State of Healthcare in Rural India 2024 | 23 Aug 2024

Source: TH

Why in News?

Recently, the “State of Healthcare in Rural India, 2024” report was released by NGO Transform Rural India and Development Intelligence Unit.

• The survey covered 21 States including Andhra Pradesh, Bihar, Maharashtra, Tamil Nādu, and Uttar Pradesh.
• The sample achieved included 52.5% male respondents and 47.5% female respondents.

What are the Key Highlights of the Report?

• Health Insurance Coverage: Only about 50% of rural households in the country have government health insurance, while 34% lack any health insurance coverage at all.
  • 61% of surveyed households do not have life insurance.
• Access to Diagnostic Facilities: It revealed that there is a lack of diagnostic facilities in the rural areas mostly because of shortage of trained personnel.
  • Only 39% of respondents have access to a diagnostic facility within commutable distance.
  • 90% of respondents do not undergo routine health checkups unless recommended by a doctor.
• Access to Subsidised Medicines: Only 12.2% of households have access to subsidised medicines from Pradhan Mantri Jan Aushadhi Kendras.
  • Only 26% respondents had access to a government medical store located within the premises of a health facility that provides free medicines.
  • 61% have access to a private medical store within commutable distance.
• Drainage Systems: 20% of the households reported no drainage system in their villages and only 23% had a covered drainage network system in their villages.
  • 43% of households did not have any scientific system of waste disposal and they ended up with dumping their waste everywhere. 
  • Only 11% burn the dry waste and convert their wet waste into compost, while 28% reported that the local panchayat has made plans to collect household waste.
• Elderly Care: 73% of the households with elderly members need constant care and the majority (95.7%) prefer family caregivers, predominantly female (72.1%), highlighting the need for caregiver training on home-based care.
  • Only 3% of households have engaged in paid external caregivers.
  • 10% rely on neighbourhood support in the absence of family caregivers.
• Caregiving for Pregnant Women: Majority of caregivers for pregnant women include husbands (62.7%), mothers-in-law (50%), and mothers (36.4%).
  • The report emphasises the need for strong social networks, supportive environments, and capacity building for family caregivers.
• Mental  Health Disorders: 45% of the respondents across gender most of the time have anxiety and worry that impacts their state of mind.
  • Anxiety and worry impact mental health much more among the older population than the younger ones.

What are the Reasons for Poor Healthcare Infrastructure in Rural India?

• Out-of-Pocket Expenditure: According to the National Health Accounts Estimates for India (2019-20), out-of-pocket expenditure (OOPE) constitutes 47.1% of the total health expenditure. 
  • In Orissa, 25% of households that had any healthcare costs, and 40% of households that experienced a hospitalisation, had to take out loans or sell assets to pay for healthcare costs.
• Qualified Personnel Shortage: India suffers from a severe lack of qualified healthcare professionals in rural areas. 
  • Among the states, Chhattisgarh has the highest vacancy of doctors (71%), followed by West Bengal (44%), Maharashtra (37%), and Uttar Pradesh (36%) in Primary Healthcare Centers (PHCs).
  • The overall vacancy for Auxiliary Nurse and Midwife (ANM) in the country is 5%. 
• Doctor-Patient Ratio: The doctor-patient ratio in India is approximately 1:1456, which is below the World Health Organization (WHO) recommended ratio of 1:1000. 
  • The situation is worse in rural areas, where the ratio is significantly higher due to a shortage of doctors.
• Low Public Health Spending: Government expenditure on health remains low at around 1.28% of GDP. Rural health infrastructure often receives a smaller share of this budget, leading to underfunded facilities.

Way Forward

• Strengthening Health Insurance Coverage: Expand the reach of government health insurance schemes, such as Ayushman Bharat, to cover the missing middle which constitute around 350 million Indians without access to health insurance. 
  • This would reduce out-of-pocket expenditure and prevent families from falling into debt due to healthcare costs.
  • All factory labourers need to be included under the state sponsored subsidised health insurance schemes.
  • “Missing middle” consists of population groups that are engaged in informal sector work and are not poor enough to benefit from state subsidised contributions to insurance premiums.
• Incentivizing Rural Postings for Healthcare Workers: Provide attractive incentives such as higher salaries, better living conditions, and career advancement opportunities for healthcare professionals willing to work in rural areas. 
  • Special focus should be given to states with high vacancy states like Chhattisgarh, West Bengal, Maharashtra, and Uttar Pradesh.
• Expanding Medical Education: Increase the number of medical colleges and nursing schools in rural areas, ensuring that students are trained with a focus on rural healthcare needs. 
  • This would help improve the doctor-patient ratio over time.
• Leveraging Technology: Utilise telemedicine and mobile health clinics to bridge the gap in doctor-patient ratios in rural areas.
  • These can help provide remote consultations and follow-up care, reducing the burden on existing healthcare facilities.
• Mobile Diagnostic Units: Deploy mobile diagnostic units that can travel to remote areas, offering essential diagnostic services and reducing the need for patients to travel long distances.
• Community-Led Sanitation Programs: Encourage community participation in maintaining sanitation facilities and managing waste. 
  • Programs like Swachh Bharat Mission should be strengthened and adapted to local needs to ensure sustainable sanitation practices.