‘If hospitals do not want to comply with norms,they should stop calling themselves charitable’

Large-scale vacancies in primary health centres (PHCs) has been a cause for grave concern in the state. In an Idea Exchange with The Indian Express,health minister Suresh Shetty reveals the steps the government is taking to overcome the staff crunch. He also speaks on a range of other issues such as hospitals failing to reserve beds for the poor,unregulated surrogacy market in Mumbai and the declining child sex ratio.

Written by Express News Service | Published:April 8, 2013 2:48 am

P Vaidyanathan Iyer:Are the large number of vacancies in PHCs being filled? How many vacancies are there and how is this shortage of staff impacting health care?

Suresh Shetty:Vacant posts is the only big concern for the health ministry at present. About 1,200 posts of medical officers should be filled in the next two months. In the past three years,we have tried a number of new things to fill these posts. A lot of changes need to be made in the recruitment rules. Remuneration to doctors posted in rural areas also needs to be looked at. MBBS and post-graduate doctors do not want to go to rural areas because in many places,there are no government quarters and school education facilities are largely inadequate.

Earlier,we used to advertise for vacant posts and hold a written exam and a personal interview. This not only caused delay but also left room for influence. Now,we are giving jobs based only on marks secured in MBBS final exam and also allowing doctors to work in districts of choice. We received 3,500 applications for 1,000 posts,but less than 500 joined the service. A lot of Marathwada doctors took up jobs in the region but we struggled to find doctors for Ratnagiri and Sindhudurg and hence offered an incentive of 20 marks for working in tribal areas of these districts for three years.

Earlier,there was no specialist cadre in the state. Recently,we created 524 posts of specialist doctors,for which 425 people have applied. Earlier,specialists and medical officers would be paid the same salary,but we recently offered six increments for specialists to practice in rural areas.

Shubhangi Khapre:A few years ago,the state allowed ayurvedic,homeopathic and unani doctors to practice in rural areas. Has that affected quality of health services?

Yes,it definitely affects quality because one cannot force a patient to turn to alternative forms of medicine. While we decided to offer 25 per cent of posts to ayurvedic doctors,in some places they,along with unani doctors,occupy more than 50 per cent.

Our effort should always be to recruit MBBS. For this,we need to have basic services in place in rural areas. Under National Rural Health Mission we have taken up a huge project of building residential quarters for doctors in rural areas. We are also working out ways to increase their remuneration. To avoid delay in recruitment by cutting red tape — getting sanctions from a number of departments,etc — we need urgent administrative reforms. At present,it takes 8-10 months to recruit.

Stuti Shukla:Doctors do not want to do internships even in peripheral hospitals of Mumbai such as Govandi and Kandivali. They want to stick to KEM,Sion,Nair.

This is a worldwide phenomenon. Places I visited in Quebec had no doctors. Patients there spoke to doctors in Montreal via video-conferencing. The Chinese health minister once told me they do not have qualified doctors in rural areas.

The biggest reason for this crunch in India is government-funded medical education is limited. Deemed universities charge huge amounts. As such,it is natural for a doctor to want to work in known government hospitals to quickly get a job in a good private hospital and repay his education loan.

Shubhangi Khapre:How well is the concept of mobile hospitals working?

SS:We have at least one mobile hospital in each district and in tribal areas of Nandurbar and Gadchiroli we have four. They have proved useful in remote areas.

Sagnik Chowdhury:The surrogacy market is growing in Mumbai without regulation. How much control does the state health ministry have in these matters?

Government of India is drafting a Bill in this regard. As of now,there is no monitoring by the state. We are waiting for the central Bill. It is a well-drafted Bill with adequate checks and balances.

Mayura Janwalkar:Shouldn’t the government do something in the interim?Also,the draft Bill is being criticised by many who fear it will commercialise surrogacy.

This is a new trend. Now that the Centre has drafted a Bill it should not waste more time in getting it ratified by Lok Sabha and Rajya Sabha. Every new Bill receives feedback from NGOs and it is practically impossible to accommodate each and every suggestion. One cannot stop surrogacy but we can ensure it is done in a lawful manner.

Sandeep Singh:The number of patients waiting for organ transplants is far greater than the number of transplants. Is this because of a lack of coordination between hospitals and designated transplantation centres?

After recently making it easy for hospitals to retrieve organs of brain dead patients,we are working on a software to link all hospitals with zonal transplantation coordination committees,designated transplantation centres and those who are on the wait list for larger benefit.

Stuti Shukla:Do you think private hospitals do not keep the government in loop and violate rules such as reserving a percentage of services for the poor?

A number of hospitals registered with the charity commissioner have gained benefits from government such as land and electricity at subsidized rates,concessions on import duty and income tax. There are 53 such hospitals and clinics in Mumbai and they are required to reserve 20 per cent of services for the poor. Hospitals have to set aside 2 per cent of revenue for this purpose. In a recent survey,we found all but 11 hospitals flouting norms. While some were found submitting forged bills for surgeries not performed,others were found catering to relatives of staff or to a particular community and calling it charity. We have sent notices to these hospitals and 12 have written back that they would comply with norms.A committee is calculating benefit,in terms of money,these hospitals have gained from the government. We have taken this up seriously because ideally,1,800 beds should be reserved for the poor.

We have a big waiting list in government hospitals. People on this list can easily go to a Jaslok or a Lilavati. If hospitals do not want to comply with government norms,they should stop calling themselves charitable to get concessions.

P Vaidyanathan Iyer:Is it true a number of big private hospitals are not joining Rajiv Gandhi Jeevandayee Arogya Yojana? Are government-prescribed rates unrealistic?

Yes,many hospitals are not part of the voluntary scheme. However,had the rates been unrealistic the state would not have seen 48,000 surgeries under the scheme last year — 40 per cent of the surgeries were cardiac requiring Rs 2-3 lakh in a private hospital.

Under the scheme,630 Vidarbha children with heart problems were operated on last year. We have 140 private hospitals on panel under the scheme in eight districts. We would ideally want 500 hospitals empanelled. We have set aside Rs 350 crore for the scheme this budget and will need Rs 500 crore more in the near future. By year-end,we expect 2 lakh families to benefit from the scheme. The limit per surgery — Rs 1.5 lakh — is the same in the old and new schemes,but now the monitoring is more stringent. We have developed an online mechanism under which government doctors who refer patients to private hospitals are mandatorily informed of treatment private hospitals recommend.

Mihika Basu:Why is the metro blood bank proposed in Sion taking so long?

Since the state government did not have suitable land for the purpose,we asked BMC to acquire a plot in Sion Hospital. They still have not been able to acquire it.

P Vaidyanathan Iyer:What percentage of state budget do you spend on health?

About three to four. We get about Rs 5,000 crore annually and the utilization is 91 per cent. We got Rs 1,800 crore under National Rural Health Mission and the utilization was 96 per cent.

Stuti Shukla:The ever-declining child sex ratio in the state is a big concern. From 965 in 2001 it dropped to 913 in 2011.

After PCPNDT Act came into force,the situation has improved. Supreme Court has also appreciated state efforts to curb female foeticide. There is tremendous social and political pressure. Even today,we have MLAs telling me to tone down the campaign,to open seals of hospitals and clinics found guilty (of female foeticide).

(Transcribed by Stuti Shukla)

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