Rural healthcare in India has been a real concern, still in 2017. Due to many reasons, government has failed to implement proper healthcare facility in most of the rural areas. Doctors always become the easy target whenever there is discussion about lack of healthcare facilities in rural India. Govt. and authorities quickly blames doctors that they don’t want to work in villages and bla bla.
In india around 50000 doctors graduate every year and at least 30% are from rural areas themselves. The irony is even doctors originally from rural India doesn’t want to work in villages for long time, so there must be some reason why this is happening. Most Medical Officers either stop attending the PHC/CHC or leave the job altogether.
After working in periphery for few months and talking to many doctors who are working and trying to work in villages i found out that many doctors are willing to work in villages and also start working there but due to a number of factors they lose interest in continue working in villages. The reasons are numerous but i tried to list a few most contributing.
1. No hope of professional growth: This is one of the major reason why doctors leave village areas. Our govt system in healthcare gives no opportunity of professional growth except for in service pg quota (which is also not available at all places), and not all doctors are able to get the opportunity. Many doctors start as medical officers in rural area and also retire from rural area spending almost 30 years in periphery. This also become a reason of concern when the doctors have to stay away from their family at one point of time, when they have to keep their families at city for better education of their children. This cause stagnation and loss of interest in work over due course of time.
2. Lack of proper facilities at health centers: For the past few years all state govt and central govt claim to spend a lot to improve health care in rural areas but unfortunately conditions (like infrastructure and other basic medical facilities) at majority of rural PHC and CHC are deficient. So I don’t know where that money is going!! May be govt is not spending it on necessary requirements and wasting on unnecessary stuff like the scam of IAS Neeraj K Pawan (Read the NEWS article below for details). In absence of basic facilities like essential medical investigations, good quality medicines, etc there is a obvious shortage in delivery of health care to the patients which in turn cause dissatisfaction and anger among villagers and also the medical officers appointed. Due to poor quality drug supply (see news clip below) and low standard reagents the recovery of sick is not as per expectation. Finally this lead to conflicts and become a cause to leave rural areas.
3. Burden of a lot of non medical work on medical officers: This is a issue which is increasing from last few years. Govt is introducing many new health programs, and in turn asking for progress reports for monitoring of such programs, which is actually essential. But at most PHCs there is only one medical officer and even at CHCs there are 1-2 MOs only and there is no other competent staff who can bear the responsibility of making such reports, so finally all this extra paperwork of sending unending reports of all the health programs comes on the shoulders of doctors. After that there are numerous review meetings for all these programs which are held at block and district level each month, for which doctors have to travel 60-70 km multiple times to attend. Doctors also have to conduct and attend various camps even when the camp is for administrative works. In addition to this govt expects medical officers to collect water samples from villages, do fogging, monitor cleanliness of village etc etc. This not only create problems for medical officers but also decrease efficiency on treatment front and finally the patients suffer. With all such pressure, doctors feel dejected and depressed and so overwhelmed which lead to quitting the job.
4. Lack of proper living conditions: A lot of PHC and CHC still do not have proper quarters to stay, and the one which are there, the condition of quarters are pathetic. There is no proper drinking water facility and full time electricity at many places. Doctors have to stay at 45 degree temperature without coolers and fans in many remote areas in rajasthan. The water supply is of hard and non palatable water and there is no facility for water filtration. These all collectively cause staying at the health center a very difficult task and doing up down from city is again a hectic , time wasting and irritating practice. Such conditions over a time create a feeling of uneasiness and restlessness, finally culmination into leaving the job. Such poor condition at workplace also encourage absenteeism, which is also a major problem at remote areas. Again it comes to the obvious fact that the spending on healthcare sector is unplanned.
5. Harassment by local mob: In every village there are people, may be a son in law of sarpanch or a brother of thesildaar who thinks that he owns the village. Such goons create unnecessary pressure on doctors, so that they can make them do whatever they want which mostly include making fabricated MLCs, or medical certificates for their relatives. The doctors who work many kms away from their homes at remote areas feel unsafe due to such mobs. If some doctor say no to do such wrong practice, they become target for violence by such groups. The violence against doctors is increasing day by day and most of these are not because of negligence, but due to some conflicts with the mob.
6. No defined duty hours: Healthcare is a continuous and essential service and it is almost impossible to restrict it with time limitations. But in the end doctors are also human beings and need rest and have their own personal work. At most PHCs there is one one doctor, so the burden of attending emergency lay with a single person 24x7x365. This creates a feeling of restriction and compulsion for doctors. There are no defined duty hours for medical staff at PHCs and no policy on when and how medical officers can take leave without causing disruption in health-care delivery at their centers.
7. Gaps in govt. healthcare policies: Our government is very quick in making new healthcare policies and programs, may be for public welfare or for political reasons, we cant say. But when it comes to successful implementation of such programs we see a major gap between the program on paper and achievement in the field. This cause dissatisfaction among general public, by such improper planning by the top tier, which is faced by doctors, who are the first contact for the patients.
So what can we do to prevent doctors from leaving rural service.
Is it impossible to make doctors stay at rural health centers? Absolutely NO!! when a person enter medical college and stay almost half of his/her youth, we also learn public service and learn how important our job is for society. Most doctors are ready to serve provided they feel safe and mildly comfortable. For this government need to rethink the policies related to health care and need to take steps in improving infrastructure and living conditions. A few things which come to my mind to improve availability of doctors in periphery.
- Govt should ensure that there is a time bound transfer of medical officers from PHC -> CHC -> City hospitals so that there is scope of professional growth for those who for some reason unable to get into Post Graduation.
- There should be steps to ensure quality drugs and other medical facility at PHCs/CHCs because without proper support systems doctors alone are no good and secondly it is difficult for patients too to get referred to city for investigations and treatment. Without wholesome facilities, doctors are forced to refer the patients to higher centers.
- Medical Managers should be appointed in rural areas according to requirement so that doctors can be freed from the burden of reporting and meetings. This will also improve the quality of treatment because doctors will be able to devote more time in treatment aspect.
- A part of healthcare budget should be invested in building better living conditions at health facilities so that more and more doctors choose to stay at their place of posting rather than traveling for hours from city to villages.
- The security of doctors and other staff should be improved. Modifications in law may be needed for that.
- Government should consider posting 2 doctors at PHCs also so that rotation duties can be assigned for round the clock emergency services without affecting the personal life of doctors. If 2 doctors is not possible at every PHC there can be a provision of few extra positions of medical officers at block level who can compensate the duties of MOs posted at PHCs when they need leave or day offs.
These may not be the solution for all the problems faced by doctors, but it is definately the first step. If you have any suggestion to improve, do post in comments.