In a first of its kind initiative, Karnataka has invited specialists to quote their price online for moving to towns and cities where posts are vacant in public healthcare facilities. This can be called desperation but the present condition of state hospitals calls for such a step. As many as 1,221 specialist posts are unoccupied and there is a shortage of nurses. Joyeeta Chakravorty reports.
Starved of health specialists, the state appears to be willing to pay them their quoted price to fill the many vacancies in its hospitals across Karnataka. In a first of its kind initiative, it has called on specialists to quote their price online for moving to towns and cities where the posts are vacant in public healthcare facilities. The desperation seems to stem from the fact that as many as 1,221 specialists posts are vacant in various health centres, including district hospitals in the state, going by state Health Minister, K.R. Ramesh Kumar.
“It is a new idea in which we have tried to let go of the traditional approach to fill vacancies. We want to capture the talent that is out there and so have given specialists the option to mention their monetary expectation from the government and the place they would be interested to serve in online," explains Health Commissioner, Subodh Yadav.
While acknowledging that not many states have adopted such an approach, he says the few that have, have received an enthusiastic response. “This prompted us to adopt the same approach,” he reveals.
Ironically, Karnataka has a massive shortage of specialists despite having the largest number of medical colleges and the third largest number of doctors trained in the country.
"There is a severe shortage of health workers (especially specialists) in the most vulnerable regions of the state, namely north Karnataka and Hyderabad-Karnataka. With an irrationally large number of primary health centers in southern Karnataka, the actual shortage of human power in these regions is disproportionately high,” observes Dr Giridhar R Babu, Additional Professor, Indian Institute of Public Health(IIPH), e Public Health Foundation of India (PHFI).
"Contrary to the increase in the number of doctors trained in Karnataka, the shortage of specialists went up from 32 per cent to 39 per cent going by the Rural Health Statistics for 2015. The shortage of Junior Health Assistants (female) commonly called as ANMs at Health Sub-Centres increased from 13 per cent in 2005 to 28.5 per cent in 2015," he points out, regretting that despite the strong recommendations of the Karnataka Health Task Force, 2001 and the Halagi committee, 2012 for the establishment of a public health cadre, nothing has been done about this as yet in the state. Whether it is due to a lack of specialists or other factors, more people both in the rural and urban areas of the state appear to be relying more on private healthcare facilities rather than government. Going by the 71st round of the National Sample Survey Office (NSSO) 81.7 per cent of the urban population received treatment in private healthcare facilities, as did 73.2 per cent of the rural population.
While only a meagre 18.3 per cent of the urban population relied on public healthcare facilities, the figure was a low 26.8 per cent in rural areas too.
Public sector needs to revamp package
The Lancet 2015 report on human resources for health in India says:
India has a severe shortage of human resources for health. It has a shortage of qualified health workers and the workforce is concentrated in urban areas.
Bringing qualified health workers to rural, remote, and under-served areas is very challenging. Many Indians, especially those living in rural areas, receive care from unqualified providers. The migration of qualified allopathic doctors and nurses is substantial and further strains the system. Nurses do not have much authority or say within the health system, and the resources to train them are still inadequate. Little attention is paid during medical education to the medical and public health needs of the population, and the rapid privatisation of medical and nursing education has implications for its quality and governance. Such issues are a result of under-investment in and poor governance of the health sector—two issues that the government urgently needs to address.
A comprehensive national policy for human resources is needed to achieve universal healthcare in India. The public sector will need to redesign appropriate packages of monetary and non-monetary incentives to encourage qualified health workers to work in rural and remote areas. Such a policy might also encourage task-shifting and mainstreaming doctors and practitioners, who practice traditional Indian medicine (ayurveda, yoga and naturopathy, unani, and siddha) and homoeopathy to work in these areas while adopting other innovative ways of augmenting human resources for health. At the same time, additional investments will be needed to improve the relevance, quantity, and quality of nursing, medical, and public health education in the country.
NSSO 71ST Round recommends
When looked at from a health system perspective, it is important to recognise the differences in performance of different states and the need for a differentiated healthcare strategy for different states. Since a greater number of poorer households tend to seek care from the government facility on account of financial constraints or access barriers, we need to pay much greater attention to enforcing accountability, improving their quality of service and seeking better value for the tax money spent on it.
The many reasons behind dearth of nurses
Besides being short of specialists, hospitals are finding it hard to find nurses as many are switching to different careers or leaving the country for lucrative jobs abroad.
Confirming this , Dr Girdhar Babu, Additional Professor at the Public Health Foundation of India(PHFI), Bengaluru branch, says a lot of nurses are either switching careers or leaving for better jobs abroad because of the poor pay they get in hospitals here.
“The hospitals in this country are not willing to pay nurses well. The nursing profession is not given its due respect," he regrets.
According to a recent report released by FICCI’s Health Services Committee and EY, nursing as a sector in India continues to experience challenges in terms of 'Availability, Distribution and Retention.'
As compared to other professions, compensation in the nursing sector has lagged behind, contributing to the decreased appeal of nursing as a career choice, it says.
The report explains that nurses are not given a chance to grow within an organisation and have a say in important administrative and policy decisions.
This gives them very limited opportunity to expand or challenge their boundaries, prompting many to give up nursing altogether. Going by the report, the monotony of their lives generates apathy among nurses and creates a vacuum of role models for those entering the profession. It observes that at present, they don’t have a strong representation in hospital administration across the country, except in a few organisations.
One of them happens to be the Bangalore Baptist Hospital , which has started introducing nurses as administrative officers post 4.30 pm and coaxes them to take the lead in decision- making, and taking care of law and order, ambulance facility and security. "This helps them feel important and included in decision-making. It also helps change their mindset and makes them more assertive, which is reflected in their day to day job," says Dr Alexander Thomas of the hospital.
"If you look at the nursing community, we are two million short of the total requirement across the country which indicates that the profession is not given its due. I don't see why their income should not be equal to that of doctors," he adds.
Realising the need to make the profession more lucrative and attractive to the nursing community, the Association of Healthcare Providers (India) of which Dr Thomas is executive director, has been championing the introduction of nurse intensivists courses and has started a nursing leadership programme. "Hopefully, in a few years with the introduction of such courses and programmes mindsets will change and the job will become more lucrative just like in the West,” he says.