Indian health services are being either provided by government hospitals (public hospitals) or by the hospitals run by the private sector. In the last 20 years we have seen that there has been massive proliferation in private health services available in the country. Same has been the trend in the medical education sector. Almost 50% of the all the existing medical colleges have come up in the last decade or so. It is presumed that no new government medical college has opened during the same period. Private health services have become popular and wherever possible, an Indian patient prefers to get his/her treatment done in the private sector. This trend has been observed over the last decade or two.
The question to be addressed by people at helm is why has this happened! Health is a state subject, not much funding available for government hospitals, apathy of the politicians and bureaucrats, corruption in purchases of medical equipment and drugs, lack of maintenance and biomedical engineering departments in the hospitals, poor facilities, dirty wards, unhygienic facilities and many more reasons can be attributed to this malady. However, in my opinion, it is introduction of Non Practicing Allowance or what is popularly called NPA is the root cause of this problem.
NPA was introduced in the late 60s to stop government employed doctors from doing private practice within the boundaries of a government hospital. Before its introduction, doctors were allowed private practice in special OPDs in evenings, thus helping them augment their incomes as well providing more income to the government. As time passed, the low total remuneration of a doctor started having affects on maintenance of academic standards for doctors. Continuing medical education in the form of books, journals, attending workshops and conferences is a part and parcel of a doctors life. However to do this cost money. Unable to support these activates with the nominal pays received by doctors and medical teachers resulted in some of these to resort to private practice on the sly. With time this became a norm, thus taking the doctors away from government hospital work. That resulted in a major loss of human resource availability for these hospitals. Non availability of these doctors resulted in lacunae in hospital administration as well fall in clinical standards of delivery of medicine. This also resulted in standards of the attached medical colleges to fall below the acceptable levels.
While this was happening, private sector started proliferating and thus big salaries were offered to senior doctors of various government medical colleges and hospitals. Thus started a migration, which has never stopped. Time to look into this aspect and make government jobs lucrative to stop this brain drain. Once this migration stops, there is hope. Time for the new MCI to look into these aspects.
Friday, May 21, 2010
Subscribe to:
Post Comments (Atom)
Dear Rajeev
ReplyDeleteThere is some truth in your comments, but I do not think it is the whole issue. Govt doctors may not earn as much as their counterparts in the private sector, but it is still a comfortable living. The problem, to my mind,lies in the administration and running of the Primary and Subsidiary health centres and the doctors there. The centres are poorly run, funding does not reach the intended destinations, drugs and supplies are in short supply, and doctors do not live where they are supposed to, or work the required hours. All these issues have to be tackled simueltaneously. Getting a job as a govt. doctor is not easy and quite in demand, as evidenced by the large amounts of incentive that change hands prior to selection. This demand must translate into better services all round.
You are spot on. Since i was just concentrating on the tertiary care centers, I choose not to discuss this, but low salaries and no private practice is a service requirement for any doctor in state health service.
ReplyDeleteDelivery of medicine at the primary and secondary levels is almost non existent. Health is a state subject and there may be a variance of non existent facilities at these centers across the states. While we try to ape the west regarding building and running of airports, multiplexes, high rise apartment - time has come to start looking at the western model of health service delivery. The corporate world has adopted that model and the results are for everyone to see; except the delivery of medicine at these hospitals is for a selected few because of the high cost.
I am very convinced that if the government of a state is willing and supportive, the whole system can be over hauled. It will cost money and time - but can be done. Infrastructure renovation, provision of residential facilities for the employees, arrangements to provide transport for education of children and other incentives, a proper laid down policy of what to treat and what to refer for each center, having a state ambulance fleet for these transfers and making sure all the facilities stay up and running is crucial for this system to run efficiently. The top person needs to be given a free hand and should have the will to do it. Delhi Metro Supremo is one example!
Once successful, this model can be translated in other states.
Thanks for your comments!
Hi Rajeev
ReplyDeleteDo you have any idea how people are nominated to the MCI - is there a set procedure, are there elections, are there eligibility criteria etc - or is it all ad-hoc, or just a matter of seniority and whoever wields the most influence or contacts?? Maybe you could rsearch this a bit and let the readers of this forum know....
There are elections! Its just that elections are won by doctors who are active in state medical associations and may not have anything to do with medical colleges and medical education.
ReplyDeleteLet's wait and see what happens now!