| | APRIL 202319An astounding 60 percent of this is out of pocket expense. India has one of the highest proportions of private health spending, only to only 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 goes 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:1. One quarter of hospitalised Indians slip below the poverty line because of hospital expenses alone. This number has been estimated to be sixty million people every year but has risen exponentially during the last year because of the Covid pandemic.2. Hospitalised Indians spend more than half of their annual expenditures on healthcare.More than 40 percent of those hospitalised borrow money or sell assets to cover expenses.3. 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. 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 because in 2021-22, India had already battled the first wave of COVID-19 and it was common knowledge that because the worst had not happened yet, preparations were a must. 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). CHCs are 30-bed block-level health facilities that are supposed to provide basic care related to surgery, gynecology, pediatrics, and general medicine. There are 6,064 CHCs across India, and the Health Ministry has been unsuccessful in meeting the requirement for specialist doctors in most of these centers. 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 National Health Profile 2021, released by the Central Bureau of Health Intelligence, reveals that the rural areas of the country are facing a severe shortage of healthcare facilities and personnel. According to the report, there is only one government doctor for every 10,189 people in rural areas, while the ratio in urban areas is one doctor for every 1,844 people. The report also highlights that the rural areas have a shortage of nurses, paramedics, and other healthcare workers. This shortage of healthcare personnel in rural areas is further compounded by a lack of infrastructure. The rural population of our country deserves the same access to healthcare as their urban counterparts and it is our duty to make sure they get it
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