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Ailing Health System in UP Results From Neglect of Health Workers During BJP’s Tenure

A weak and inadequate health workforce results in poor health care for people. UP is a case in point where health workers, especially at the primary level of care in rural UP, continue to struggle with low remuneration, severe workload and numerous vacant posts.
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Representational use only.

As the Assembly elections in Uttar Pradesh draw nearer, there is an abundance of poll promises made by the incumbent Bharatiya Janata Party (BJP) government. There have also been several recent claims that show Uttar Pradesh as a model state, which effectively dealt with the COVID-19 crisis.

However, if we look at the ground situation, we see that the health system in UP is ailing. In an earlier report, we looked at how the health infrastructure in UP is tottering. In this report, we look at the state of the health workforce at the primary health care level in UP.

Dilapidated health infrastructure and an inadequate and weak health workforce result in poor care delivery to the people, visible clearly during the COVID-19 pandemic, especially during the second wave in 2021. As many news reports brought out, the health system in UP collapsed - the government tried to hide the actual number of deaths, but the floating corpses, unmarked graves on river banks, and overwhelmed crematoriums and burial grounds exposed the crisis.

As we show below, UP has huge shortfalls from the required numbers at various positions of the health workforce. Some of these positions, such as the Anganwadi functionaries and the health workers at sub-centres and primary and community health centres, are crucial in reducing the number of avoidable maternal and child deaths. No doubt UP has some of the worst indicators among various states in the country – second-highest infant and maternal mortality rates.

Anganwadi Functionaries – False Claims by the UP Government

In recent rallies and public addresses, the UP Chief Minister lauded the efforts of Anganwadi workers during the COVID-19 pandemic and announced the distribution of smartphones.

However, the government has taken no concrete measures to make their conditions better. For all categories of Anganwadi services’ functionaries, there is a significant percentage of sanctioned posts lying vacant. What is more concerning is that the vacant posts have increased over the years since 2018, when the current government came into power.

As Figure 1 shows, for the Child Development Project Officer (CDPO) post, 42% of sanctioned posts were lying vacant in 2018, increasing to 57% in 2021 – an increase from 378 vacant CDPO posts to 514 vacant posts as against a requirement of 897 officials. CDPOs are key District level functionaries in the Integrated Child Development Services (ICDS) department – a crucial scheme for 0-6 years of children, and pregnant women and lactating mothers to ensure nutrition and early childhood care and development.

For Supervisors, 43% of sanctioned posts were lying vacant in 2018, increasing to 57% in 2021, a rise from 2,890 vacant posts to 3,815 vacant posts as against a requirement of 6,718 supervisors. Similarly, the proportion of sanctioned posts lying vacant for Anganwadi workers and helpers have increased over the past four years. There were 16,762 vacant posts for Anganwadi workers in 2018, which in 2021 have increased to 19,252 vacant posts. For Anganwadi helpers, the current number of vacant posts is 27,089.

Vacant Positions of Anganwadi Services’ Functionaries – 2018 to 2021 (in %

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Source: Rajya Sabha Unstarred Question No. 1272

These shortages have put excess pressure on the existing functionaries, especially with the increased workload during the pandemic. The increase in workload has not seen any commensurate increase in remuneration. Scores of Anganwadi workers have staged demonstrations, demanding an increase in monthly remuneration. In September 2021, the UP government claimed to have increased the monthly honorarium of Anganwadi workers and helpers. However, the workers exposed the government’s claim as the meagre hike announced was actually under the performance-linked incentive scheme and not added to the monthly honorarium.

In 2017 the BJP Manifesto had promised a fair increase in the honorarium based on a freshly constituted committee report. However, there has been no such increase; the monthly honorarium for an Anganwadi worker remains at Rs 5,500 in the main Anganwadis, Rs 4,500 at the mini Anganwadis, and the helper earns Rs 2,750 a month.

Continuing Shortages of Health Workers at PHCs and CHCs

Anganwadi services’ functionaries are not the only category of primary health workers who have been suffering. Health worker shortages persist at all levels of care in rural UP. The Community Health Centres (CHCs) were designed to provide a secondary level of health care for referral cases from the primary level and cases in need of specialist care. At some of the crucial positions in CHCs, shortages exceed 70% of the required workforce.

Figure 2 shows a shortfall of nearly 77% for obstetrics and gynaecologists from the required numbers at rural CHCs in UP – as, against a requirement of 711, only 161 are in position. In addition to this, surgeons are also 77% short of the required – only 166 in position against a requirement of 711 surgeons. Only 180 paediatricians are in position as against the required 711 amounting to a shortfall of 75% from the required numbers. Similarly, radiographers and physicians at CHCs are short by73% and 57%, respectively. As against the requirement of about 2844 specialists (including obstetricians & gynaecologists, paediatricians, physicians and surgeons) at CHCs, there are only 816 in place – a shortfall of 71%.

Shortage of Health Workers at CHCs (as of March 31, 2020) (in %)

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Rural Health Statistics 2019-20

Primary Health Centres (PHCs) were envisaged as the “first port of call to a qualified doctor of the public sector in rural areas for the sick and those who directly report or referred from Sub-Centres for curative, preventive and promotive health care”. Sub-Centres (SCs) are the most peripheral and first point of contact between the primary health care system and the community. The latest figures for PHCs and SCs in UP show huge shortfalls for some of the important categories of health workers at this level of care.

At PHCs in UP, the nursing staff is short of the required numbers by about 44% - 1613 are in position, whereas the required number is 2880. For laboratory technicians, this percentage is as high as 65%. For another crucial position of health assistant (both male and female) at PHCs, the shortage is a whopping 92%! Only 475 health assistants are in position as against a requirement of 5760.

At the level of SCs, the shortage of health workers (male) is as high as 91%, which is a shortfall of 18,877 posts against a requirement of 20,778.

Shortage of Health Workers at PHCs (as of March 31, 2020) (in %)

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Source: Rural Health Statistics 2019-20

Such huge shortfalls for key positions of rural health workers at the primary level translate into poor care delivery or even non-existent healthcare services. Most of these services, such as under the ICDS, are crucial for the health of pregnant women, lactating mothers and very young children. These health worker shortfalls would have implications regarding the incidence of malnutrition in the state.

However much the UP government advertises with claims of UP making significant progress in providing healthcare to the people, the ground reality emerges to be the opposite. The fact is that the delivery of healthcare services is far from satisfactory. Moreover, the UP government has also failed its health workers. While the health workers, especially the frontline workers such as Anganwadi workers, continue to provide services even under such challenging situations as the pandemic, the government has not provided them with either decent remuneration or employment by filling up a large number of vacant positions.

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