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This is compounded by nearly-absent private healthcare in these area.”>
The second Covid-19 surge in India so far seems largely contained to urban areas. Data compiled by covid19india.org shows that eight of the ten districts seeing the largest spike in daily new cases are predominantly urban, with major cities such as Delhi, Mumbai, Bengaluru and Chennai figuring amongst these. Nine among the top ten districts in terms of active cases at present are also chiefly urban. However, with major cities like Delhi and Mumbai going for temporary lockdowns and other restrictions, a repeat of migrant exodus of last year is feared, with reports of crowded inter-state bus terminuses in the national capital and elsewhere. This, mass religious gatherings over the past few weeks, and the huge election rallies in the states could change matters for rural areas. And, while healthcare infrastructure is already creaking in cities, India’s second Covid surge spreading to the rural areas will surely spell disaster. The country’s chronically deficient public health infrastuucture and human resource is particularly pronounced in the rural areas—some states, including many that contribute the largest shares of out-migration, are worse off than others—as per the Rural Health Statistics (RHS) 2019-2020. This is compounded by nearly-absent private healthcare in these area. While the pandemic is the immediate concern, unless the gaps in healthcare infrastructures are bridged, the rural population will remain under-served for a host of other health services that should have ordinarily been available to it.
Against the national norm of a sub-centre (SC) serving 5,000 people, a primary healthcentre (PHC) 30,000 people and a community health centre (CHC) serving 1,20,000 in ‘general’ areas (as opposed to ‘hilly or tribal areas’), rural SCs in the country serve 5,729, PHCs 35,730, and CHCs a whopping 1,71,779. In Uttar Pradesh, rural CHCs nearly twice the national catchment norm, at over 238,000 people. Rural SCs and PHCs in the state serve 1.6 times and 1.97 times the norm, respectively. Bear in mind, the state accounts for one of the largest migrant worker population in the country. Rural CHCs in West Bengal, similarly, serve populations 1.8 times larger than the national norm. In Bihar, another state that sees large out-migration, rural CHCs serve catchments that are 15 times the norm! The problem, though, is not limited to poor states—a Maharashtra, with the catchment for functioning rural CHCs more than two times the norm, fares worse than an Odisha, where every rural CHC serves a significantly smaller catchment than the norm. Rural healthcare centres’ suffer from a personnel crunch, too—PHCs, against a sanctioned strength of 35,890 doctors, have just over 28,000 in position. The CHCs in the country are missing 15,775 specialists (surgeons, OB-gyns, physicians and paediatricians). The situation is especially poor for states like Gujarat, UP, Madhya Pradesh, Odisha and Rajasthan. It isn’t hard to imagine the implications for the national goals on child and maternal health. A similar shortage of ANMs, radiographers and other healthcare personnel also grips the villages.
While the pandemic underscored the urgency of the need to bolster public healthcare—and the RHS numbers are mostly from March 2020 (before India mounted a meaningful response to the pandemic)—whether states have been able to do this is not clear. Chances are, with pandemic-strained resources, they would have been quite hamstrung. Against this backdrop, the Centre and the states, especially the laggards, must bridge the gap—whether through funding and other support to private healthcare or through allocating a larger chunk of their spending to healthcare.
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