, is throwing money at complex problems really a solution? A look at the progress of a crucial program of the government, the National Rural Health Mission (NRHM), indicates that money can’t buy everything.
    One of the biggest bottlenecks facing policy-makers is that of medical personnel. Recently released data by the ministry of health and family welfare shows a shocking shortfall of doctors, nurses, health assistants, radiographers, pharmacists and other personnel in the rural health delivery structure. This is despite over 82,000 new personnel being appointed under NRHM in the past four years and many villages getting to see a doctor for the first time.
    The situation is worse for qualified doctors. Just 20% of required paediatricians and only about 26% of surgeons, obstetricians and gynaecologists, and general physicians are in place. They are needed at the Community Health Centres (CHC), each serving a population of 1.2 lakh. Among technical personnel, only about 40% of the required radiographers and 47% of laboratory technicians are in place to run diagnostic labs. There is a shortfall of about 25% for pharmacists, and 16% for staff nurses.
    Even at the lower rungs of the medical service hierarchy, like the health sub-centres and primary health centres, many of the key personnel are not yet appointed. Nearly a quarter of 46,000 male and female health assistants are missing, while over 60% of health workers are not yet in place. The situation is much better for the auxiliary nurse and midwife (ANM) with about 90% appointments having taken place, but that still leaves nearly 16,000 ANM posts vacant. Two ANMs are required at the primary level in order that delivery cases are handled day and night. Just about one third of the PHCs are functioning with two ANMs.
    Expenditure data shows that the problem is not of resources. Out of the Rs 42,000 crore released by the central government in the past four years for NRHM, nearly Rs 10,000 crore is lying unspent with state governments. In addition, all state governments together have allocated an eye-popping Rs 1,06,388 crore for health and family welfare in their respective states.
    Yet, progress under NRHM, has been uneven, and the country is still far from achieving goals set for various health indicators.
    “Spending money jazzing up an auto-rickshaw is not going to convert it into a car”, says public health expert Dr Amit Sengupta. A thorough revamp of the infrastructure is needed and the government needs to think afresh about it, he says.
    But why are medical personnel not in place? “An indifferent political leadership and bureaucracy, deficient medical education infrastructure, especially for technical and paramedical staff, low salaries for doctors, and frustration among them in rural postings as there are no drugs, no support staff and erratic infrastructure, are some of the problems,” Sengupta said. “Sadly, doctors prefer lucrative private incomes in urban areas or foreign lands, rather than serving people in the villages,” he says.