The gaps are showing

Shortage of staff at government hospitals and CGHS dispensaries is turning the situation from bad to worse in health care delivery 

 If only Rasheed Ahmed had found the right treatment at the right time, his two children would have continued studying in the Corporation run school, his young wife would not have been widowed at the age of 23 and his ailing mother could have afforded to stay home and get better instead of going back to working as a maid.

Rasheed had travelled from Orissa to Delhi some years back in hope of a better future for his children and himself. He found employment as a driver here, his wife took up a course in switching and his mother who had carried tuberculosis with her to Delhi found a `quack' to treat her.

While the treatment gave her little relief, Rasheed too got infected. His deterioration, aided by his high risk behaviour was rapid. Later doctors found that Rasheed not only had tuberculosis, his body was also host to a number of other diseases too for which proper treatment was never sought.

“Though the State government runs several schemes for the poor, it is impossible for uneducated people from the economically weaker section to avail of the facilities. Trying to access healthcare in a hospital is intimidating, because of the paper work, series of counters, overworked medical staff and inability to ask for medicines from the hospital chemists,” said Nazia Ahmed.

She adds that the Rasheed had found it easier to seek medical help from the same ‘quack' that his mother was getting treatment from. “By the time we actually got around going to a government hospital it was too late for my husband,” said Nazia.

Nazia along with her children and mother-in-law now lives in a jhuggi cluster in Delhi hoping that they will be able to afford a better life some day. Their lives, however, mirror the struggle that several lakh people go through to access quality healthcare in the India.

“And one of the biggest bane ailing health care in India is acute shortage of trained manpower that it is facing. Most badly hit are the small dispensaries where because of the staff problems the patients from lower economically group simply opt out of getting quality treatment. The large hospitals are inaccessible and the small ones  don't have adequate medical staff to cater to the population dependent on them. This allows patients who require quality treatment at the right time to slip away until their condition either takes a turn for the worse requiring long hospital stay, which most can't afford, or they simply die. Worse, several lakhs end up taking treatment from quacks which hastens the deterioration of their health. This is a phenomena that is not just restricted to big cities but is duplicated many times over in the country,'' said Dr. Anil Bansal who heads the anti-quackery team in Indian Medical Association.

Even the country's premier centre for medical health care and research, the All India Institute of Medical Sciences (AIIMS) is facing a staff crunch that has put pressure on the existing staff and caused the facilities offered to suffer.

The Parliamentary Standing Committee on Health noted that 303 posts of assistant professor are lying vacant at AIIMS. Forty seven posts of professors, nine additional professors, 16 associate professors and 13 nursing lecturers was empty. The hospital authorities have said that they are, however, working on reducing the gap between the demand of trained medical staff and their supply.

“It is common knowledge among hospital staff that for the institution that sees over 9,000 patients a day in its out patient department alone and there isn't enough staff. There is also acute shortage of support staff which adds to the workload of the doctors and nurses. The Institute also looks into teaching and research which get adversely affected because the staff is simply overworked and stretched,” said a senior faculty member at AIIMS.

Meanwhile, the bad news continues even for the Central Government employees dependent on the Central Government Health Scheme (CGHS) dispensaries in Delhi, which is reportedly facing crushing shortage of doctors and paramedic staff which is hampering operations.

According to the Union Health and Family Welfare Department, there is a recorded shortage of 676 positions in group C and D staff, nine positions are vacant in group B and 66 are vacant in group A. “While the Department of Health and Family Welfare is filling these vacant posts through UPSC and bringing people on deputation in order to meet the immediate requirement of doctors, CGHS is now filling these vacant posts on a contract basis. Action has been taken to expedite the requirement of non-gazetted staff as well,” a Ministry official involved in the exercise said.

The CGHS claims to provide comprehensive health care facilities for the Central Government employees and pensioners and their dependents residing in CGHS covered cities. Started in New Delhi in 1954, the Scheme is now in operation in 25 cities across the country. The dispensary is the back bone of the Scheme. “With the rapid and continuous expansion of the Scheme, however, situation has changed and problems pertaining to the rapidly expanding staff requirement at various dispensaries and centers are now hampering efficient operations,” noted a Ministry official.

According to statistics there is only one bed per 1000 patients, while it should have been at least 300 in India. “It is no hidden fact that hospitals in the country are facing a shortage of qualified manpower in all categories of doctors, nurses and paramedical staff. Though government investment in the health sector has grown over the years, we fear that not enough is being done to ensure that quality treatment is given to all on time. The healthcare industry is expected to grow at a steady 15 per cent annually, however, work needs to be done to make this growth translate into easy accessibility, quality care and timely interventions, which is a challenge,'' said a senior faculty member at AIIMS.

Source : The Hindu, April 29, 2012