Opinion In UP, begin with public health centres

Ever since the launch of its flagship health programme, Ayushman Bharat, in 2018, the Centre has repeatedly underlined the significance of improving accessibility to medical care, especially in rural areas. The project envisages refashioning 1,50,000 public health centres (PHCs) to health and wellness centres (HWCs) to “bring healthcare closer to peoples’ homes”. From the outset it was apparent that this would require addressing the sector’s chronic shortages — doctors, frontline medical professionals and healthcare infrastructure. Since health is a state subject, the Centre’s resolve requires a matching commitment by state governments. By all accounts, most states that have traditionally lagged on welfare indices have not risen to this challenge. As a report in this paper shows, more than 200 community healthcare centres and PHCs in Uttar Pradesh are not even brick-and-mortar structures. A majority of these projects began years before the Yogi Adityanath government assumed office and the state’s health department has flagged irregularities in these construction works. Given that several data repositories place UP as amongst the worst performers in rural healthcare, the state government would be well advised to expedite work on these PHCs.

Private facilities dominate the country’s healthcare landscape. But these centres are concentrated in urban areas, do not have a community-oriented approach and do not focus on preventive care. The latest edition of the Centre’s Rural Health Statistics shows that the medical system outside urban areas continues to be plagued by a shortfall of doctors and infrastructure. Barely 45 per cent PHCs adhere to their mandate of functioning 24×7. Also worrying is the shortage of nurses in several states, including in India’s most populous state. A study published in The Lancet in February placed UP among the five states where district hospitals offer only 1 per cent of the basic services.

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A PHC is the first point of contact between the village community and a medical professional and, therefore, plays a key role in building local confidence in the system. The significance of these health centres has been highlighted during several disease outbreaks in recent times, including the Covid pandemic. While the public health emergency tested medical preparedness in all parts of the country, it underscored that well-equipped medical centres at the village and district levels are imperative to prevent disease escalation. Other medical emergencies — encephalitis outbreaks in Bihar and Uttar Pradesh, for instance — have also driven home this point. That’s why UP — and other states that lag on healthcare indices — must waste no time in getting their act together.