Rural Health Care System in India

The health care infrastructure in rural areas has been developed as a three tier system as follows.

1. Sub Centre : Most peripheral contact point between Primary Health Care System & Community manned with one HW(F)/ANM & one HW(M)
2. Primary Health Centre (PHC) : A Referral Unit for 6 Sub Centres 4-6 bedded manned with a Medical Officer Incharge and subordinate paramedical staff
3. Community Health Centre (CHC) : A 30 bedded Hospital/Referral Unit for 4 PHCs with Specialized services

Norms for rural healthcare infrastructure

The three tier infrastructure is based on the following population norms:

As on 31st March 2022, there are 157935, 24935 rural SCs and PHCs functioning in the country respectively.  A total of 5480 CHCs are also functioning in rural areas 

Sub Centres (SCs)

The Sub Centre is the most peripheral and first contact point between the primary health care system and the community.

Sub Centres are assigned tasks relating to interpersonal communication in order to bring about behavioral change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhoea control and control of communicable diseases programmes.

Each Sub Centre is required to be manned by at least one auxiliary nurse midwife (ANM) / female health worker, one male health worker and one Voluntary Worker. Under National Rural Health Mission (NRHM), there is a provision for one additional second ANM on contract basis. One lady health visitor (LHV) is entrusted with the task of supervision of six Sub Centres. Government of India bears the salary of ANM and LHV while the salary of the Male Health Worker is borne by the State governments.

There are 157935 SCs functioning in rural areas of the country as on 31st March, 2022.  Significant increase in Sub Centres is recorded in the States of Rajasthan (3011), Gujarat (1858), Madhya Pradesh (1413) and Chhattisgarh (1306). Similarly, significant increases in the number of PHCs have been seen in the States of Jammu & Kashmir (557), Karnataka (457), Rajasthan (420), Gujarat (404) and Assam (310). 

Percentage of Sub-Centres functioning in the Government buildings has increased from 43.8% in 2005 to 69.1% in 2022.

Primary Health Centre (PHC)

PHC is the first contact point between village community and the medical officer.

The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the State governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services (BMS) Programme.

As per minimum requirement, a PHC is to be manned by a medical officer supported by 14 paramedical and other staff. Under NRHM, there is a provision for two additional staff nurses at PHCs on contract basis. It acts as a referral unit for 6 Sub Centres and has 4-6 beds for patients. The activities of PHC involve curative, preventive, promotive and family welfare services.

At the national level, there are 24935 PHCs functioning in rural areas as on 31st March 2022. Significant increases in the number of PHCs have been seen in the States of Jammu & Kashmir (557), Karnataka (457), Rajasthan (420), Gujarat (404) and Assam (310). 

Percentage of PHCs functioning in Government buildings has increased significantly from 69% in 2005 to 91.1% in 2022. 

For allopathic Doctors at PHCs, there is a shortfall of 3.1% of the total requirement for existing infrastructure as compared to manpower in position. This is
again mainly due to significant shortfall of doctors at PHCs in the States of Odisha (298), Chhattisgarh (279) and Karnataka (60). Apart from Allopathic doctors, there are 8473 AYUSH doctors available at PHCs.

As on 31st March, 2022 the overall shortfall in the posts of HW(F)/ANM is 3.5% of the total requirement, mainly due to shortfall in States namely, Uttar Pradesh (2288), Himachal Pradesh (1368), Gujarat (1003), Uttarakhand (500), Odisha (470) and Tripura (415).

Community Health Centres (CHCs)

CHCs are being established and maintained by the State government under MNP/BMS programme.

As per minimum norms, a CHC is required to be manned by four medical specialists i.e. surgeon, physician, gynecologist and pediatrician supported by 21 paramedical and other staff. It has 30 in-door beds with one OT, X-ray, labour room and laboratory facilities.

It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations.

As on 31st March 2022, there are 5480 CHCs functional in rural areas of the country.  In case of CHCs, significant increase is observed in the States of Uttar Pradesh (443), Tamil Nadu (350), Rajasthan (290), West Bengal (253) and Bihar (168). 

The % of CHCs in Govt. buildings has increased from 91.6% in 2005 to 996.9% in 2022.

The current position of specialists manpower at CHCs reveal that as on 31st March, 2022, out of the sanctioned posts, 71.9% of Surgeons, 63% of Obstetricians & Gynecologists, 67.5% of physicians and 69.7% of pediatricians are vacant.

First Referral Units (FRUs)

An existing facility (District Hospital, Sub-divisional Hospital, Community Health Centre etc.) can be declared a fully operational First Referral Unit (FRU) only if it is equipped to provide round-the-clock services for emergency obstetric and New Born Care, in addition to all emergencies that any hospital is required to provide. It should be noted that there are three critical determinants of a facility being declared as a FRU:

• Emergency Obstetric Care including surgical interventions like caesarean sections;
• new-born care; and
• blood storage facility on a 24-hour basis.

A total of 1275 Sub Divisional/Sub District Hospital are functioning as on 31st March, 2022 throughout the country. In these hospitals, 18643 doctors are available. In addition to these doctors, about 45992 paramedical staffs are also available at those hospitals as on 31st March, 2022.

In addition to above, 767 District Hospitals (DHs) are also functioning as on 31st March, 2022 throughout the country. There are 29817 doctors available in the DHs. In addition to the doctors, about 95444 para medical staff is also available at District Hospitals as on 31st March, 2022

Source : Rural Health Survey 2022