Open Access Global Journal of Infectious Diseases and Immune Therapies

Volume 4 Issue 1 ISSN: 2694-3824

Commentary Article

Catching on to the Pandemic Jolt on Rural Healthcare System in India

Gautam Kr Ghosha* and Arpita Deb
aPh.D. PG in Reproductive and Child Health Management, and is research scientist at ICMR NICED, Kolkata, India
bMPH, Junior Consultant, NHSRC under Ministry of Health &Family Welfare, Government of India

Article Info Abstract

Article History:
Received: 13 April, 2022
Accepted: 18 April, 2022
Published: 23 April, 2022
*Corresponding author: Gautam Kr
Ghosh Ph.D., sociology with PG diploma
in Reproductive and Child Health
Management, and is research scientist at
ICMR NICED, Kolkata, India; Tel: +9l
98310 4847; Email:
gautamkghosh@hotmail.com DOI:
https://doi.org/10.36266/GJIDIT/121
Three consecutive waves of COVID-19 have evidently expressed an insufficient rural health
infrastructure of India, in facing the pandemic onslaught. The rural healthcare system in rural India,
primarily developed on the suggestions of Bhore Committee Report, guided Government of India in
adopting population-based norms for establishing the three-tier public health care facilities in rural India.
One of the ramifications of receiving the population-based standards for setting up public health care
facilities in the rural areas is that numerous rural habitations, particularly small ones, have no public health
care facility. The Ministry of Health and Family Welfare latest report indicated notable shortage in the
required number of Sub-Centers, Primary Health Centers, and Community Health Centers, that form the
backbone of rural healthcare. Also, shortage in Specialist, Doctors, Nursing staff and Paramedics to man
these centers can be observed. Taking lessons from the impact from current pandemic conditions on rural
healthcare, this paper suggests steps at empowering rural health care and building healthy rural
communities for facing future unforeseen health emergencies.

Keywords: Pandemic Waves; Rural Healthcare; Manpower Shortage; Suggestions

Copyright: © 2022 Gautam Kr Ghosh, et al. This is an open-access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original author and source are credited.

every 5 thousand population in plain areas and for every 3 thousand

Main Text
Three consecutive waves of COVID-19 have evidently expressed
an insufficient rural health infrastructure of India, in facing the
pandemic onslaught. Fortunately, some private organizations,
industrial houses and charities gathered in order to collect the
rural healthcare system. Help in the form of funding, supply of
equipment, rapid test kits, PPE, among others flowed in. While
this gave a huge respite to struggling rural hospitals in their battle
with COVID-19, but nonetheless pointed towards immediate
need for health policy and funding rejig to confront unforeseen
future crisis situations.
The first pandemic wave affected directly the health and welfare
of women and children in the poorer section of society, as media
reports stated. Considerable numbers of pregnant women
succumbed during child birth, being unable to access to proper
medical help, and others gave birth to underweight and severely
undernourished children subjected to life-long health issues. The
ordinary times struggles of Indian healthcare system as came out
in the public domain, multiplied manifold during the pandemic;
and has had a devastating impact on social and economic lives.
The rural healthcare system in rural India, primarily developed
on the suggestions of Bhore Committee Report, guided
Government of India in adopting population based norms for
establishing the three-tier public health care facilities in rural
India. The lowest public health care facility is the Sub-Centre
(SC) which is established on the basis of the norm of one SC for
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population in hilly/tribal and difficult areas. Besides there is a
primary health cent (PHC) is established following the norm of one
PHC for every 30 thousand population in plain areas and 20
thousand population in hilly/tribal/difficult areas. Similarly, there is
one community health centre (CHC) for every 120 thousand
population in plain areas and 80 thousand population in
hilly/tribal/difficult areas [1]. There are hierarchical linkages
between the three types of public health care facilities in the rural
areas so that the entire rural population of the country is covered by
the network of CHCs, PHCs and SCs. One of the ramifications of
receiving the population-based standards for setting up public health
care facilities in the rural areas is that numerous rural habitations,
particularly small ones, have no public health care facility.
The National Health Profile 2021 projects that India’s rural health
care system is comprised of total 158417 Sub-Centre, 25743 Primary
Health Centres, and 5624 Community Health Centres but marked
with the shortfall in health facilities as- 18% in SC, 22% in PHC and
30% in CHC levels [2]. Going by the country’s Rural Health
Statistics 2020-2021, it can be observed that 14.1% of the sanctioned
posts of Health Workers (Female)/ ANM and 37% of the sanctioned
posts of Health Workers (Male) are currently vacant in the Sub-
Centres. Further, there is a shortage of doctors (1,704 positions) in
PHCs across the rural areas, as well as nursing staff (5,772), female
health workers (5,066), pharmacists (6,240), and laboratory
technicians (12,098). The healthcare workforce availability is
substantially below the World Health Organization recommended
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Citation: Gautam Kr Ghosh and Arpita De (2022). Catching On To the Pandemic Jolt on Rural Healthcare System in India. Global J Infect Dis Immune
Ther 4(1): 119
levels, as can be observed. As published reports indicate, India
has 1154686 registered doctors in the speciality of modern
medicine. At present single Government Allopathic Doctor cater
to the need of 10926 individuals in the country.
Utilizing the available information from National Health Profile-
2021, it is noticeable that there are 7,13,986 government hospital
beds available in India. This adds up to 0.55 beds per 1000
populace. Once again, there are between-the-states variations in
the number of beds accessible per patients. On record 12 states
as, Bihar, Jharkhand, Chhattisgarh, Madhya Pradesh Gujarat,
Uttar Pradesh, Andhra Pradesh, Haryana, Maharashtra, Odisha,
Assam and Manipur, where dwell nearly 70% of the country’s
total population, they lie below the national level figure (0.55
beds per 1000 populace). However, some states have improved
upon the national level, as Sikkim with 2.34 bed per 1000
population in North-East, in East West Bengal with 2.25
government beds per 1000 population, and the southern states as
Tamil Nadu with 1.1 bed per 1000 population and Kerala with
1.05 beds per 1000 population. Again, going by the information
available from the Rural Health Statistics 2019-20, as against
155404 Sub-Centers across the country, only 5383 SCs was
functioning as per IPHS norms [3]. The total 24918 Primary
Health Centers (PHC) were functioning, of which just 8514
PHCs function on 24x7 basis. As against the requirement of
20732 Community Health Centers (CHC), just 4957 CHCs
currently functioning in rural areas. The rural healthcare set-up
does not provide assuring state of affairs, currently. Besides,
there is among the states, dissimilarity as far as access to medical
care, appropriation of public health expenditure as well as health
outcomes.
With the implementation of the National Rural Health Mission
in 2005 and the launch of Ayushman Bharat Programme in 2021,
India’s rural health infrastructure is observably improving [3,4].
However, it still remains ill-equipped to tackle the challenges of
unforeseen emergencies and that posed by the recent pandemic.
The basic health infrastructure in rural India can be observed
from the diagram below-
Source: Ministry of Health and Family Welfare.
The pressing public health challenges for rural India include
preventing, controlling or eliminating major communicable
diseases, as Tuberculosis, Malaria, and in bringing down the risk
of deaths in maternal and peri-natal conditions [5,6]. Endemic
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DOI: https://doi.org/10.36266/GJIDIT/121
diseases arising from infection or lack of nutrition continue to
account for almost two thirds of morality and morbidity India [7].
With rural areas lacking access to basic healthcare facilities, there
remain considerable challenges to setting up robust emergency
medical services, as well.
Both increases in government spending and private sector initiatives
have improved the health infrastructure, but given rising
demographic pressure in India, this increase does not seem to make
the desired difference [8]. It is the extension of life expectancy that
has a direct impact on many households. This is because rising
healthcare cost exacerbate the problem for lower- and middle-class
households [9]. The suggestive way forward, at this juncture, at
empowering rural healthcare systems and building healthy rural
communities, can be as follows-
Maximise the implementation of establishing Health and
Wellness Centres
The HWCs under Ayushman Bharat was a good beginning, for it
proposed a more comprehensive, better-equipped, and better-staffed
model of primary healthcare services in the government health sub-
centres and primary health centres. Most of these are located in rural
India, and upgrading them would surely help in achieving the level
of preparedness needed to face pandemic situation and other
unforeseen emergencies in rural India.
Long-term public-private partnerships (PPP) to support
healthcare inclusion
PPP partnerships have the potential to revolutionize Indian rural
healthcare system in number of ways, while also providing a long-
term sustainable approach. With our country’s growing population,
government efforts will not be enough to strengthen the healthcare
system. PPP can assist in overcoming financial, technological,
educational, and human resources constraints. While the government
can develop policies to support rural healthcare infrastructure,
private players can ensure that these policies are implemented
appropriately. Long-term partnerships like these improve access to
healthcare, especially hard-to-reach rural areas, because private
actors’ extensive expertise, experience and financial resources may
aid in the development of novel solutions.
Establish an on-ground supervisory committee
An on-ground supervision committee should be formed to develop a
set of core and additional strategies for improving access to better
healthcare and overseeing the implementation of rural healthcare
projects. While most rural healthcare programs get off to a terrific
start, the results are not always as anticipated. To revive rural health
systems through efficient monitoring of rural health enhancement
operations, and on-the-ground supervisory committee is required.
Continuous competency development and mentoring
Another key concern in rural regions is skill development and
2 Global J Infect Dis Immune Ther
Citation: Gautam Kr Ghosh and Arpita De (2022). Catching On To the Pandemic Jolt on Rural Healthcare System in India. Global J Infect Dis Immune
Ther 4(1): 119 DOI: https://doi.org/10.36266/GJIDIT/121

mentoring. According to a report published by the Union

Ministry of Health and Family welfare, there is 76.1 % shortage
of specialists in 5,183 Community Health Centers operating in
rural areas. Doctors can benefit from skill development courses
and ongoing learning programs to assist address the dearth of
trained doctors in rural areas. Doctors in rural areas encounter
several problems when it comes to accessing training
opportunities due to their location. This is where a focused
mentoring program, with online or offline sessions, skill
upgradation and exchange programs may be immensely
beneficial.

Coherent machine upgrade and paramedic training

Essential amenities, such as most up-to-date medical equipment
and skilled medical personnel to operate them, are lacking in rural
areas. While medical equipment can still be upgraded on a regular
basis, training courses for nurses and paramedical workers on
how to handle, operate and manage these machines are also
necessary. As new technologies become available, the
requirement for training becomes more pronounced and require
to be recognized.

Conclusion
In summing up, it needs to be point out that it is impossible to
transform the primary health care system of the country in a day
or a week or a month, and that a sporadic approach to uplifting
rural healthcare infrastructure will be an exercise in futility. But,
with the ongoing dedication and regular efforts can a robust
healthcare system be developed in rural areas. Implementing the
procedures outlined above will have positive benefits in the long
run and will aid in the development of a robust health care system.
The primary goal should be to improve preparation beyond
COVID, rather than focusing simply on short-term fixes that will
return the system to its previous state once external help is
withdrawn.

References
1. Rural Health Care System in India.
2. National Health Profile (NHP) of India- 2021.
3. National Rural Health Mission.
4. Ayushman Bharat Programme in 2021.
5. WHO Background Paper: Burden of Disease in India.
6. Prakash A, Swain S, Seth A. Maternal mortality in India:
current status and strategies for reduction. Indian Pediatr.
1991; 28: 1395-400.
7. Health care in India-vision 2020.
8. Relationship between Infrastructure and Population; ADBI
Working Paper Series.
9. Balarajan Y, Selvaraj S, Subramanian SV. Health care and
equity in India. Lancet (London, England). 2011; 377: 505-
515.
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