A recent survey in the country has found the reason for lack of quality in primary healthcare in India. According to a recent ASSOCHAM survey, about half the posts of specialists at various community health centers remain vacant, when it accepted that existing manpower is an important pre-requisite for the efficient functioning of rural health infrastructure.

The report points out that 59.2 percent of posts for surgeons, 46.4 percent posts for obstetricians and gynecologists and 51.9 percent for pediatricians are vacant in the 4,500 community health centers of the country.

As of now there is fear of relapse of ailments like malaria, polio, kalaazar, Japanese encephalitis and even tuberculosis in different parts of the country. Also, the Health Ministry is thinking of a paradigm shift in medical curriculum revamp, initially at JIPMER the medical institution and college in Pondicherry. And follow the pattern in Stanford University in USA.

Union Health Minister Dr. Anbumani Ramadoss, during his visit to the US University in summer this year found that students were given practical knowledge along with theory in the first year of the course. In India however, the first year syllabus does not include any practical exposure. JIPMER has been selected for this new curriculum as it is an autonomous body and can have an independent curriculum according to the Minister.

What with possibilities of seasonal ailments cropping up every year and grossly insufficient facilities and manpower dogging the country the ASSOCHAM report points out that primary health care is a low priority issue for state governments. About 2,525 community health centers should have been added to the current operational CHCs that number around 5,000 by the end of 2007-2008, which did not happen at all and speaks of utter apathy of state governments towards them.

Even in the case of sanctioned posts, a significant percentage has remained vacant. For example, about 9 percent of the sanctioned posts of female health workers remain vacant as compared to about 32 percent of the sanctioned posts of male health workers. It was further pointed out that at primary health centers, about 14 percent of the sanctioned posts of female health assistant and 22.1 male health assistants remain vacant.

The report underlined that a large shortfall among male health workers resulted in poor male participation in family welfare and other health programmes. At least six out of every hundred primary health centers were without a doctor and about 40 percent were without any laboratory technician and about 17 percent were without pharmacist. About 50 percent of sub centers, 75 percent of primary health centers and over 90 percent of community health centers are located in government buildings. The rest are located in tented building or rent free panchayat or voluntary society buildings. In the case of sub-centers, more than 66,400 buildings are required to be constructed. Similarly, over 3,600 buildings are required for primary health centers and about 200 for community health centers. The report stressed that existing manpower is an important pre-requisite for the efficient functioning of rural health infrastructure.

The urgent and indispensable need for health infrastructure remains imperative because of fears of ailments that were considered to have been rooted out, have reared their ugly heads all over again. For instance in Andhra Pradesh in August this year there was a fresh rush of P3 poliovirus infections amongst fishermen community in East Godavari district and the government had to rush a team of doctors to investigate and ensure that mop-up vaccination rounds are given in all neighbouring districts within a month.

Andhra Pradesh, which had managed to stop its indigenous poliovirus transmission long ago claimed to have successfully prevented all importations through rapid and intense mop-up vaccination rounds. According to reports, as the country enters the crucial final stages of polio eradication, most of the cases outside Uttar Pradesh and Bihar are in migrant population and in those living in close proximity to them.

Reports of polio incidence have also come in from Gurgaon, Haryana where the victims are from migrant families from Bihar. Almost 80 percent families in this area belong to poor sections of society and do manual labour for a living.

As the existing but too few health staff struggle to fulfill the tasks of their missing colleagues, India has not been able to retain the trained and qualified staff from migrating abroad to greener pastures, even as the mother country suffers. There have been recent reports that Europe and Canada are trying to build a nucleus of Para-medical staff who would be taking charge of health-care requirement in old people's homes. And there is no dearth of aspiring Para-medics from India.

The shortage of trained staff or doctors in recent times have found a reflection in treatment of AIDS, it was concluded at an international seminar at Mexico City. A first of its kind study by WHO conducted for India's National AIDS Control Organisation estimated that nearly 10,000 HIV infected people- being treated by private physicians were following irrational drug combinations and faulty regimens. This was making them resistant to first line anti-retroviral (ART) drug faster than usual.

Very clearly, and more urgently, all these aspects of health maintenance and health education must be taken up on an emergency basis for the country as a whole.

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