A controversial order by Karnataka's health department to "rationalise" specialist postings is set to trigger a large-scale downgrading of community health centres (CHCs) across the state, sparking protests and legal challenges from medical professionals and rural communities. The directive, issued on November 7, 2025, aims to redeploy gynaecologists, anaesthetists, and paediatricians from dozens of CHCs, fundamentally altering the landscape of emergency obstetric care in rural areas.
What Does the Rationalisation Order Entail?
The core of the change involves reclassifying the capabilities of CHCs. Currently, 249 CHCs function as Comprehensive Emergency Obstetric and Newborn Care (CEmONC) centres. Under the new plan, only 42 of these will retain their full CEmONC status. Approximately 200 others are slated to be converted into Basic Emergency Obstetric and Newborn Care (BEmONC) centres. The fate of 26 CHCs under construction remains undecided.
The critical difference lies in the services offered. A CEmONC facility requires the full triad of specialists—a gynaecologist, an anaesthetist, and a paediatrician—enabling it to handle complex deliveries, perform caesarean sections, and manage critical newborn emergencies. A BEmONC centre, stripped of these specialists, can only manage uncomplicated births and provide basic stabilisation before referring patients elsewhere, as it cannot conduct surgeries or blood transfusions.
The government's rationale hinges on utilisation data. The order states that CHCs with fewer than 30 deliveries per month are "non-performing" and do not justify the cost of specialist doctors. It argues such centres can be managed by MBBS medical officers and staff nurses. Specialists from these centres will be moved to fill vacancies in 147 taluk hospitals and the 42 retained CEmONC facilities.
Redistribution and Rising Maternal Health Concerns
The scale of the human resource reshuffle is significant. Data annexed to the order shows that the 233 "non-performing" CHCs currently employ 114 gynaecologists, 86 anaesthetists, and 119 paediatricians. This pool will be used to address glaring vacancies at the taluk level, where 21 hospitals lack anaesthetists, 11 need gynaecologists, and 19 are without paediatricians.
However, this move comes against a worrying health backdrop. The order itself acknowledges that Karnataka's Maternal Mortality Ratio (MMR) remains higher than that of neighbouring southern states. It also notes a rise in high-risk pregnancies due to factors like repeat C-sections, hypertension, and diabetes. Public health experts argue this trend necessitates more decentralised access to comprehensive care, not consolidation that forces patients to travel farther.
Ground Realities: Infrastructure Waste and Access Fears
The practical consequences of the downgrade are causing deep anxiety. On paper, downgraded CHCs are to get a physician or paediatrician. In reality, posting lists indicate most of these doctors are also being sent to taluk hospitals. This leaves many CHCs reliant solely on MBBS doctors and nurses for deliveries.
A major fallout is the underutilisation of expensive infrastructure. Several CHCs marked for downgrading have fully functional operation theatres built to CEmONC standards. With specialists gone, these theatres will be shut, saving maintenance costs but rendering the infrastructure idle.
For rural families, the change could mean longer, riskier journeys during obstetric emergencies. Communities living over an hour from a taluk hospital now face narrowed access to life-saving surgical intervention. The government calls the policy "dynamic," stating CHCs can be upgraded if deliveries increase. Yet, healthcare workers fear that once specialist posts are withdrawn and facilities reclassified, rebuilding these crucial services will be an uphill battle, leaving a permanent gap in rural healthcare safety nets.
