Poor people get poor health systems !
While basic health infrastructure has expanded numerically, the public health system in Surguja remains critically non-functional in terms of quality, accessibility, and staffing, making it unable to meet the population’s needs. This system suffers from the threat of further unregulated privatization as well as underfunding.
Inaccessibility
A sub-centre in Chhattisgarh covers an average area of 25.35 km², far above the national average of 18.98 km². Patients routinely travel 50–80 km to reach secondary care and over 300 km for tertiary care, with no public transport available. In many tribal villages, houses are scattered across hills, and during the rains, 78 villages in Surajpur district alone are cut off from roads. In emergencies, the absence of motorable roads and functional ambulances forces families to carry pregnant women in labour on cots or people bitten by snakebites to reach hospitals too late.
Figure — The long road to care: distance, terrain, and seasonal isolation
Severe Manpower Shortages
There is a persistent inability to attract and retain trained medical personnel in rural health facilities of Surguja. The District hospitals have gone months without a full-time anaesthesiologist, making even caesarean sections unavailable even at a district level. Community Health Centres are mostly manned by MBBS doctors with minimal specialist support, while Primary Health Centres are predominantly run by Assistant Medical Officers — a cadre with only three years of training.
Figure — The widening gap between ideal and actual clinical cadre at each tier
Neglected and Hollow Secondary Care
Policy attention on primary and tertiary levels has left secondary care at district hospitals under-resourced and ill-equipped to handle complex, prolonged illnesses. This gap forces families into expensive private facilities far from home, deepening their financial distress and eroding trust in the public system.
Poor Quality of Primary Care: The Missing Foundation
The primary health care (PHC) system in Surguja, though statistically expanded, fails on every measure of functional quality. Sub‑centres and PHCs routinely operate without essential drugs, diagnostic kits, or even a regular electricity supply, making basic maternal and child health services unreliable. Staff absenteeism is endemic: doctors and ANMs posted to remote tribal PHCs often do not report for duty, and when they do, the absence of laboratory facilities and referral transport reduces their role to a cursory out‑patient consultation. A study across Chhattisgarh’s tribal districts found that only 36% of PHCs had a functional labour room, and stock‑outs of oral rehydration salts and zinc — first‑line treatments for diarrhoea — were reported in over 40% of facilities [NRHM facility survey]. This hollowing out forces patients with conditions that should be managed locally — hypertension, tuberculosis, or childhood pneumonia — to travel 50–80 km to an already overstretched district hospital, simply because the nearest PHC cannot perform a haemoglobin test or dispense a week’s worth of iron‑folic acid tablets. In effect, the public primary care system exists on paper but is clinically absent for the majority of the tribal population.
Catastrophic Costs of Care: The Price of a Broken System
When the public system fails at the primary and secondary levels, the burden shifts directly onto the poorest households. In Surguja, a family managing a chronic illness like chronic kidney disease, cancer, or complicated tuberculosis faces out‑of‑pocket expenditures that rapidly exceed their annual income. Transport alone is a punishing cost: a single trip to the district hospital costs ₹500–₹1,500 in hired private vehicles (where available), while a referral to tertiary care in Raipur or Bilaspur can cost ₹3,000–₹5,000 just for travel. Add to this the costs of medicines, diagnostics, and informal payments at private facilities, and a hospitalization episode can push a family into a debt trap from which recovery is near‑impossible. National Sample Survey data shows that Chhattisgarh has one of the highest rates of catastrophic health expenditure in India, with over 25% of rural households experiencing impoverishment due to medical costs. For the tribal communities of Surguja, this is not a statistical abstraction: it means selling livestock, mortgaging land, or pulling children out of school to work — perpetuating the very cycle of poverty that the health system was meant to break.
Why Is the Health of People in Surguja Poor?
The causes of poor health in Surguja are not simple, nor are they solely medical. They are rooted in a complex web of social, economic, and environmental factors.
Access to nutritious food remains a fundamental challenge—dietary intake is low in quantity and even lower in proteins and fats. Assured quality drinking water continues to be scarce in several hamlets and villages. Social stressors, including financial insecurity and social marginalisation, take a daily toll. There is no cheap transport for travel, especially in emergencies. Education, particularly higher education, is of poor quality, limiting opportunities and awareness. Agricultural yield is low, trapping families in cycles of poverty and food insecurity.
The health system itself faces deep-seated challenges. It is chronically underfunded. Health insurance support is partial, for some people and for only inpatient care, and is often inaccessible. There is a tendency to trivialise the needs of rural populations—an assumption that “people in small places have small problems.” Quality is often deprioritised. Laboratories have been privatised, and supply chains are frequently broken. These are not failures of intent, but systemic weaknesses that require systemic solutions.
Social support services are equally inadequate. The Public Distribution System provides only cereals and salt and some pulses. The Integrated Child Development Services (ICDS) continues to functions poorly with the Anganwadis opening for 3 to 4 hours a day. School mid day meal program is inadequate with no eggs anymore. Pensions are too low to meet basic needs. Land rights are under threat, further eroding the economic security of tribal communities.
Larger structural issues underpin these challenges. Geography—mountainous, remote, forest-fringed—often makes access difficult. Climate change and environmental stressors are intensifying. Labour and environmental laws are getting weaker and poorly enforced. Privatisation of land and sell-out to the private sector threaten traditional livelihoods. Social cohesion is fragile, leaving communities vulnerable and isolated.