Prescription is no longer available at AIIMS or CHCs

We don’t need any more AIIMS. We don’t need any more CHCs. Check out what’s available now. Get them working first and build new ones. Make your promises, keep them, and then make new promises within the Budget. This is sound advice.

From the outside, 11 of the 18 All India Institutes of Medical Sciences (AIIMS) built recently are impressive to look at. They are huge infrastructures built in the cities of different countries as Centrally Sponsored Scheme (CSS) under Ayushman Bharat Health Infrastructure Mission. But what’s inside is a pit and sorrow for the patients. These educational institutions have 40% of the vacancy in teaching and research departments.

How are students trained in special skills with such a shortage of teachers? These educational institutions must provide specialist doctors to the District and Community Health Centers (CHC). Roughly, when it comes to professional jobs, two-thirds in rural areas and one-third in urban areas are vacant. So, instead of setting up a new AIIMS we need to strengthen the existing medical colleges.

The reality on the ground

The Health Dynamics of India 2022-23 report presents a shocking and depressing picture – 79.9% vacancy in 5,491 rural CHCs in 757 districts in India. Moreover, only 4,413 professionals are available against the required 21,964 workers. As of 2014, the shortage of professionals in CHC is still around the 17,500 mark despite the creation of additional post-doctoral seats – 72,627 in 731 medical colleges. Professionals are not willing to work with the reason for the lack of essential facilities such as good staff housing, nursery schools and the additional support of peer doctors. If there is a specialist available, poor people from rural and tribal areas should not go to district headquarters hospitals or medical college hospitals. In CHC, there should be an initial phase of 30 beds with four to five specialists for a population of 1.6 lakh to 2 lakh. CHCs are handicapped by a chronic shortage of professionals – a problem that has existed for many years. However, States are building ​​many CHCs using funds available under CSS. Since the National Rural Health Mission (NHRM) started in 2005, till last year, 2,145 CHCs have been added in Bihar, Rajasthan, Tamil Nadu, Uttar Pradesh and West Bengal.

There is another catch. States must draw 60% of this fund from the 15th Finance Commission allocation, not from the normal annual allocation. Furthermore, this is a capital investment in infrastructure and the money used regularly for the maintenance of these new buildings must be met from the Government’s annual health budget. Apart from construction, human resource costs for medical education and health services can be partly met from CSS. The lack of skilled workers for the health sector in the service and the unavailability of the open market for employment, make the use of funds difficult. There was a 29% underspend of the CSS budget in 2022-23 and only 50% in the 2023-24 financial year. Only construction contractors have benefited from such a strong capex allocation.

The lesson is this: don’t reduce the health Budget to just a pool of structural works, without having the same amount for other areas like drugs, blood tests, health services ambulance, emergency care and salaries of temporary workers employed for the operation of such. health centers built with CSS funds. If CSS’s goal is to improve people’s health, it must focus on performance outcomes rather than just sinking money into building buildings that have been locked and keyed for years.

Emergencies and specialized care for cases referred from primary care centers cannot wait for these white elephants to survive and function. They want ‘purchased care’ from the exploitative and unregulated private sector. There is a risk of patients facing a “debt trap” for patients. There is already an influx of patients to tertiary care centers that are over-utilized and have problems in district hospitals or medical college hospitals. Current needs are met “somewhat”. There is no denying this. But things can be much better if there are professionals.

Ghost CHCs

There are 785 districts in the country (as per local government information by Ministry of Panchayati Raj and National Information Centre, Government of India) but only 714 have a district hospital which provides higher education care. There was a model of specialized care in the district in the form of the first referral center, or FRUs – four per district in the 600 districts of the country to provide emergency care for pregnancy and newborns. Other requirements were to have an obstetrician, an anesthesiologist, a pediatrician with a surgical center and a blood bank or blood storage facility. This was designed and partially implemented under the Child and Maternal Survival Program (1992-97).

The CHCs are 30-bed units with five specialists – a doctor, a surgeon, an obstetrician, a pediatrician and an anesthetist – to cater to 1.6 lakh to 2 lakh people. There are 5,491 CHCs in 785 districts, ie seven CHCs in the district, which is unnecessary. With the availability of only 4,413 professionals in India. apparently these are spiritual CHCs with less than one expert (0.8) per available CHC. It is a mockery of public health. If we assume, for the sake of theory, that there is an equal distribution of all five experts in an equal number in the pool of 4,413 experts, we can have 882 groups of experts that will work in the CHC as ‘ other than the district hospital for specialists. maintenance. All those operating theatres, staff rooms and other facilities built are a huge waste of taxpayers’ money.

There must be careful planning and availability of experts, with the best infrastructure designed to co-locate five teams of experts in one or two CHCs at the district level for of special care. Time. There should be no room for any political pressure. When professionals are deployed together, there is group support for the success of work and family life. Having good workers quarters with running water and 24 hour electricity supply will go a long way in boosting worker morale and preventing worker stress.

Discussion and dealing with the issue of producing more experts for registration at the district level is another issue that can be progressed in parallel.

Students and medical service

From this point forward, all seats supported by the government service for post-graduate medical education must be linked to a CHC or district hospital post. The government must ensure this and there must be the commitment of medical students seeking employment. There may be an initial reservation for those who want to do a service bond of seven to 10 years in CHCs in districts or underserved areas. Those willing to do part-time work can be posted under the National Health Mission (NHM) – NHRM and National Urban Health Mission combined as NHM – with a higher incentive package but without pension benefits. . In the current crisis, this is an important step that will meet the needs of the workers.

Creating a team of family medicine professionals with special training in the necessary skills and emergency operations, care of infection, emergency infection and care of newborns, and intensive care are only short-term methods as it takes a lot of time to ensure that there is a shortage of professionals. resolved.

What is needed now is to manage things with the tools available in a smart and efficient way.

Dr. KR Antony is a pediatrician and public health consultant in Kochi, Kerala, and previously worked for UNICEF.