A recent survey has revealed a concerning state of affairs in India's rural healthcare system, with approximately 60% of health sub-centres (SCs) lacking the necessary resources and capabilities to manage basic medical conditions. This deficiency raises serious questions about the accessibility and quality of primary healthcare services available to a significant portion of the population, particularly in rural areas where these sub-centres serve as the first point of contact for individuals seeking medical assistance.

The survey, conducted by a collaborative team of researchers from the Indian Council of Medical Research (ICMR) and the World Health Organization (WHO) across 19 districts in seven states, assessed the preparedness of these sub-centres in managing common ailments such as hypertension (high blood pressure) and diabetes. The findings, published in the Indian Journal of Medical Research (IJMR), paint a grim picture of the state of primary healthcare infrastructure in the country.

According to the survey, only about 40% of the assessed sub-centres were adequately equipped to treat hypertension and diabetes. A significant number of these facilities lacked even the most basic medicines required to manage these conditions effectively. Specifically, the survey revealed that nearly one-third of the sub-centres experienced stock-outs of metformin, a crucial anti-diabetes medication, while almost half (45%) reported shortages of amlodipine, a drug commonly used to manage high blood pressure. The median duration of these stock-outs ranged from one to seven months, highlighting a persistent and systemic issue in the supply chain.

The IJMR report also pointed out that government medical colleges were better stocked with these essential medicines compared to other levels of public health facilities, indicating a disparity in resource allocation and access. Furthermore, the survey highlighted a shortage of specialists at the Community Health Centre (CHC) level, a problem that was also underscored in the rural health statistics report of 2020-21, which revealed a significant shortfall of physicians (82%) and surgeons (83%) at CHCs.

These findings are particularly alarming in light of the increasing prevalence of non-communicable diseases (NCDs) in rural India. The ICMR-India Diabetes Study (ICMR-INDIAB) has reported evidence of an NCD epidemic spreading to rural areas, driven by lifestyle changes and other factors. In this context, the lack of preparedness among sub-centres to manage conditions like hypertension and diabetes poses a significant threat to public health. Strengthening these sub-centres is crucial to ensuring that primary care services are readily available to people in their local communities.

The deficiencies in India's health sub-centres are not limited to a lack of medicines and equipment. Several underlying issues contribute to the problem, including inadequate infrastructure, staffing shortages, and a lack of coordination between different levels of the healthcare system. Many sub-centres operate from rented buildings or spaces provided by local village panchayats, lacking the basic amenities and infrastructure required to deliver quality healthcare.

Moreover, a significant number of sub-centres do not have access to regular water or electricity supply, further hindering their ability to provide essential services. The shortage of healthcare professionals, particularly male health workers, also affects the implementation of national health programs.

To address these challenges, the government has launched initiatives such as the Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), which aims to establish Ayushman Arogya Mandir (AAM) sub-centres to provide comprehensive primary healthcare services. However, these initiatives need to be implemented effectively and scaled up to ensure that all sub-centres are adequately equipped and staffed. The Indian Public Health Standards (IPHS) also provide guidelines for upgrading health facilities.

Improving the functionality of sub-centres is crucial for tackling the underutilization of public health facilities and strengthening public trust in government healthcare services. By addressing the gaps in infrastructure, staffing, and medicine availability, India can ensure that its health sub-centres are capable of providing quality primary healthcare services to all, regardless of their location or socioeconomic status.