Punjab's rural health system is a network of subcentres, primary health centres and community health centres, with district hospitals above them and medical colleges at Patiala, Amritsar and Faridkot.
Vacancy rates for doctors in rural posts are high and have been for decades. In practice a large share of first-contact rural care is provided by unqualified practitioners, locally called quacks, and by chemists.
Out-of-pocket spending on health is a major driver of rural debt. Illness in a family and a wedding are the two events most often named in farm indebtedness surveys as the point at which a household borrowed from the arhtiya.
The state runs an OOAT programme for opioid dependence with a very large registered caseload, which is more developed than in most Indian states.
Punjab's health indicators are better than the Indian average and worse than its per capita income would predict, which is true of most things in the state.
The public system runs from the subcentre and the primary health centre up to the community health centre and the district hospital, and the vacancy rates for doctors and specialists in the rural posts are high.
What a village actually uses is the private practitioner in the nearest town, the unqualified practitioner in the village, a charitable hospital, or a referral to Chandigarh for anything serious.
Out of pocket health spending is a leading cause of rural debt in Punjab, as it is across India, and it meets the land collateral system in the obvious way.