Doctors at PHC level – Challenges and Way Forward

Context

Despite being the backbone of India’s rural health system, PHC doctors face crushing workloads, administrative overload, and burnout, highlighting the urgent need to strengthen their support and working conditions.

Role of PHC Doctors

• First Point of Contact: PHC doctors are the first interface between the community and the health system, providing essential medical care to rural and peri-urban populations.
• Population Coverage: Each PHC covers ~30,000 people in rural areas, 20,000 in hilly/tribal areas, and ~50,000 in urban regions.
• Beyond Clinical Work: They conduct immunisation campaigns, school health programs, disease surveillance, outbreak response, and health education sessions.
• Community Engagement: Participate in gram sabhas, Anganwadi visits, and inter-sectoral meetings, and mentor ASHA, ANM, and village health workers.
• Programme Implementation: Act as nodal officers for schemes like Rashtriya Bal Swasthya Karyakram, National Vector Borne Disease Control Program, and maternal-child health missions.
• Bridge Between Policy and People: They operationalise national health policies at the grassroots, ensuring equitable access and preventive care.

Challenges Faced by PHC Doctors

• Crushing Clinical Load: On average, a PHC doctor sees ~100 outpatients daily; antenatal OPDs alone may bring ~100 pregnant women per day.
• Multi-Specialty Burden: Expected to handle emergencies across pediatrics, obstetrics, geriatrics, mental health, infectious diseases, and trauma without specialist support.
• Administrative Overload: Maintain 100+ registers (OP, MCH, NCDs, drugs, sanitation) plus data entry into Ayushman Bharat Portal, UWIN etc. Often, there is duplication of work.
• Burnout and Fatigue: Emotional exhaustion, detachment, and loss of motivation – recognised by WHO’s ICD-11 as an occupational phenomenon.
• Limited Learning Space: Lack of time for research, upskilling, or continuous medical education despite being key contributors of health data.
• Infrastructure Constraints: Many PHCs lack proper equipment, medicines, or referral facilities, leaving doctors helpless in emergencies.

Way Forward

• Reduce Documentation Burden: Eliminate redundant registers, integrate platforms, and adopt automation & AI-based health records. 
  • Models like the U.S. 25 by 5 campaign (cut clinician documentation time by 75%) can guide reforms.
• Task Shifting: Delegate non-clinical duties (data entry, logistics, IEC campaigns) to trained staff or mid-level health workers.
• Strengthen Infrastructure: Ensure functional labs, drug supply, telemedicine support, and emergency referral networks in every PHC.
• Address Burnout: Provide counseling, flexible hours, and rest periods; officially recognise burnout as a public health issue.
• Incentivise Rural Postings: Better remuneration, housing, career advancement, and academic opportunities for doctors serving in PHCs.
• Community-Centric Governance: Leverage panchayats, SHGs, and local volunteers for surveillance and awareness, reducing pressure on doctors.
• Reframe Policy Focus: Shift from a compliance-driven model (targets, checklists) to a facilitation model where systems enable doctors to deliver quality care.

Sharing is caring!