HT Special: Siblings Punjab and Haryana not in the pink of health
All is not well: Faced with shortage of doctors and hamstrung for resources, healthcare is the casualty in Punjab and Haryana. Flourishing private hospitals offer life support to govt institutions in Punjab, while the poor patient has no choice but to pay up. Haryana’s villagers are worst-hit
Health takes hit due to staff crunch
Government health services in Haryana have remained a work in slow progress for 50 years.
In 1967 soon after the state was born, there were 785 government health centres with six general hospitals. Today, there are more than 3,500 health centres, including 58 general hospitals, 119 community health centres (CHCs), 485 primary health centres (PHCs), and 2,630 sub centres.
While 30 lakh patients were treated in government health centres in 1966-67, while over 2 crore were attended to in 2015.
In the first phase of the National Rural Health Mission (NRHM) from 2005-12, Haryana was adjudged the best-performing state among non-high focus ones. In the second phase of NRHM (now the national health mission or NHM) from 2012-17, the focus is on maternal and child healthcare.
The maternal mortality rate (MMR) of Haryana, which was 186 in 2004-06, was reduced to 127 in 2011-13. The infant mortality rate (IMR), which was 60 for every 1,000 births in 2005, fell to 36 in 2014. Institutional deliveries increased from 43.3% in 2005 to 92% this June. There are 5.5 lakh deliveries in government health centres of the state every year.
Dearth of doctors
Government health institutions are facing a shortage of medical professionals.
The national norm is a doctor for every 1,000 people, while the average ratio in the country is a doctor for 1,700 people. In Haryana, there’s only one doctor for 5,100 people. Of the sanctioned strength of 3,150 doctors in the state, only 2,000 are working.
Director general, health services, Dr Kamla Singh says there is a shortage of doctors in the government sector across the country. The health department has started higher-level pre-hospital care training for paramedical staff, especially in the rural areas, to overcome the shortage of doctors. “Our aim is to train them to provide immediate care (first aid) and stabilise the patient till the intervention of doctors,” she says.
Requesting anonymity, senior doctors say that not all medical professionals prefer to join government health services. They cite the “unprofessional working culture” in the government health sector in which doctors are often deputed on duties other than healthcare.
The state has seen protests by doctors working in government health centres, demanding better pay scales and promotion avenues.
The government’s focus has been on meeting health infrastructure and staff requirements in the urban areas, while facilities in villages are in a worse state.
There is not even a single doctor in 72 public health centres (PHCs) and three community health centres (CHCs).
There are 485 PHCs and 112 CHCs in the state.
In the alternative system of medicine or Ayush (ayurveda, yoga, naturopathy, unani, siddha and homeopathy), Haryana progressed rapidly in the past decade and today it has an institute of Indian system of medicine and research, three ayurvedic hospitals, a unani hospital, six ayurvedic primary health centres, 458 ayurvedic dispensaries and several unani and homoeopathic dispensaries.
Govt hospitals ail, pvt sector thrives
Fifty years ago, a hospital bed was available for 25 paise a day, the price of a cold drink, in Punjab. Today, a surgical indoor patient is charged Rs 1,200 a day in a government hospital. This shows how money has become a key factor in the state’s healthcare system.
With few government hospitals holding credibility, the Punjab government is forced to empanel private hospitals to deliver healthcare through its schemes, particularly in tertiary care. The government health insurance schemes —Bhagat Puran Singh and Rashtriya Sehat Bima Yojana — have more than 200 private hospitals empanelled across the state.
With private hospitals mushrooming in Punjab, healthcare can be described as ‘government for the poor and private for the rich’.
Healthcare in government institutions became a money game in 1995 when the state government formed the Punjab Health Systems Corporation, taking Rs 422-crore loan from the World Bank to run its hospitals. User charges were imposed on patients for the first time in the state. The healthcare cost escalated, especially for surgical indoor patients who paid Rs 5.25 as fee in 1994 and pay Rs 1,200 today.
Tackling staff crunch
State principal secretary, health and family, Vini Mahajan, says the last census indicators for Punjab were better than the national average. “The human resource is improving in government-run institutions, while the private sector has been a great support in sharing footfall from outside states as well and in implementing the government’s health insurance schemes,” she says.
Mahajan flags cancer treatment and drug de-addiction as key challenges for the health department. The state has come up with a 100-bed advanced cancer institute in Bathinda and a 25-bed Homi Bhabha Cancer Hospital at Sangrur in three years.
The state health department faces a shortage of specialists, particularly oncologists, anaesthetists and neuro-surgeons. After re-organisation, Punjab had 500 posts of MBBS doctors in 1967 with hardly any vacancy. In contrast, 1,600 of the 4,400 posts regular posts of doctor are vacant.
The number of registered doctors in the state has, however, increased six times from 4,332 in 1967 to 26,204 in 2015.
The outpatient department (OPD) footfall rose from 53.21 lakh patients in 1967 to 1.52 crore in 2015.
The Government Medical College in Patiala faces 17% faculty shortage and the Medical Council of India has expressed concern over this. The GMC witnessed one of the worst tragedies when five infants were charred to death as their incubators caught fire in January 2009.
The faculty at GMC, Amritsar, is also facing a staff crunch, while the private Guru Ramdass Medical College in the same town is doing well.
Among the six private medical education institutions, Chintpurni Medical College in Gurdaspur district is on the verge of closure with the MCI set to take a final call after an inspection in December. More than half the medical students have been shifted to other institutions either within or outside the state after the college came under the MCI scanner earlier this year for lack of faculty and infrastructure.