Determinants of performance of Doctors in the Public Health Systems

(Preliminary Observations from three States of India)

Shiv Chandra MathurExecutive Director, RHSRC-NRHM, Jaipur

andThamma Rao D.

Advisor, NHSRC-NRHM, New Delhi

Issues

• Human Resource is the most critical component in a Health Facility

• Competence and morale of the Doctors as Leader of Peripheral Health Facilities determines the quality and effectiveness of health services

Objectives

• Process of Recruitment/ Deployment

• Workforce Management Issues

• Compensation Package/ Incentives

• Support System

• Gaps between Provisions/Expectations

Methods

Interviewing State Level Officers including Secretaries and Directors

Jharkhand Rajasthan UttarakhandDumka Palamu Ranchi Bikaner Bharatpur Jhalawar Sirohi Hardwar Dehradun nagar

DH 1 1 1 1 1 1 1 1 1 1

CHC* 5 5 5 3 3 3 3 5 5 5

PHC 10 10 10 6 6 6 6 10 10 10

MO 30 29 32 10 10 10 10 30 29 32

Spel’s 10 11 8 10 10 10 10 10 11 8

Do Peripheral Health Facilities have sufficient Doctors?

Doctors in Jharkhand

• Out of 131 positions in Dumka, 95 were filled up

• Only 30 available against 96 positions in Palamu

• 29 vacancies out of 101 positions in Ranchi

Doctors in Rajasthan•8162 positions of Doctors in the Health Systems (200-11)

•745 and 658 positions of Generalists were announced in budget in 2009-10 and 10-11 respectively

•2991 vacancies – 1390 positions sent to RPSC, contractual appointments against the existing vacancies

•DPC for Senior positions

Uttarakhand

• Sanctioned Positions of 1922 GDMO and 259 SMO

• 946 GDMO and 195 SMO available

• 976 GDMO and 64 SMO vacant

HRH Density

Non- availability of adequate HRH is the

constraint in High Focus States - WHO recommends HRH of 25 per 10,000 - in India variance in States is too wide - 10 in Bihar to 38 in Kerala

Recruitment/ Deployment

• Filling up vacancies is a consistent challenge

• PSC selection is a long procedure• Contractual System accepted albeit insecurity continues

• Postings and Transfers is always uncertain• Gradual acceptance to ISM at PHF

• Deploying Specialists is now receiving attention

Promotions/Grievances

• Limited scope of Promotions for Generalists

• Subjective Appraisals

• Grievance handling is lethargic

Compensation/Incentives

• Comparative Anomalous Pay structure

• Rural/Difficult Area Allowance

• Perks: Telephone/Mobility/Insurance/LTC

• Non Practicing Allowance

• Residence/Security

Physical Facilities

• Water supply - 24 Hours

• Electricity-24 Hours

• Generator/Inverter

• Ambulance

• Operation Theater

• Telephone

• Computer with Internet

Equipments

• Functional Delivery & Episiotomy

• Functional OT light

• Functional OT table

• Boyle's Apparatus (for Anesthesia)

• Instruments for Surgery

• Sterilizer/Autoclave

Training

• Induction versus In-Service Training

• In-Service versus CME

• Lack of Training Policy

• Exclusive project based training

• Several compartments

Diagnostic/Therapeutic Facilities

• Laboratory Services

• X- Ray Machine

• Ultrasound Machine

• Medicines

• Blood Storage/Banking Facilities

How far IPHS is a reality?

Ranchi Jharkhand

Estimated Population in 2010 35,02,364 3,40,75,853

PHC (Actual/IPHS) 28/175 330/1103

CHC (Actual/IPHS) 14/44 194/265

Medical Officers (Actual/IPHS) 72/350 1710/2205

Specialists (Actual/IPHS) 2/306 188/1852

Striking a Balance

• Sub-Centers loaded with female staff• Male Workers extinction• Job responsibilities to be defined• PMU reaching to the block• Referral linkages required• Balancing the National Health Program• Review UG Medical Teaching

Thank you