Thinking global, living local: Voices in a globalized world

The Shameful Frailty of the Rural Healthcare System in India

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Rural Health Care

Far from the madness of city life, a child lies limply on a hospital bed, suspended somewhere between the brutality of life and the sick sad humor called democracy, watching the ceiling and wondering will he be forgotten like the other patients sharing that inhospitable room in a run-down hospital or will he survive and  fulfill his dreams.

This is the story of every child in all the villages, small towns, and cities across India. Every year and in its 5 year plans, the government announces health benefits and promises to strengthen the healthcare system. And every year hundreds of children and adults end up facing a life full of uncertainty. It seems that the current healthcare system just serves the growing needs of metropolitan cities but even there, it plays a cruel joke by being accessible only to those who can afford it.

Rural Health Care

Lack of healthcare facilities in rural India is the major reason for high mortality. Photo Collage by the author (CC BY-NC-SA 3.0)

According to a report by the United Nations, 75% of the health infrastructure in India  – including doctors and specialists and other health resources – is concentrated in urban areas where only 27% of India’s population lives. The rural population of India is around 716 million people (72%) and yet there is a chronic lack of proper medical facilities for them. This is one of the reasons for the differences in urban and rural healthcare indicators.

The table below shows the disparities in healthcare indicators between urban and semi-urban and rural populations:

Indicators of Healthcare

Key indicators of the healthcare system in India. 

The majority of these statistics show the sad state of affairs in the rural healthcare system in India. The fact is that most people living in rural areas or small cities and towns across India don’t have access to critical medical facilities including hospitals, medicines, and doctors. Ensuring proper medical care as well as preemptive care facilities is mentioned regularly in every 5th year plan but somehow the plans all end up being shelved and every year economists come up with new death statistics. So where are we going wrong?

Addressing the Shortfalls

The healthcare industry includes a wide range of services like hospitals, pharmaceutical companies, drug manufacturers, diagnostics and device manufacturers, and health technology and information providers.

One of the most critical requirements for healthcare in rural areas is doctors. Doctors and medical specialists are an integral component of the Indian healthcare system but rural India is currently facing a 64% shortage of doctors.

Today, rural India faces a shortage of more than 12,300 specialist doctors. There are vacancies for 3,880 doctors in the rural healthcare system along with the need for an astounding 9,814 health centers.

The rural health care system in India  has been developed as a three tier system comprising of the following:

1.The Community Health Centre( CHC)-A 30 bed hospital/referral unit for 4 PHCs with specialist services.

2.The Primary Heath care centre(PHC)-A referral unit for 6 (4-6 bed) subcenters staffed by a medical  officer in charge and 14 paramedics.

3.The Sub Centre-The most peripheral point of contact between the primary health care system and the community, staffed by 1 Health Worker-Female (HM-F)/Auxiliary Nurse Midwife (ANM) and 1 Health Worker-Male (HW-M).

Rural Healthcare System

The  three tier health care infrastructure in rural India

In the rural healthcare programme in India, structured in these three tiers, there is a basic need for primary health centres (PHCs) and community health centres (CHCs). These PHCs could serve approximately 20,000 people in tribal and hilly areas and around 30,000 people in the plains, while the CHCs would serve approximately 80,000 people in tribal and hilly areas and around 120,000 people in the plains.

Rural Clinic

Rural clinics like this one in Assam lack a strong infrastructure.
Photo by the author (CC BY-NC-SA 3.0)

Some of the key facts relative to the current state of the rural healthcare system in India have been highlighted in a report by the National Rural Health Mission (NHRM). They are:

  • The ratio of rural population to doctors is six times lower than in urban areas
  • The ratio of rural beds vis-à-vis the population is 15 times lower than in urban areas
  • 66 percent of the rural population in India lacks access to preventive medicines
  • 31 percent of the rural population in India has to travel over 30 km to get needed medical treatment
  • 3,660 PHCs in rural India lack either an operationing theater or a lab or both
  • 50 percent of the posts for obstetricians, pediatricians, and gynaecologists in PHCs or CHCs are vacant
  • There is a 70.2 percent shortfall of medical specialists in CHCs
  • 39 percent of PHCs are currently without a lab technician
  • Infectious diseases dominate the morbidity pattern in rural areas: 40% in rural areas vis-à-vis 23.5% in urban areas.

These facts are for real, and the reasons behind the poor healthcare infrastructure can be attributed to lack of investment incentives for the private sector, gross inefficiency in public healthcare system, and a chronic lack of quality doctors and medical professionals.


A blood donation camp in Delhi
Photo by Dr Niki Shrestha (CC-BY-NC-SA-3.0)

Although the National Rural Health Mission (NRHM) spends Rs 101,166 crore (US$485 Billion) on rural healthcare in India, various key issues including healthcare infrastructure and access to medical services still leave much to be desired. There are serious gaps in the Indian rural healthcare infrastructure which need to be addressed with urgency.

 Is there any hope for rural India?

Yes, there is still hope but the government needs to work harder. It needs to implement a clearly defined policy with a set of guidelines that will aid in ensuring the sustainability of rural healthcare plans. This will help in attracting private investment in the rural healthcare segment including tele-medicine services, remote diagnostics, and operation of other rural health services. Above all, rural healthcare needs to be declared as a “priority” growth area by both central government and the state governments.


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