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:

The average population covered by a Sub Centre, PHC and CHCs are 5616, 35567 and 165702 respectively as on 31st March, 2019.

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 are 7821 SCs which are upgraded as Health and Wellness Centre-Sub Centres (HWC-SCs) out of total 157541 SCs functioning in rural areas of the country as on 31st March, 2019. The significant conversion of SCs into HWC-SCs have been observed in the States of Tamil Nadu (985), Maharashtra (939), Gujarat (813), Uttar Pradesh (726), Chhattisgarh (650), Assam (628), Andhra Pradesh (612) and Karnataka (571). Significant increase in Sub Centres are recorded in the States of Rajasthan (3000), Gujarat (1892), Karnataka (1615), Madhya Pradesh (1352), Chhattisgarh (1387), Jammu & Kashmir (1146), Odisha (761) and Tripura (433).

Percentage of Sub-Centres functioning in the Government buildings has increased from 43.8% in 2005 to 75.3% in 2019.

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.

At the national level, there are 24855 PHCs functioning (i.e 16613 PHCs and 8242 HWC-PHCs) in rural areas as on 31st March 2019. There is an upgradation of 8242 of PHCs as HWC-PHCs. The significant number of conversion of PHCs into HWC-PHCs have been observed in the States of Andhra Pradesh (1145), Uttar Pradesh (946), Odisha (827), Gujarat (772), Tamil Nadu (716) and Telangana (636). Significant increases in the number of PHCs have been seen in the States of Karnataka (446), Gujarat (406), Rajasthan (369), Assam (336), Jammu & Kashmir (288) and Chhattisgarh (275).

Percentage of PHCs functioning in Government buildings has increased significantly from 69% in 2005 to 94.5% in 2019. 

For allopathic Doctors at PHCs, there is a shortfall of 7.6% of the total requirement for existing infrastructure as compared to manpower in position.

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 2019, there are 5335 CHCs functional in rural areas of the country.  Significant increase is observed in the States of Uttar Pradesh (293), Tamil Nadu (350), West Bengal (253), Rajasthan (245), Odisha (146), Jharkhand (124) and Kerala (121).

The % of CHCs in Govt. buildings has increased from 91.6% in 2005 to 99.3% in 2019.

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.

As on 31st March 2019, there are 3204 FRUs functioning in the country. Out of these, 95.7% of the FRUs are having Operation Theatre facilities, 96.7% of the FRUs are having functional Labour Room while 75.3% of the FRUs are having Blood Storage/ linkage facility.

Source : Rural Health Survey 2019