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The shortfall of specialist doctors in community healthcare centres (CHCs) in rural areas has increased over the past decade in India. Surgeons, obstetricians, gynaecologists, physicians and paediatricians were considered specialists for this analysis. In 2012, the shortfall of specialists was already high at 69.7%, but it increased further to 79.5% in 2022.
As per the norms of the Indian Public Health Standards, a CHC is required to be manned by four medical specialists: surgeon, physician, obstetrician/gynaecologist, and paediatrician. As on March 31, 2022, according to the 2021-22 Rural Health Statistics, released recently, 21,920 specialist doctors were required in rural areas across India. However, only 4,485 were available, which means that there was a shortfall of 17,435 specialists. This translates into a shortfall of 79.5% (17,435 as a percentage of 21,920), which is nearly 10% points more than a decade ago (Chart 1). The shortfall of obstetricians/gynaecologists was 74.2% in 2022, which is a 9.1% point increase from a decade ago. The shortfall of surgeons was 83.2% in 2022, a 8.3% point increase from 10 years ago.
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There was a shortfall of specialists in urban CHCs too, but this was far lower than the shortfall in rural CHCs. In urban CHCs, there was a 46.9% shortfall in 2022, which is 32.6% points less than the shortfall in rural CHCs. Therefore, the crisis was more acute in rural areas.
While these numbers show a shortfall of specialists, it is important to understand that the calculation is done with the assumption that there should be four specialists in every CHC. This is crucial because a State with a lower number of CHCs than what is required can escape scrutiny when it comes to the shortfall of specialists, as the number of such doctors required is low to start with. So, it becomes important to analyse the number of CHCs in each State. Chart 2 shows the shortfall percentage and surplus percentage of CHCs in each State as of March 2022. Both figures were arrived at by using the requirement levels based on the prescribed norms calculated using the 2022 rural population estimates. In each State, the number of functioning CHCs was subtracted from the required number of CHCs to arrive at shortfall or surplus. Kerala had a surplus of 171% — the highest in India. While the requirement was 78 CHCs, the State had 211 in place. It was followed by Himachal Pradesh (63% surplus) and Tamil Nadu (28%) among the major States. Of the 27 States considered for analysis, only 10 had either a surplus or the required number; the rest had a shortfall. Among the States with a shortfall, Bihar (71% shortfall), Andhra Pradesh (64%), Maharashtra (56%), Karnataka (45%) and Uttar Pradesh (44%) stood out.
The number of States with a shortfall in CHCs slightly reduced in 2022 from a decade ago. Chart 3 shows the shortfall percentage and surplus percentage of CHCs in each State in 2012. In 2012, the number of States with a shortfall was 20; this reduced to 17 in 2022.
In 2012, all the northern States had a shortfall of CHCs, while in 2022, only Punjab and Himachal Pradesh did not. In the east, except Odisha, all the States had a shortfall in both years. India’s shortfall of CHCs remained unmoved at 36% in both years.
Chart 4 shows the shortfall percentage of specialists in 2022 only among the States that had a shortfall of CHCs in 2022. Tripura, Meghalaya and Sikkim had a nearly 100% shortfall. This means the number of specialists in these regions was zero or close to zero. The shortfall of specialists was lowest in Karnataka (46% shortfall), Andhra Pradesh (64%) and J&K (43%).
Source: Rural Health Statistics
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