Mahatma Gandhi, the father of the nation, believed that, village should be the center of all activity in India. He saw the village as the backbone of India and believed that the true measure of the nation’s progress lies in the well-being of its rural population. As we mark the 75th anniversary of his death on January 30th, it is a tragic reality that we have failed to live up to his vision for the village. This is particularly evident in the state of Healthcare in Rural India.

Today as the world stresses on economic growth, globalization and privatization; a silent section of the society seems to slip through all safety nets. In India, one is talking about at least 26 percent of the population who fit into this category. The percentage varies from state to state. In most of the northern states poverty seems to be increasing and if you further disaggregate from urban to rural, you will find that 40 percent of the rural population in 10 states in India are below the poverty line. Further disaggregating the figures into schedule caste, schedule tribes, the marginalized etc., the percentages just keep on rising.

In India, health care has emerged as one of the largest sector with maximum expenditure incurred. An astounding 60 percent of this is out of pocket expense. India has one of the highest proportions of private health spending, comparable only to a few countries in the world with a recent history of major internal unrest, such as Cambodia and Myanmar. Such is the lack of trust in the public health system that not only do 80 percent of the wealthy seek treatment in the private sector, but a similar percentage of the poor also go to private practitioners, even though the treatment may be of low quality and provided by untrained practitioners.

Some unfortunate statistics reflect this state of affairs:
●One quarter of hospitalized Indians slip below the poverty line due to hospital expenses alone. This number is estimated to be 60 million people every year but has risen exponentially during the last year due to the COVID-19 pandemic.

●Hospitalized Indians spend more than half of their annual expenditures on healthcare.

●Over 40 percent of those hospitalized borrow money or sell assets to cover expenses.

●The poorest 20 percent Indians have more than twice the rate of mortality, malnutrition and fertility of the richest 20 percent.

Gandhi's vision for rural India was that of a self-sufficient and self-reliant village where the people were the masters of their own destiny. He believed that the village should be the center of all economic and social activity, with the people having control over their own resources. He said, "The true measure of any society can be found in how it treats its most vulnerable members."

Recent reports on rural healthcare in India, though paint a bleak picture for most of the vulnerable members, a large majority of whom live in the rural areas. The Rural Health Statistics 2021-22 released recently show that health sub centres (SCs), primary health centres (PHCs) and community health centres (CHCs) functioned with a staff strength that was less than even the preceding year, 2020-21. According to the RHS 2021-22, the number of auxiliary nurse midwives (ANMs) at SCs in the country in March 2022 was 2,07.587. This number was 2,14,820 in March 2021. They are the first point of contact at SCs.

Similarly, the number of doctors working at PHCs decreased to 30,640 in 2021-22 as against 31,716 in the previous year. This is important since in 2021-22, India had already battled the first wave of COVID-19, with

preparations being done to brace the worst. The shortfall in rural health resources was going to have an impact and was also, therefore, not difficult to gauge. The RHS report also highlights the acute shortage of specialist doctors in the country, with a shortfall of nearly 80 percent of the required specialists at Community Health Centers (CHCs). The report points out that there is a shortfall of specialist doctors, including surgeons (83.2 percent), obstetricians and gynecologists (74.2 percent), physicians (79.1 percent), and pediatricians (81.6 percent).

Apart from specialist doctors, there is also a shortage of female health workers and auxiliary nursing midwives, with up to 14.4 percent of these posts lying vacant in PHCs and SCs.

The government must invest in increasing the number of healthcare facilities and personnel in rural areas. It is also important to address the underlying socio-economic and environmental factors that contribute to poor health in rural areas.

Laggard states continue to be in the red. For instance, as per norms an SC should be present for every 5,000 people. But in Uttar Pradesh, Bihar and Jharkhand, more than 7,000 people depend on one SC.
The higher level of health facility, a CHC, is needed for every one lakh people. But in Karnataka, Andhra Pradesh, Telangana, Maharashtra, Madhya Pradesh, Bihar and Uttar Pradesh, 2-5 lakh people depend on one CHC.
The report highlights the stark disparities between urban and rural healthcare, with rural areas lacking basic infrastructure, trained personnel, and essential medicines. The report also highlights the lack of government funding and political will to address these issues.

The report states that nearly 70 percent of healthcare facilities in rural India are run by the government, but they are often understaffed and underfunded. This results in poor quality care and high rates of maternal and infant mortality. The report also states that many rural areas lack basic facilities like clean water and sanitation, which further exacerbates the health problems faced by the rural population.

However, the reality is that the Indian government has failed to prioritize the needs of the rural population, particularly when it comes to healthcare. This is evident in the lack of funding and political will to address the issues highlighted in the report.
The report states that the maternal mortality rate in rural areas is higher than in urban areas, and that infant mortality is also higher in rural areas. Additionally, the report highlights that the prevalence of communicable diseases such as tuberculosis and malaria is higher in rural areas.

Gandhi, in his writings, emphasized about a decentralized healthcare system, with the village as the focal point. He believed that the village should be self-sufficient in terms of healthcare and its community should take responsibility for the health of its members. He said, "The true source of rights is duty. If we all discharge our duties, rights will not be far to seek." However, in the current scenario, we can see that the rural population is not getting their rights as there is no one to discharge their duties.
It is time for the government to discharge its duty to the people of rural India by prioritizing the development of healthcare in these areas. It is time for us to live up to Gandhi's vision and ensure that the rights of the rural population are not far to seek.

The government must invest in increasing the number of healthcare facilities and personnel in rural areas. Additionally, there should be a focus on strengthening primary health care and community-based health care systems. It is also important to address the underlying socio-economic and environmental factors that contribute to poor health in rural areas.