Azad, Imkong share medical headache
DIMAPUR | AUGUST 16
RURAL community-concentrated medical facilities in Nagaland such as Public Health Centers (PHCs) and Community Health Centers (CHCs) are in dire need of specialized medical personnel owing to a growing gap between requisition and deployment of medical practitioners for the rural areas. On Friday, August 16, the Union Ministry of Health & Family Welfare, the National Rural Health Mission (NRHM) and, closer home, Nagaland’s department of Health & Family Welfare shared a consensus – there is extensive shortage of medical personnel in the state. At least for now, both the governments have a reasonable defense – the shortage is both collateral and administrative and not necessarily because of policy imperatives.
The Union Health ministry and the NRHM have offered startling details (see figure below) that the rural health sector in Nagaland may need to undertake stronger and more-concentrated mitigation measures to “supply” physicians. Likewise, the Nagaland government has also admitted Friday, August 16, that the aforesaid gap in the health services needs to be filled.
Union Minister for Health & Family Welfare Ghulam Nabi Azad expressed worry days ago that Nagaland – along with a number of other ‘frontier’ states – needs more surgeons, obstetricians, gynecologists and even radiographers and pharmacists in the rural areas to man the community health centers if Naga villagers are to be assured qualified health services. “The shortage of doctors in rural areas as per Rural Health Statistics in India, 2012 indicates that doctors are unwilling to work in rural areas,” Azad told the Rajya Sabha on August 13 in New Delhi.
Nagaland Minister for Health & Family Welfare Imkong Imchen echoed Azad’s sentiments. He admitted that the rural areas are facing a shortage of specialized doctors – as much as the urban areas need more. ‘Doctors are not willing to stay in the rural areas and we are seriously looking at it. The Center is willing to sanction any number of posts based on the ground reality rather than necessity,” Minister Imchen said Friday.
He is aware that ‘doctors’ refuse posting in villages or rural area. “Under the NRHM doctors and nurses are employed under contract. We have offered them good salary (as an incentive). They do not stay because of there is no proper accommodation, staff quarters and facilities,” Imchen said. “We have taken care of the salary segment. We are looking at the infrastructure aspect. He are looking at it”
Reality in Figures
A separate written set of statistics prepared by Union Health Minister for the Rajya Sabha, detailing the shortfall of medical professionals in Nagaland’s rural areas, show a disturbing picture.
The most paradoxical of Nagaland’s ‘health problem’ as stated in the minister’s list is that the state needs more specialized professionals (i.e., doctoring physicians, specialists and technicians etc) than nursing and care personnel. In fact, according to the list, Nagaland enjoys “surplus” in nursing and care personnel.
According to Azad’s update, Nagaland requires 84 specialists at the CHCs. The specialists range from surgeons to obstetricians and gynecologists, physicians to pediatricians. Only 9 specialists are “in position,” causing a shortfall of 75 specialists.
Likewise, CHCs need 21 radiographers, while both the CHCs and PHCs need at least 147 pharmacists. 60 pharmacists are in place but there is still a need for 87 more pharmacists for the state’s community health centers. Also, both the community health institutions need at least 147 laboratory technicians. About 70 are in place but there is still a shortfall of 77 more laboratory technicians.
Interestingly, the list shows that nursing personnel in Nagaland’s PHCs and CHCs are in “surplus.” Nagaland requires 273 nursing staffers but 334 positions are sanctioned while 382 nursing staffers are in position! “Vacant and shortfall are in surplus,” the minister’s list remarked. Information provided by the NRHM also corroborates Azad’s figures (see chart).
Causes attributed to the ‘shortage’
A worried Commissioner & Secretary for Health & Family Welfare Sentiyanger Imchen told Eastern Mirror Friday that doctors in Nagaland become reactive to the idea of getting posted to the rural areas. Recently the Center sanctioned some funds to recruit doctors, he said. ‘They are not willing to go to the rural areas. Then there are those who prefer private practice while some are unemployed,’ he said, suggesting that the shortage is not only in the rural areas but pervades the state’s health sector in general.
The health official assured that the government is skimming measures to address the gap. The government is regulating their salaries as incentives and conversely, taking action against those who refuse to stay in areas designated as their post.
The cause for the shortage is both administrative and collateral: Firstly, Nagaland needs more doctors coming out of her colleges. Secondly, medical personnel deputed to the rural areas or villagers refuse or do not remain in their rural posts. Thirdly, those who actually man their posts are personnel working on contract and period-to-period basis. Fourthly, most medical professionals in Nagaland prefer a private practice. Meaning, the service expediency of medical professionals working in the rural areas on-contract is basically opportunistic and without long-term guarantee.