The Indian Health care delivery system is a 3-tiered structure under the National Rural Health Mission comprising the sub-centers, primary health centers (PHCs) and community health centers (CHCs). Ayushman Bharat Yojana was launched exactly a year ago relabelling the 1,50, 000 sub-centers and PHCs as ‘health and wellness centers’. The main role of the sub-centers is envisioned to educate patients on non-communicable diseases as well as maternal and child health.
The proper treatment and education of patients in these sub-centers and PHCs is supposed to reduce the load on the CHCs and the tertiary care centers.
However, they are formidable challenges or gaps in ensuring the achievement of this goal. Broadly the gaps can be classified under two headings: The Quantity Gap and The Quality Gap.
The Quantity Gap refers to the number of healthcare workers available. Let us look at some broad statistics. It is estimated that though 70% of the Indian population lives in villages, only 40% of India’s total health care workers work in rural India. Close to 2000 PHCs in the country are without doctors, 50% of the 150000 health and wellness centers do not have male health workers. Approximately 6000 centers are without midwives and more than 4000 centers do not have either male health workers or nursing midwives.
This significant gap in skilled health workers shows the weak infrastructure of the public health delivery system and is an obstacle that the Government has recognized and trying to address.
The second gap is the ‘Quality’ gap. The quality gap can only be assessed on the healthcare workers already present in the system.
A WHO report estimated only 11% of the sub-centers, 13% of the PHCs and 16% of the CHCs met the minimum standards of healthcare delivery. Furthermore, it stated that only 58% of the doctors in urban areas and 19% in rural areas are medically qualified. The situation for nurses and midwives is even more of a concern with 66% of them not having even studied beyond secondary school and 89% of them not having any medical certification or qualification.
In all the debates for strengthening healthcare access, the focus predominantly is on the quantity gaps and the quality or skill gaps get missed out.
The Government is trying to ensure that skill development takes place amongst health care workers by rolling out training and mentoring programs for nursing and midwife skill building at the grass root levels.
While filling the quantity gaps can take more time, building the skills to address the quality gaps can be done immediately to ensure an impact on healthcare delivery and customer experience.
(Disclaimer: Writer is Dr Vikram A Munshi, Founder, WhiteSpace Consulting and Capability Building. Views expressed are a personal opinion.)