When the Siddaramaiah-led Congress government came to power in Karnataka five years ago, it promised to change the condition of government hospitals, Primary Health Centres (PHC) and Community Health Centres (CHC). As the chief minister returns to the poll fray, many of his promises related to the health sector remain unfulfilled.
Five years later, a government report released in December 2017 says: "... vacancies is a big concern that needs to be addressed, current infrastructure is poor and needs to be improved both in urban and rural settings". It further said, "A major factor affecting the efficiency and quality of care provided by the secondary and tertiary care hospitals in the government sector is the mismatch between requirements and the provision of buildings, number of beds, equipment, laboratory and other facilities on the one hand and the actual human and material resources."
The government had said it will provide mobile hospital-cum-ambulance services that can reach every village, but the above-mentioned report says, "The ambulance service serves a population of 85,000. This needs to be reconsidered."
There is a severe shortage of staff and beds in PHCs, among other things. During 2016-17, in rural areas, there were 2,136 doctors who attended to as many as 2.45 crore patients in PHCs across the state. This means a doctor examines about 32 patients daily. With only 2,359 PHCs functioning in the state as of March 2017, a PHC receives an average of 29 new patients a day.
“There is a shortage of proper equipment, staffing, infrastructure and qualified doctors. In north Karnataka, almost all the PHCs are run by unqualified doctors and there is no one to check this. The state of rural healthcare is even worse,” said a Surgeon with Government of Karnataka who has been serving in North Karnataka for last 15 years. He requested anonymity as he is not authorised to speak to media.
Positions vacant across state
There is a huge shortage of doctors, specialists and nursing staff across the state. More than 9,000 posts (40 percent) are vacant in government health care facilities, as per a government report released in December last year. It’s noteworthy that 40 percent positions for specialists at government hospitals are vacant across the state, as per the report. Besides, around 80 percent of the CHCs do not have all four of surgeons, physicians, pediatricians and gynecologists.
“The biggest problem is to have doctors at the primary health centres, especially in rural areas. There is a shortage of doctors. Not many doctors are interested in working in rural areas. To overcome the shortage of doctors in the rural areas, it would be good to introduce the licentiate medical practitioners’ (LMP) course,” said Kathyayini Chamaraj, executive trustee, CIVIC Bangalore.
At the sub-center level, 42 percent of the positions meant for male health workers remain vacant. This raises a serious concern as male health workers play a major role in supporting female health workers, including auxiliary nurse midwives (ANMs), says a government report. It is observed that there is an urgent need to fulfill vacancies at the CHC level where there is a high percentage of staff shortage, the report said.
The situation is similar in the case of nursing staff. Against the total sanctioned posts of 2,667, the posts of 462 nurses remain vacant, i.e 17.3 percent vacancy. There is a shortage of 1,033 laboratory technicians across the state. Moreover, as many as 28 percent of sub-centers are functioning without any health worker as of March 2016.
Sadly, the appointed staff complain they are not given proper allowances. “Although we work as health assistants or nurses in villages dealing with patients suffering from contagious diseases and deadly diseases, we aren’t given risk allowances,” said Shakuntala Dandi, health union president, Bidar.
Norms flouted at every stage
Although the government promised to provide quality medical care, not even a single PHC or CHC functions as per norms set up under the Indian Public Health Standards of National Rural Health Mission (NRHM). It is disappointing to note that around 24 percent of CHCs don’t have an X-ray machine and about 52 percent don’t have a regular supply of AYUSH medicines for common ailments. The government in its manifesto promised a maternity ward in each PHC but as per available data as many as 29 percent and 47 percent of PHCs don’t have a labour room and an operation theatre respectively.
“Only a quarter of government health benefit schemes reach people in need. It has become very difficult to get treatment,” said Abdul Khadar, a Haveri-based social worker. The Congress government had promised to upgrade every PHC by including 20 beds, a maternity ward and a minor operation theatre. However, even after five years, many PHCs have less than 10 beds.
Data and a government report says not even one taluk hospital has 200 beds. In fact, there are many taluk hospitals that still have only 100 beds and many of them lack basic facilities. The party, however, had promised to keep a bed strength of 200 and provide dialysis centres for kidney patients, where dialysis will be made free for all patients in every taluk-level hospital. A senior government healthcare official said, “I have been working in the department for the last 18 years. The government starts distributing equipment and inspecting PHCs only during elections. Had they been genuinely concerned about public health, they would have done all these in the last five years.”
The manifesto also promised a government medical college in every district leading to the establishment of a super specialty hospital. However, not more than 17 of 30 districts in Karnataka have government medical colleges. There are only eight super speciality institutions in the state, as per the report.
The government doctor quoted above, however, blames officials for the sad state of affairs. “The present government introduced many healthcare schemes but only 20-40 percent of these were implemented. The government authorities who are responsible for improving public health care are running private medical colleges and they don’t want to lose their business,” he added.
High mortality rate an indicator?
These factors could be a reason for the high mortality rate in the state. Karnataka has an infant mortality rate of 24, while the neighbouring states of Kerala and Goa have an IMR of 10 and 8, respectively. “The infant mortality has come down by 4 per cent. It was 28 per 1,000 in 2014-15. It has come down to 24 per 1,000 in 2016-17,” said Dr Ramachandra Bairy, deputy director, Health and Family Welfare Department.
The same is the case with maternal mortality rate — Karnataka's stands at 133, while Kerala's stands at 61. The life expectancy in Karnataka is 68.8, about 6 years less than that in Kerala.
“When Dr Shalini Rajneesh was the principal secretary of Department of Health and Family Welfare, the government announced the launch of Universal Health Scheme aimed at providing free treatment for all the people in the state. But the government has not taken any measure to implement it. However, for its implementation, upgradation of infrastructure, equipment and medicines, an increase in manpower is required. Where is the action plan for that?" Chamaraj underlined.
Quality assurance program in healthcare was started under the National Health Mission as a pilot project in Tumkur district. Out of the 4,000 hospitals across Karnataka, only 123 have National Accreditation Board for Hospitals and Healthcare Providers (NABH) recognition; and only four out of the 123 NABH-recognised hospitals are government institutions, as per the government report. NABH accreditation ensures sustainability to a great extent as the concepts of surveillance, re-accreditation and surprise assessments are a major part of the process.
Dr Prashanth NS from the Institute of Public Health said that there are some positive developments with respect to Karnataka’s health. The state recently updated its health policy. “The state has also implemented wonderful schemes to benefit the poor who are most disadvantaged in our health systems, such as 108 ambulances and the very popular Arogyasri scheme (SAST). However, there is a lot to be achieved. Within south India, for example, Karnataka is still a poor performer with respect to various indicators when compared to Tamil Nadu or Kerala," Prashanth said.
(Prince Singhal and Tamanna Naseer are freelance writers based out of Deoghar (Jharkhand) and Bijapur (Karnataka), respectively. They are both members of 101Reporters.com, a pan-India network of grassroots reporters)
Updated Date: May 10, 2018 17:04 PM