Bihar Elections: Primary Health Care Missing from Political Discourse

The Bihar Assembly elections are just around the corner. However, the ill-equipped and skeletal primary health care system in the state, especially during the ongoing pandemic, has not become an important part of the political discourse in the days leading up to the elections.

According to the Rural Health Statistics (RHS) 2018-2019, published by the Ministry of Health and Family Welfare (MoHFW), the primary health care system in Bihar needs 11,388 more sub centres, 1,649 Primary Health Centres (PHCs), and 737 Community Health Centres (CHCs).

The required number of sub centres in Bihar is 21,337. However, currently, the state has only 9,949 sub centres, which is just 46.6% of the required number. The state has only 1,899 out of the required 3,548 PHCs (53.5%), and 150 out of 887 required CHCs (16.9%). However, even these significantly lower numbers of healthcare facilities lack proper mapper and infrastructure. Between the years 2015n and 2019, the number of sub centres has decreased by 388, while the numbers of PHCs and CHCs increased by just 251 and 49 respectives.

Manpower in Primary Health Care Facilities

The PHCs and CHCs do not have enough doctors, health workers, technicials, or specialists. According to the data presented by the MoHFW in the RHS 2018-2019, while there is a surplus of doctors at sub divisional hospitals and district hospitals, most of the posts at the PHCs and CHCs remain empty, which is to say that to access healthcare facilities, one would have to travel to the district hospital even for the smallest of problems, because the local clinics and dispensaries do not have adequate manpower.

While the numbers of sanctioned posts for doctors in district hospitals and sub divisional hospitals in the state are 888 and 55 respectively, the numbers of doctors in position are 1,301 and 286. When it comes to sub centres PHCs and CHCs, the scenario is reversed, except for the position of Auxiliary Nurse and Midwife (ANM) and female health workers.

The total number of physicians required at CHCs across the state is 150, one for each centre. However, according to the RHS, out of these, only 8 physicians are in position, while the remaining 142 posts, that is, 94.6% of the posts remain vacant.

Out of the 9,949 male health workers required at sub centres, only 1,244 (13.5%) are in position. The number of male health assistants and female health assistants required at PHCs across the state is 1,899 each, but only 212 male and 95 female health assistants are in position. The number of dental surgeons required at PHCs is 1899. However, all the posts remain empty. The picture is similar at CHCs. There are 300 dental surgeons required at CHCs, but not a single person has been recruited.

The number of specialists (physicians, surgeons, obstetricians and gynecologists, and paediatricians) required across the CHCs in the state is 600, out of which 518 posts were empty, as of March, 2019. The CHCs in the state have 13 surgeons, 30 OB/GYNs, 8 physicians, and 31 paediatricians. According to the National Rural Health Mission (NHRM), each of the 150 CHCs should have one specialist from each category.

The numbers of pharmacists and laboratory technicians required at the PHCs and CHCs in Bihar are 2,049 each. However, only 287 pharmacists and 611 lab technicians are in positions, while a large percentage of the seats remain vacant. Out of the 150 radiographers requires, only one is in position. The number of nursing staff required at CHCs and PHCs combined is 2,949, out of which only 1,630 (55.3%) are in position. Out of the 1,04,239 ASHA workers needed in the state, 89,439 are in position, while 14.19% of the posts remain empty.

BJP has promised everyone free COVID vaccines in Bihar if they win the Assembly elections. However, if they were to win, and try to keep their promise, they would find out that the primary health care facilities do not even have enough manpower to administer the vaccines to everyone.