Litmus Test For Rural Healthcare Infra As Reverse Migration Soars

Coronavirus started gradually expanding to rural areas soon after India declared the presence of covid-19 in the country in January. Covid-19 cases have already been recorded in areas, such as Lakhimpur Kheri in Uttar Pradesh and Bhilwara in Rajasthan to Ratnagiri in Maharashtra, which are officially provinces in rural India.

The reverse migration has further increased possibilities of fast spread of the contagion in rural India that has a shortfall of healthcare services and doctors.

The government is perturbed over the risk of migrants carrying the virus and the ministry of health and family welfare on Tuesday issued an advisory to state governments for quarantining migrant workers. The ministry has said that if the migrants who are infected are not identified properly it would be difficult to track them and their contacts.

The ministry has issued guidelines for state and district authorities to ensure that all those who have returned to villages recently or are on their way undergo thermal screening. It said that the risks of these people should be assessed and they should be mandatorily home quarantined for 14 days. Those who show symptoms or heightened risk, as well as people above 60 or those with co-morbidities, should be kept in administered isolation facilities, it said. This will impact essential healthcare services in rural areas, with the focus on covid-19 prevention, claim public health experts.

The Union health ministry said there was a shortfall of primary health centres and community health centres by 22% and 30% across India, with the highest shortfall in West Bengal, Uttar Pradesh, Bihar, Jharkhand, Rajasthan and Madhya Pradesh. In such a grim scenario, following these protocols may be difficult.

“These guidelines have to be strictly adhered to if we have to contain further spread of the virus in rural areas which are grossly unequipped to deal with the disease health wise. At the same time, we need to equip our healthcare system for a potential surge in cases that is likely to happen over the next two weeks. We need to have thousands of new ventilators ready within a week, as well as adequate protective equipment such as N95 masks, gloves and hazmat suits,” said Dr Shankar Narang, chief operating officer, Paras Healthcare, a hospital chain.

At least 60% of PHCs in India have only one doctor while about 5% have none, according to the Economic Survey 2018-19. More than 10% PHCs in Jharkhand and 20% in Chhattisgarh don’t have any doctors. More than 90% PHCs in Gujarat have only one doctor. The situation is the same in 80% of PHCs in Kerala and Karnataka, and 70% of those in Rajasthan, Uttar Pradesh and Bihar.

“What this data does not reveal is that even if the personnel are present, their participation in providing health services may not be at desirable levels because of lack of supplies, inadequate infrastructure facilities, poor monitoring of the staff,” the survey had said.

“The pressure of handling patients in rural India is twice as much as the national average. On average, for every 10,000 people in the country, there is one allopathic doctor available. In rural India, one doctor is available for every 26,000 people,” said Himanshu Sikka, chief strategy and diversification officer, health, nutrition and wash, IPE Global, an international health consultancy.

“If a spike in cases happens in rural India, especially those requiring artificial oxygen supply, this would hit the weakest link of India’s health systems and lead to higher death rates. The doctor per patient ratio and availability of ventilators in rural areas is really low and would put additional pressure on the limited resources, and the government is preparing for this eventuality,” he said.-Livemint