12 states ahead of Gujarat in basic rural health facilities, state lags in institutional deliveries: SRS report

By A Representative
Sample Registration Survey (SRS) data, recently released by the Census of India, have shown Gujarat in poor light with regard to health facilities, especially in the state’s rural areas. The data show that as many as 12 major states of India out of 20 have a higher proportion of primary health centres (PHCs) than Gujarat in rural areas.
Gujarat’s just 19.5 per cent of “sample rural units” are found to have (PHCs), as against the national average of 29.7 per cent. Kerala tops the list with 67.9 per cent of rural areas having PHCs, followed by Telangana 62.0 per cent, Haryana 49.3 per cent, Andhra Pradesh 46.6 per cent, and Tamil Nadu 45.5 per cent.
Even Bihar (22 per cent), Rajasthan (31.4 per cent) and Assam (41.1 per cent) have a higher proportion of PHCs than Gujarat.
PHCs are essentially single-physician clinics, usually with facilities for minor surgeries. They are part of the government-funded public health system in India and are the most basic units of this system. Presently there are 23,109 PHCs in India.
Each PHC has five or six sub-centres, staffed by health workers for outreach services such as immunization, basic curative care services, and maternal and child health services and preventive services. Gujarat’s 41.1 per cent rural areas are covered with sub-centres, but this is again lower than the all-India average of 47.8 per cent.

As for Community Health Centres (CHCs), which constitute the secondary level of health care designed to provide referral as well as specialist health care to the rural population, Gujarat’s just about 8.7 per cent of rural areas have them, as against the national average of 13.4 per cent.
A relatively poor spread of health centres in Gujarat tells adversely on the availability of delivery services to pregnant mothers, suggest data. Thus, Gujarat’s 38.1 per cent sub-centres, 18.2 per cent PHCs and 6.1 CHCs provide facility for delivery, as against the national average of 43 per cent, 25.1 per cent, and 10.3 per cent respectively.
The data appear to suggest that the Gujarat government-sponsored Chiranjivee project, under which private gynecologists are “hired” for providing free delivery to the rural folk, may have helped bring down maternal mortality rate in Gujarat; yet, it has not been able to increase institutional deliveries vis-à-vis the rest of India.
Thus, in 52.4 per cent of cases, the deliveries are allowed to happen at the hands of an auxiliary nurse midwife (ANM), or a lady health worker (LHV), or an accredited social health activists (ASHAs), and not in any of the government or private health facilities. Traditional dais remain equally important, as they carry out deliveries in 23.8 per cent of cases.
In fact, Gujarat has failed in its attempt to privatize institutional health facilities deliveries, too, failing to keep pace with the rest of India. Thus, as against Gujarat’s 9.5 per cent institutional deliveries in private dispensaries and clinics, nationally they happen in 25.2 per cent of cases. Further, while in Gujarat 3.5 per cent of the rural folk go in for delivery to a private hospital, it’s 12.8 per cent for the country.
Lack of health facilities forces rural folk to travel more than two kilometres in Gujarat in 38.5 per cent of cases, as against the national average of 29.1 per cent. Kerala is the best performer, with just 3.6 per cent of the rural folk having to travel more than two kilometres, followed by Assam 5.6 per cent, and Maharashtra 9.7 per cent.