Determinants of performance of doctors in public health systems of three states in India-Shiv...
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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