Plagued by shortage of specialists in community health centres in rural areas, states have granted huge salary hikes to paediatricians, surgeons and gynaecologists posted in rural areas — in states such as Jharkhand and Tripura, these specialists can earn anything between Rs 3 lakh and Rs 3.5 lakh per month. Even then, many are reluctant to join.
Jharkhand, in fact, is one of five states that had advertised a scheme under which doctors could quote their own salaries. The others are Madhya Pradesh, Uttar Pradesh, Chhattisgarh and Karnataka. The highest quoted was in Jharkhand where a senior person could earn upto Rs 3 lakh, followed by Chhattisgarh at Rs 2.47 lakh per month. In both MP and Karnataka, depending on seniority, the salary quoted was up to Rs 2 lakh. Salaries are higher for postings in states and Union Territories that are small and remote. Tripura is paying specialists at CHCs upto Rs 3 lakh. In Andaman and Nicobar, the maximum salary is Rs 2.5 lakh and in Dadra and Nagar Haveli, it is 2.25 lakh. The salaries in these states ranged from Rs 40,000 to Rs 1 lakh before the decision was taken to pay salaries at rates comparable to market rates.
In Bihar, specialists are now being paid Rs 50,000-1,00,000 depending on seniority, in Odisha they are paid Rs 83,000-93,000, in Himachal Pradesh Rs 40,000 to 73,750, in Andhra Pradesh Rs 52,500 to Rs 1,52,250 and between Rs 55,125 and Rs 1,75,000 in Gujarat. In Tripura, specialists’ salaries range from Rs 75,000-Rs 3.5 lakh.
Manoj Jhalani, Additional Secretary and Mission Director of the National Health Mission, said, “We want to avert all preventable deaths and disease. Specialists add enormous value to the health system. We are prepared to pay what it takes to get them to save precious lives.”
The 2017 rural health statistics report shows a crippling shortage of specialists in CHCs. Of the total 22,496 sanctioned posts of surgeons, paediatricians, physicians and obstetricians/gynaecologists, 18,347 were vacant. Of 5,624 paediatrician posts, 4,554 were vacant. There were 4,760 vacancies for physician posts, 4,170 unfilled posts for obstetricians/gynaecologists and 4,866 for surgeons. For each kind of specialist, the total number of sanctioned posts in the country is the same. Many CHCs have never seen a specialist being posted there ever since the National Rural Health Mission was launched.
Explains a senior health ministry official, “These salaries were approved under the National Health Mission because that was the only option we had to get specialists in rural areas. Without specialists, it is not possible for NHM to function at capacity. It is understandable that when these doctors get paid much more in the private sector, we will not get good people unless we give competitive salaries. That is why some states even asked doctors to quote their own salaries.”
Interestingly, despite the salaries, lack of facilities, lack of good schools and uncertainty about the quality of life make doctors reluctant to go to these postings. Says Sant Lal Verma, civil surgeon, Mewat, who has since been transferred, “We were trying to hire a couple, one of them a gynaecologist and the other a paediatrician. We thought hiring the two together would make the decision easier for them. We were paying the gynaecologist Rs 2.5 lakh and the paediatrician Rs 2 lakh. He wanted 2.5 lakh too. I even sent that file up for processing. Earlier, these people were paid anything between Rs 80,000-Rs 1 lakh. Now they want a place to stay. Where will I get that from?”