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Journalism of Courage
Six years after it was launched,the plan to have 24/7 functioning community health centres (CHCs) under the National Rural Health Mission (NRHM) is yet to be realised,largely because of paucity of specialists.
The state-wise progress report compiled by the ministry that was circulated internally in September shows that at least a third of the sanctioned posts of specialists in CHCs remain vacant. Each CHC is entitled to seven specialists apart from nine staff nurses with the specific objective of enabling it to function as the place of first contact with the patient from which he/she can be subsequently referred.
Interestingly CHCs were supposed to function 24/7 even before NRHM started. With their designation under the ambitious health plan as first referral units (FRUs) the importance of having a centre that functions throughout day and night has increased manifold. The number of specialists in CHCs is roughly about 6,500 against a sanctioned strength of close to 10,000.
The specialist position is particularly dismal in some of the high focus Northeast states,with just one specialist in place each in Manipur,Arunachal Pradesh and four each in Meghalaya and Mizoram. The only state where the figure is respectable is in Assam where 209 of the total 432 sanctioned specialists posts are filled. In Nagaland there are 34 specialists in place against a sanctioned strength of 84.
In the high focus non-Northeast states which includes Bihar,Chhattisgarh,Himachal Pradesh,Jammu and Kashmir,Jharkhand there are 2,942 specialists in place against a sanctioned strength of 5,082. Himachal Pradesh is by far the worst off in the group with just three specialists against a sanctioned strength of 292. Madhya Pradesh has 245 out of 1,332 specialists,while Rajasthan has 492 out of sanctioned 1,472.
In the non-high focus large states,the situation is far better with a total of 3,571 specialists having been appointed against the sanctioned figure of 4,644. Haryana with 70 doctors against sanctioned 372 and Gujarat with 79 against 346 posts are among the laggards.
The staff position,in particular the lack of specialists interested in working in a rural set-up has been a matter of concern for some time now. An NRHM status report commissioned by the ministry and released in August had dealt in some detail on how the staff shortage was affecting the plan to make CHCs function round-the-clock.
