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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 kavita.d@ians.in)
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