As the general elections in Uttar Pradesh approach, electoral promises made by the outgoing government of the Bharatiya Janata Party (BJP) are multiplying. There have also been several recent claims that show Uttar Pradesh as a model state, which has effectively managed the COVID-19 crisis.
However, if we look at the situation on the ground, we see that the UP health system is sick. In a previous report, we looked at how the UP’s health infrastructure is faltering. In this report, we examine the state of the health workforce at the primary health care level in the UP.
Dilapidated health infrastructure and inadequate and weak health personnel lead to poor delivery of health care to the population, clearly visible during the COVID-19 pandemic, especially during the second wave of 2021. As numerous reports have it revealed, UP’s healthcare system collapsed – government tried to hide the true death toll, but floating corpses, anonymous riverbank graves and overwhelmed crematoriums and cemeteries exposed the crisis .
As we show below, UP has huge deficits in relation to the number of staff required in various positions of the health workforce. Some of these positions, such as Anganwadi officials and health workers in sub-centers and primary and community health centers, are critical in reducing the number of preventable maternal and child deaths. There is no doubt that the UP has some of the worst indicators among the various states in the country – the second highest infant and maternal mortality rates.
Anganwadi officials – False allegations by the UP government
In recent rallies and public speeches, the UP chief minister praised the efforts of Anganwadi workers during the COVID-19 pandemic and announced the distribution of smartphones.
However, the government has taken no concrete steps to improve their conditions. For all categories of officials in the Anganwadi services, there is a significant percentage of vacant sanctioned posts. What is more concerning is that vacancies have increased over the years since 2018, when the current government took office.
As shown in Figure 1, for the Child Development Project Manager (CDPO) position, 42% of sanctioned positions were vacant in 2018, rising to 57% in 2021, an increase of 378 CDPO vacant positions in 2018. 514 vacancies compared to a requirement of 897 civil servants. CDPOs are key district-level officials in the Department of Integrated Child Development Services (ICDS) – a crucial program for children 0-6 years old, pregnant women and breastfeeding mothers to provide nutrition and early childhood care and development.
For supervisors, 43% of sanctioned positions were vacant in 2018, rising to 57% in 2021, going from 2,890 vacant positions to 3,815 vacant positions for a need of 6,718 supervisors. Likewise, the proportion of sanctioned vacancies for Anganwadi workers and helpers has increased over the past four years. There were 16,762 vacancies for Anganwadi workers in 2018, which in 2021 has grown to 19,252 vacancies. For Anganwadi assistants, the current number of vacancies is 27,089.
Vacant positions for Anganwadi Services officials – 2018 to 2021 (in%
These shortages have put undue pressure on existing officials, especially with the increased workload during the pandemic. The increased workload did not lead to a proportional increase in remuneration. Dozens of Anganwadi workers staged protests, demanding an increase in monthly pay. In September 2021, the government UP claims increase the monthly fees for Anganwadi workers and helpers. However, the workers exposed the government’s claim as the meager announced increase was in fact under the performance-related incentive program and not added to the monthly fees.
In 2017, the BJP Manifesto promised a fair increase in fees based on a newly formed committee report. However, there has not been such an increase; the monthly fees of an Anganwadi worker remain at Rs 5,500 in the main Anganwadis, Rs 4,500 in the mini Anganwadis, and the assistant earns Rs 2,750 per month.
Continued shortage of health workers in PHCs and CHCs
Anganwadi service officials are not the only category of primary health workers who suffer. Shortages of health workers persist at all levels of care in rural areas of the UP. Community Health Centers (CHCs) were designed to provide a secondary level of health care to primary level referrals and cases requiring specialist care. In some of the critical CHC positions, shortages exceed 70% of the workforce required.
Figure 2 shows a shortfall of nearly 77% for obstetricians and gynecologists compared to the number of staff required in rural UP CHCs – because, against a requirement of 711, only 161 are in post. On top of that, surgeons are also below 77% of the number required – only 166 in position against a requirement of 711 surgeons. Only 180 pediatricians are in place against the 711 required, ie a shortfall of 75% compared to the number of staff required. Likewise, radiographers and physicians in CHCs lack 73% and 57%, respectively. Compared to the requirement of about 2,844 specialists (including obstetricians and gynecologists, pediatricians, doctors and surgeons) in CHCs, there are only 816 in place – a shortfall of 71%.
Shortage of health workers in CHCs (as of March 31, 2020) (in%)
Primary health centers (PHC) were envisioned as “the first port of call for a qualified public sector doctor in rural areas for patients and those who report directly or are referred by sub-centers for care. of curative, preventive and promotional health ”. Sub-centers (SCs) are the most peripheral point of contact and the first between the primary health care system and the community. The latest figures for UP PHC and CS show huge gaps for some of the important categories of health workers at this level of care.
In the UP CSP, nurses lack about 44% of the required staff – 1613 are in post, while the number required is 2880. For laboratory technicians, this percentage reaches 65%. For another crucial post of health assistant (male and female) in PHC, the shortage is 92%! Only 475 health assistants are in place against a need for 5,760.
At the health center level, the shortage of health workers (men) reached 91%, i.e. a deficit of 18,877 positions against a need for 20,778.
Shortage of health workers in PHC (as of March 31, 2020) (in%)
These huge shortages in key rural health worker positions at the primary level translate into poor health care delivery or even non-existent health services. Most of these services, as with the ICDS, are critical for the health of pregnant women, nursing mothers and very young children. These shortages of health workers would have implications for the incidence of malnutrition in the state.
No matter how much the UP government advertises that the UP will make significant progress in providing health care to the people, the reality on the ground turns out to be the opposite. The point is that the delivery of health services is far from satisfactory. In addition, the UP government has also let down its health workers. While health workers, especially frontline workers such as Anganwadi workers, continue to provide services even in such dire situations as the pandemic, the government has failed to provide them with decent pay or employment. by filling a large number of vacant positions.