Reforms panel for closing down 1,346 health sub-centres in Karnataka

The Karnataka Administrative Reforms Commission has recommended closing down 1,346, or nearly 15 per cent of the 9,088 health sub-centres, in the state.

Sub-centres are the first point of contact for healthcare for the public. There should be one sub-centre for every 3,000-5,000 people. The commission, chaired by former chief secretary T M Vijay Bhaskar, looked into the streamlining of government departments. It found that many of these centres exist too close to each other.

The commission had analysed geospatial data from the Karnataka State Remote Sensing Applications Centre (KSRSAC) to check whether sub-centres within a one-km distance of each other would form clusters.

It found that nearly a third of the sub-centres (2,890) were spread across 1,346 clusters.

A majority of the clusters (1,172) had two sub-centres each, whereas 150 clusters had three sub-centres and 24 had four centres each.

“The health and family welfare department may consider closure of one sub-centre in each of the 1,346 clusters and redeploy the current staff to a needy sub-centre or primary health centre (PHC),” says the commission report, released early this month.

In the case of PHCs, too, the commission identified 126 clusters. Here, a cluster was identified for PHCs within a 3-km distance of another PHC, community health centre, district or taluk hospital. Karnataka has a total of 2,531 PHCs.

The commission found that the average monthly out-patient department (OPD) footfall was low in PHCs that were in clusters — between 99 and 155. Whereas the average across all PHCs is 1,113.

Hence, the commission recommended converting one PHC out of each of the 126 clusters into an extension clinic.

The latter usually has only three staff, compared to 12 in a PHC. The excess staff in the 126 PHCs can be redeployed at other PHCs with higher footfall, the report says.

Dr R Sarala, associate dean at the Institute of Health Management Research, Bengaluru, says the commission’s recommendation contradicted the goal of universal health coverage under the Ayushman Bharat Mission.

It was under the mission funds that sub-centres were recently added and upgraded to health and wellness centres.

“Besides, many of the sub-centres exist only on paper and have no buildings. There is a severe staff shortage in both sub-centres and PHCs. So, instead of shutdown, there’s a need to verify how many sub-centres actually function and how many have adequate staff,” she said.

“If one centre gets low footfall, the government needs to identify another locality that has a higher requirement and shift the centre there.”