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Rural Health Care System in India

This topic provides information about Rural Health Care System in India.

The health care infrastructure in rural areas has been developed as a three tier system as follows.

  1. Sub Centre : Most peripheral contact point between Primary Health Care System & Community manned with one HW(F)/ANM & one HW(M)
  2. Primary Health Centre (PHC) : A Referral Unit for 6 Sub Centres 4-6 bedded manned with a Medical Officer Incharge and 14 subordinate paramedical staff
  3. Community Health Centre (CHC) : A 30 bedded Hospital/Referral Unit for 4 PHCs with Specialized services

Population norms for rural healthcare infrastructure

The three tier infrastructure is based on the following population norms:

CentrePopulation Norms
Plain Area Hilly/Tribal/Difficult Area
Sub Centre 5000 3000
Primary Health Centre 30,000 20,000
Community Health Centre 1,20,000 80,000

Sub Centres (SCs)

The Sub Centre is the most peripheral and first contact point between the primary health care system and the community.

Sub Centres are assigned tasks relating to interpersonal communication in order to bring about behavioral change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhoea control and control of communicable diseases programmes.

Each Sub Centre is required to be manned by at least one auxiliary nurse midwife (ANM) / female health worker and one male health worker. Under National Rural Health Mission (NRHM), there is a provision for one additional second ANM on contract basis. One lady health visitor (LHV) is entrusted with the task of supervision of six Sub Centres. Government of India bears the salary of ANM and LHV while the salary of the Male Health Worker is borne by the State governments.

There were 1, 56,231 Sub Centres functioning in the country as on 31st March, 2017. There is significant increase in the number of Sub Centres in the States of Rajasthan (3894), Gujarat (1808), Chhattisgarh (1368), Karnataka (1238), Jammu & Kashmir (1088), Odisha (761), Tripura (448), Madhya Pradesh (318) and Kerala (286).

Primary Health Centre (PHC)

PHC is the first contact point between village community and the medical officer.

The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the State governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services (BMS) Programme.

As per minimum requirement, a PHC is to be manned by a medical officer supported by 14 paramedical and other staff. Under NRHM, there is a provision for two additional staff nurses at PHCs on contract basis. It acts as a referral unit for 6 Sub Centres and has 4-6 beds for patients. The activities of PHC involve curative, preventive, promotive and family welfare services.

There were 25,650 PHCs functioning in the country as on 31st March, 2017. At the national level, there is an increase of 2414 PHCs by 2017 as compared to that existed in 2005. Significant increase is observed in the number of PHCs in the States of Karnataka (678), Assam (404), Rajasthan (366), Jammu & Kashmir (303) and Chhattisgarh (268) and Bihar (251).

Percentage of PHCs functioning in government buildings has increased significantly from 78% in 2005 to 90.9% in 2017. This is mainly due to increase in the government buildings in the States of Uttar Pradesh (1681), Karnataka (841), Gujarat (450), Assam (403), Madhya Pradesh (410), Maharashtra (232) and Chhattisgarh (336).

The number of allopathic doctors at PHCs has increased from 20308 in 2005 to 27124 in 2017, which is about 33.6% increase. Shortfall of allopathic doctors in PHCs was 11.8% of the total requirement for existing infrastructure.

Community Health Centres (CHCs)

CHCs are being established and maintained by the State government under MNP/BMS programme.

As per minimum norms, a CHC is required to be manned by four medical specialists i.e. surgeon, physician, gynecologist and pediatrician supported by 21 paramedical and other staff. It has 30 in-door beds with one OT, X-ray, labour room and laboratory facilities.

It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations.

As on 31st March, 2017, there were 5,624 CHCs functioning in the country. Significant increase is observed in the number of CHCs in the States of Uttar Pradesh (436), Tamil Nadu (350), West Bengal (254), Rajasthan (253), Odisha (139), Jharkhand (141), Kerala (126), Gujarat (91) and Madhya Pradesh (80).

Number of CHCs functioning in government buildings has also increased during the period 2005-2017. The percentage of CHCs in Govt. buildings has increased from 91.6% in 2005 to 96.7% in 2017.

In addition to 4156 Specialists, 14350 General Duty Medical Officers (GDMOs) are also available at CHCs as on 31st March, 2017. There was huge shortfall of surgeons (86.5%), obstetricians & gynaecologists (74.1%), physicians (84.6%) and paediatricians (81%). Overall, there was a shortfall of 81.6% specialists at the CHCs vis-a-vis the requirement for existing CHCs.

First Referral Units (FRUs)

An existing facility (District Hospital, Sub-divisional Hospital, Community Health Centre etc.) can be declared a fully operational First Referral Unit (FRU) only if it is equipped to provide round-the-clock services for emergency obstetric and New Born Care, in addition to all emergencies that any hospital is required to provide. It should be noted that there are three critical determinants of a facility being declared as a FRU:

  • Emergency Obstetric Care including surgical interventions like caesarean sections;
  • new-born care; and
  • blood storage facility on a 24-hour basis.

At present there are 3, 076 FRUs functioning in the country. Out of these total 94.2% of the FRUs are having Operation Theatre facilities, 96.3% of the FRUs are having functional Labour Room while 68.9% of the FRUs are having Blood Storage/ linkage facility.

Source : Rural Health Survey 2017

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