CHANDIGARH: It’s not just the doctors, Punjab’s healthcare system is also grappling with a critical shortage of health facilities in the rural and urban areas.
The infrastructure gap compounds the existing challenges stemming from the shortage of medical professionals, especially specialist doctors.
The latest ‘Health Dynamics of India: Infrastructure and Human Resources 2022-23’ report compiled by the Union health ministry, which provides data on health infrastructure, including manpower, up to March 31, 2023 paints a grim picture of Punjab’s healthcare.
As per the estimated mid-year population as of July 1, 2023, the state’s urban areas have a population of approximately 1,29,18,000. To provide quality healthcare, 258 primary health centres (PHCs) are required, but currently, only 124 PHCs serve the urban areas, resulting in a significant shortfall of 134 (52%) centres.
Punjab’s rural areas, home to an estimated 1,78,78,000 people, require 3,575 sub-centres for adequate healthcare coverage. However, the state has only 2,857 sub-centres – the first contact point between the primary healthcare system and the community – resulting in a shortage of 718 (20%) sub-centres.
The state also faces a significant shortfall in primary and community healthcare. Punjab has a total of 12,784 villages and 58.1% of its total population lives in the rural areas.
With 397 functional PHCs against the required 595, the state has a shortfall of 198 PHCs (33%). The community health centres (CHCs) shortage is even more pronounced, with 148 required to serve the rural population, but only 84 available, resulting in a shortfall of 64 (43%).
The rural healthcare infrastructure is structured into three tiers – sub-centres, PHCs, and CHCs – each designed to serve specific population sizes.
According to norms, a sub-centre serves 5,000 people in plain areas and 3,000 in hilly areas. A PHC – the first contact point between the village community and the medical officer – caters to 30,000 individuals in plain regions and 20,000 in hilly regions, while a CHC is intended to serve a population of 1.2 lakh in plain areas and 80,000 in hilly areas, ensuring a hierarchical and population-appropriate healthcare delivery system.
Punjab’s population density stands at 611 persons per square kilometre, with a significant disparity between the rural and urban areas.
While rural regions have a relatively lower density of 374 persons per square kilometre, urban areas are densely populated with a staggering 5,137 persons per square kilometre. The state’s population density is higher than the all-India average.
In Punjab, healthcare facilities cover a larger population than the national average. A sub-centre serves 6,258 rural residents, exceeding the national average of 5,450. Similarly, a PHC caters to 45,033 individuals, surpassing the national average of 35,602, while a CHC serves a population of 2,12,833, exceeding the national average of 1,64,388.
Acute shortage of doctors
Despite claims of enhancing healthcare, the state govt has struggled to address the persistent shortage of specialist doctors, including surgeons, gynecologists, pediatricians, and physicians. The issue has been a long-standing concern and a point of contention between the govt and the Punjab Civil Medical Services Association (PCMSA).
The PCMSA has been advocating for the recruitment of doctors to fill the gap, emphasising the need to improve the quality of healthcare services. The shortage of specialist doctors remains a significant challenge, undermining the efforts to provide quality medical care, particularly in the rural areas.
With just 119 specialists working against the sanctioned posts of 336 in the urban CHCs, there is a vacancy of over 64%. Similarly, the urban PHCs have 161 medical officers against sanctioned posts of 236, resulting in a 32% vacancy.
The situation is even more dire in rural CHCs, where only 55 specialists are working against a requirement of 336. Specialist doctor vacancies in the rural CHCs skyrocketed from 167 in 2005 to 243 in 2023, marking an alarming 45% increase over 18 years. The stark rise underscores the failure on part of successive govts to effectively recruit and retain the specialist doctors.
Rural CHCs have only 17 paediatricians against 84 such positions and eight physicians against 84 posts, besides 18 surgeons and 12 obstetricians and gynecologists, highlighting significant shortages in critical specialties. These vacancies compromise the quality of healthcare services, particularly in the rural areas.
Slack infrastructure
The report also highlighted the deplorable state of basic infrastructure at these healthcare centres, revealing that none of the 84 functional CHCs in the rural areas had the required three specialists, while only 54 had a stabilisation unit for the newborns.
Furthermore, out of 397 functional PHCs in rural areas, only 184 (46.3%) provide round-the-clock services, 13 (3.3%) have an operation theatre, and 193 (48.6%) have at least four beds.
Many sub-centres lack essential amenities, with 30 out of 2,857 not having regular water supply, 299 without electricity supply, and only 343 having quarters for the auxiliary nurse midwives (ANMs). These deficiencies severely impact the quality of healthcare services, particularly in the rural areas. Only 881 sub-centres (30.83%) ) have separate toilets for men and women patients, while 291 of 397 PHCs and 82 of 84 CHCs have facilities of separate toilets for patients.
The infrastructure gap compounds the existing challenges stemming from the shortage of medical professionals, especially specialist doctors.
The latest ‘Health Dynamics of India: Infrastructure and Human Resources 2022-23’ report compiled by the Union health ministry, which provides data on health infrastructure, including manpower, up to March 31, 2023 paints a grim picture of Punjab’s healthcare.
As per the estimated mid-year population as of July 1, 2023, the state’s urban areas have a population of approximately 1,29,18,000. To provide quality healthcare, 258 primary health centres (PHCs) are required, but currently, only 124 PHCs serve the urban areas, resulting in a significant shortfall of 134 (52%) centres.
Punjab’s rural areas, home to an estimated 1,78,78,000 people, require 3,575 sub-centres for adequate healthcare coverage. However, the state has only 2,857 sub-centres – the first contact point between the primary healthcare system and the community – resulting in a shortage of 718 (20%) sub-centres.
The state also faces a significant shortfall in primary and community healthcare. Punjab has a total of 12,784 villages and 58.1% of its total population lives in the rural areas.
With 397 functional PHCs against the required 595, the state has a shortfall of 198 PHCs (33%). The community health centres (CHCs) shortage is even more pronounced, with 148 required to serve the rural population, but only 84 available, resulting in a shortfall of 64 (43%).
The rural healthcare infrastructure is structured into three tiers – sub-centres, PHCs, and CHCs – each designed to serve specific population sizes.
According to norms, a sub-centre serves 5,000 people in plain areas and 3,000 in hilly areas. A PHC – the first contact point between the village community and the medical officer – caters to 30,000 individuals in plain regions and 20,000 in hilly regions, while a CHC is intended to serve a population of 1.2 lakh in plain areas and 80,000 in hilly areas, ensuring a hierarchical and population-appropriate healthcare delivery system.
Punjab’s population density stands at 611 persons per square kilometre, with a significant disparity between the rural and urban areas.
While rural regions have a relatively lower density of 374 persons per square kilometre, urban areas are densely populated with a staggering 5,137 persons per square kilometre. The state’s population density is higher than the all-India average.
In Punjab, healthcare facilities cover a larger population than the national average. A sub-centre serves 6,258 rural residents, exceeding the national average of 5,450. Similarly, a PHC caters to 45,033 individuals, surpassing the national average of 35,602, while a CHC serves a population of 2,12,833, exceeding the national average of 1,64,388.
Acute shortage of doctors
Despite claims of enhancing healthcare, the state govt has struggled to address the persistent shortage of specialist doctors, including surgeons, gynecologists, pediatricians, and physicians. The issue has been a long-standing concern and a point of contention between the govt and the Punjab Civil Medical Services Association (PCMSA).
The PCMSA has been advocating for the recruitment of doctors to fill the gap, emphasising the need to improve the quality of healthcare services. The shortage of specialist doctors remains a significant challenge, undermining the efforts to provide quality medical care, particularly in the rural areas.
With just 119 specialists working against the sanctioned posts of 336 in the urban CHCs, there is a vacancy of over 64%. Similarly, the urban PHCs have 161 medical officers against sanctioned posts of 236, resulting in a 32% vacancy.
The situation is even more dire in rural CHCs, where only 55 specialists are working against a requirement of 336. Specialist doctor vacancies in the rural CHCs skyrocketed from 167 in 2005 to 243 in 2023, marking an alarming 45% increase over 18 years. The stark rise underscores the failure on part of successive govts to effectively recruit and retain the specialist doctors.
Rural CHCs have only 17 paediatricians against 84 such positions and eight physicians against 84 posts, besides 18 surgeons and 12 obstetricians and gynecologists, highlighting significant shortages in critical specialties. These vacancies compromise the quality of healthcare services, particularly in the rural areas.
Slack infrastructure
The report also highlighted the deplorable state of basic infrastructure at these healthcare centres, revealing that none of the 84 functional CHCs in the rural areas had the required three specialists, while only 54 had a stabilisation unit for the newborns.
Furthermore, out of 397 functional PHCs in rural areas, only 184 (46.3%) provide round-the-clock services, 13 (3.3%) have an operation theatre, and 193 (48.6%) have at least four beds.
Many sub-centres lack essential amenities, with 30 out of 2,857 not having regular water supply, 299 without electricity supply, and only 343 having quarters for the auxiliary nurse midwives (ANMs). These deficiencies severely impact the quality of healthcare services, particularly in the rural areas. Only 881 sub-centres (30.83%) ) have separate toilets for men and women patients, while 291 of 397 PHCs and 82 of 84 CHCs have facilities of separate toilets for patients.
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