By Kavita Bajeli-Datt, IANS,
New Delhi : The next time you walk into a clinic for a cough and cold, spare a thought for your rural brethren. Latest government data reveals that rural India is short of over 16,000 doctors, including 12,000 specialists.
As many as 12,263 specialists are needed in community health centres (CHCs) and 3,789 doctors in primary health centres (PHCs), health ministry statistics for 2009 show. The shortage is particularly acute in villages of Uttar Pradesh and Madhya Pradesh.
While the situation is often attributed to the unwillingness of doctors to work in difficult areas, others say not enough is being done to incentivise such postings.
“In India, the patient-doctor ratio is around 1/30,000. And of course it will be higher in Uttar Pradesh and Madhya Pradesh due to non-availability of doctors and lack of health facilities and proper infrastructure,” public health expert S. Sunder Raman told IANS over phone from Chennai.
Health ministry figures say 1,087 specialists and 614 doctors are needed in Madhya Pradesh and 1,442 specialists and 1,689 doctors in Uttar Pradesh. Surgeons, physicians and paediatricians come under the category of specialists.
The other states that face an acute shortage of trained medical practitioners in PHCs are – Assam (500 doctors), Orissa (413), Bihar (211), Gujarat (65) and Punjab (45).
Each PHC is targeted to cover a population of approximately 25,000. The PHCs act as referral centres for Community Health Centres (CHCs), which are 30-bed hospitals at the district level.
“We are aware of the shortage of doctors and paramedical staff in rural areas,” Health and Family Welfare Minister Ghulam Nabi Azad had told parliament. He agreed that lack of housing and infrastructure pose problems for doctors in rural areas.
According to a Planning Commission report of 2008, India is short of 600,000 doctors, one million nurses and 200,000 dental surgeons.
An official in the health ministry said, “Many doctors are unwilling to work in difficult and hard-to-reach areas. This could be because in these far-off places they face accommodation problems. Also, general infrastructure in remote areas poses problems (as they come from cities and towns),” the official told IANS.
One way out is to increase the number of doctors, he said.
The health ministry is working in consultation with the Medical Council of India, an apex body for medical education. “We have increased the number of medical professionals in the medical colleges, reduced the teacher-student ratio and increased the bed strength for more medical colleges. We have raised the maximum age limit for appointment of faculty from 65 to 70 years,” the official said.
Under the National Rural Health Mission (NRHM), the ministry is also trying to augment the human resource crunch.
“We are giving financial support under the NRHM for engaging doctors on a contractual basis. Also, doctors are now multitasking to overcome the shortage of specialists. Also, incentives are being given to them to serve in rural areas. Thrust is being given on better accommodation for medical professionals,” the official said.
But experts say top doctors in premier institutes leaving government hospitals to work in private hospitals for more money creates problems.
This is true of the All India Institute of Medical Sciences (AIIMS), which caters to almost 8,000 patients every day, most of them from far-flung areas. In the past three years alone, as many as 121 doctors have left premier state-run hospitals to join private hospitals. Fourteen doctors have left AIIMS since 2008.
The health official added that the shortage of specialists will also be met after the eight AIIMS-like institutes start functioning in Patna, Raipur, Bhopal, Bhubaneswar, Jodhpur, Rishikesh and one each in Uttar Pradesh and West Bengal.
The idea is to make affordable and reliable healthcare services available to the rural populace though these. Each hospital will have 960 beds and will provide undergraduate medical education to 100 students per year. Post-graduate and post-doctoral courses will also be offered.
Raman, who was health advisor to the health and family ministry six years ago, said, “The government always passes the buck saying doctors and trained specialists are not available. But are they taking an initiative to give them a status they can be proud of?” he asks.
“An administrative officer never says no to a posting in rural areas because he gets all facilities. Tell a doctor that if he works for four years in a rural health facility he will be either promoted or be given specialised training.
“Merely giving allowances as incentives won’t work in the long run. The remuneration is not comparable to the times we live in.”
(Kavita Bajeli-Datt can be contacted at [email protected])