High vacancies at primary centres behind referrals to tertiary hospitals

An anaesthetist is required for caesarean procedure during delivery, for routine orthopaedic operations or for any surgical intervention. Of 648 posts sanctioned in the state, 416 lie vacant. The

Written by ​TABASSUM BARNAGARWALA | Mumbai | Published: October 9, 2017 2:50:07 am
Maharashtra health services, healthcare, primary health care, maharashtra government, JP Nadda, Maha health system, India News, Mumbai News, Indian Express, Directorate of Health Services, DHS There is a further 35 per cent vacancy of paediatricians and 26 per cent for gynaecologists in Maharashtra. (File)

A Dearth of most commonly needed specialties such as anaesthesists, physicians and general surgeons across Maharashtra has forced its rural population to migrate to urban centres for healthcare services. Data, gathered from Directorate of Health Services (DHS), on primary health centres, rural, and sub-district hospitals shows the maximum vacancies at 64 per cent is for anaesthetists, hampering even the most basic surgeries in rural regions.

An anaesthetist is required for caesarean procedure during delivery, for routine orthopaedic operations or for any surgical intervention. Of 648 posts sanctioned in the state, 416 lie vacant. The worst districts are Gadchiroli and Washim where there is only one anaesthetist for entire the district.

Following anaesthesists, an acute shortfall is observed in physicians where 48 per cent posts lie vacant — of 274 posts, 134 are vacant — and in general surgeons, where 45 per cent (73 of 159 posts) vacancy is recorded.

“A rural hospital caters to a minimum 1 lakh population as per norms. A physician, surgeon, anaesthetist and gynaecologist are basic requirements. If there is no anaesthetist, a surgeon is of no use and a gynaecologist can only perform normal deliveries. For caesarean procedure, the pregnant woman will have to be referred,” said Abhijeet More, from NGO Jan Arogya Abhiyaan.

There is a further 35 per cent vacancy of paediatricians and 26 per cent for gynaecologists in Maharashtra, data from DHS shows. At any given time, there are over 5 lakh pregnant women linked through ASHA workers, state records show.

Districts like Nandurbar have only seven of 20 gynaecologists sanctioned, Hingoli has four of 10 posts sanctioned, Buldhana has four of 19 gynaecology posts and Gadchiroli has just three of 15 gynaecologists sanctioned.

But in certain specialties, the state sees more than the required number of doctors. For instance, ENT, where 24 doctors are sanctioned for 36 districts, 50 doctors are available. Even in such a scenario, districts like Palghar, Dhule, Solapur, Sangli, Aurangabad and Akola neither have a post sanctioned for ENT nor an ENT specialist. For skin specialist, there are only 15 posts sanctioned across all districts. Although there are 28 skin specialists available, 15 districts have no skin specialist.

The highest vacancy among doctors is recorded in Solapur, where 54 per cent medical posts are vacant, followed by Dhule with 47 per cent vacancies and Raigad and Satara with 34 per cent vacancies each.
Data from the state public health department shows that the government also relies on bonded and ad hoc doctors in regions where permanent posts are not filled. There are 363 bonded and ad hoc doctors working across the state. Of 3,338 posts carved out for MBBS, physicians, gynaecologist, psychiatrist, ENT, and others, there are only 2,465 permanent posts filled.

The recent reports of neonatal deaths in Nashik have also highlighted the need for creating posts for neonatologist in the public health department. Maharashtra has no neonatologist in its rural, district, civil hospitals to curb the high number of neonatal deaths across the state.

“States are supposed to follow Indian Public Health Standards . It mandates, for example, two ENT doctors for each district hospital, but Maharashtra has still not adhered to it. Sometimes, one doctor is made to shuttle between two PHCs or hospitals. So vacancy is still there, but it does not come on records,” said public health activist Ravi Duggal.
In the newly-formed Palghar district, for instance, there are zero sanctioned posts for ENT, dermatologist, psychiatrist and pathologist under DHS.

Those requiring specialty healthcare services have to either shuttle to Thane or Mumbai, adding to the over-burdened Thane Civil hospital or BMC hospitals.

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