It has been a mixed bag in terms of development of the health sector for Punjab during the last two years of Congress rule. Though a few good beginnings have been made, despite the efforts of Health Minister Brahm Mohindra, an overhaul of health services in the state remain a distant dream.
Posting specialist doctors, especially in rural and remote areas, to their full sanctioned strength continues to be a major challenge for the health department even as the government is trying hard to woo specialists using financial incentives.
Shortage of doctors
Of the 513 posts of specialists advertised recently, a total of 215 were recruited by the health department following interviews, but only around 120 joined their place of posting. The department, according to Additional Chief Secretary (Health) Satish Chandra, held another round of interviews subsequently, the results of which are yet to be declared.
The government is mulling a proposal to pay incentives to specialists along with salary. Depending upon the location of posting, the government plans to offer an incentive of Rs 25,000, Rs 50,000 and Rs 75,000 in a bid to encourage these doctors to provide their services in remote areas. However, with the model code of conduct in place, the government may have to wait to implement it.
Punjab Civil and Medical Services (PCMS) president Dr Gagandeep Singh said, “While an MBBS doctor is better paid in the government sector, a specialist is paid better in the private sector.” But this was not the case until last year when the government recruited 306 MBBS doctors on full pay scale. This was in sharp contrast to the arrangement during the previous SAD-BJP rule when an MBBS doctor was given a basic salary of Rs 15,600 plus a non-practising allowance per month for a three-year probation period, taking his/her total pay to around Rs 19,000 a month. With the full pay scale, a doctor now gets more than Rs 50,000 a month.
According to Chandra, of 306 MBBS doctors recruited, 285 have joined service.
No new medical college set up
Recruitment of doctors regularly every year to ensure adequate availability of medical services was one of the poll promises in Congress’ 2017 manifesto. So was the opening of at least five new medical colleges in the state, apart from improving infrastructure, facilities and manpower in existing medical colleges.
So far work is in progress at only one college, in Mohali. The government has released Rs 50 crore for initial works and another allocation of Rs 60 crore was made in the budget last month. “Similarly, new medical colleges will be set up in the districts of Gurdaspur, Pathankot and Sangrur under the PPP mode,” Finance Minister Manpreet Badal had said while giving his budget speech passing an allocation of Rs 189.15 crore for upgradation of government medical colleges in Patiala and Amritsar. Mohindra, however, said that Chief Minister Amarinder Singh has already announced medical colleges at Gurdaspur and Sangrur and only the proposed medical college at Pathankot would be under the PPP mode.
At Rs 3,465 crore, the outlay for the Health and Family Welfare department in the current fiscal is 10.87 per cent more than last year.
PCMS Association president Dr Gagandeep Singh listed free availability of blood units and efforts to recruit doctors as high points of the health department under the present dispensation. He, however, rued that medicine supply in the field is far from adequate.
On the plus side, he said that the health minister’s attitude is positive and he is “accessible”.
Mohindra has been also trying to bring back around 750 doctors from the rural development and panchayats department. During the previous stint of the Congress government, 1,186 rural dispensaries were transferred to the department as subsidiary health centres.
An activist in the field of health services and former registrar of Baba Farid University of Health Sciences Dr Pyare Lal Garg said that if the department is not willing to transfer the doctors to the health department, it should ensure that they “provide emergency services.”
“The department must ensure presence of doctors at rural dispensaries. It should ensure that any patient coming from those areas should be referred by the doctor of the concerned dispensary,” said Dr Garg, adding that doctors can be shifted to the health department only after a Cabinet decision.
Dr Garg also called for a number of other reforms. “Cancer patients should have a log book. Each visit of the patient should be recorded in the log book specifying the treatment/medication given for proper utilisation of the Chief Minister Cancer Relief Fund,” he said.
Dr Garg lamented that Punjab used to be “number one” in health services in 1980. Saying that its “deterioration” started subsequently, Dr Garg minced no words blaming the Punjab Health Systems Corporation for the current “mess” in the health sector.
He also questioned the wisdom of the Rs 5 lakh per family health insurance cover to 42 lakh families for secondary and tertiary care treatment. He said, “The insurance scheme covers secondary and tertiary care only, while patients spend a large chunk of their money on visiting the Out Patient Department. Eighty per cent of their medical expenses are on OPD services,” said Dr Garg.
Meanwhile, Chandra said the department had done tremendous work in the field of drug de-addiction. “2.35 lakh patients are registered with us and private centres under Outpatient Opioid Assisted Treatment (OOAT). Of these around 50 per cent are registered with government-run clinics and the rest with private centres,” he added.
Drug addicts are administered buprenorphine for treatment of addiction at the OOAT clinics.