Now, even the Centre has said it: Gujarat’s public healthcare system was floundering even before the State was hit by the coronavirus pandemic. Compiled by the National Health Systems Resource Centre and National Health Mission, The Human Resource for Health in District Public Health Systems of India Report 2020 revealed that 54% posts of specialist doctors and 28% posts of Medical Officers within the State lay empty till last March.

The impact was felt within the very first Covid wave when the State health department ordered medical students to start training as ‘helpers’ in Coviddesignated hospitals. the rationale given: “lack of manpower within the State’s health sector” thanks to Covid pandemic.

The report clearly shows that Gujarat had sanctioned fewer posts than the particular requirement of healthcare providers. what’s worse is that the govt didn’t refill even these posts.

The data has been collected over 2017-18 and 2018-19, and includes all public healthcare facilities like district hospitals, Sub-District Hospitals, CHCs and PHCs. It calculates the particular number of healthcare providers needed, the amount of posts sanctioned by the state governments, and therefore the number of posts actually in six major categories of auxiliary nurse midwife (ANM), staff nurse, lab technicians, MBBS/medical officers, specialists, and dentists.

Requirement vs sanctioned posts

The report states that in three of the six categories, Gujarat has not even sanctioned posts as per the national requirement guidelines. The State has sanctioned only 72% of required number of nurses, and 53% of required ANMs. The worst category, however, is that of specialist doctors with master’s degree. The Gujarat government has sanctioned just 28% posts against the particular requirement.

On the opposite hand, the State has sanctioned 113% posts for lab techs, 115% for MOs and 103% for dentists.

Sanctioned vs vacant posts

What makes the entire situation worse is that while the sanctioned human resources in district healthcare systems is fewer than the particular requirement as per the population, Gujarat doesn’t even have the sanctioned strength.

Against five public healthcare providers sanctioned per 10,000 by the government , there are only four providers (specialists, MOs, nurses, ANMs) per 10,000 people in Gujarat.

The report stated a 54% vacancy in specialist doctors across Gujarat. this suggests though only 28% posts of required specialist doctors were sanctioned, quite half even these few posts lay vacant. Mirror had reported about the State facing severe shortage of senior doctors during the height of the primary wave of coronavirus (Dear Gujarat govt, where are senior doctors we’d like to fight our Covid-19 battle?; AM, July 25). The crisis arose because the government has been dragging its feet over hiring permanent doctors for many years . Even within the midst of the pandemic, its solution has been to rent doctors on 11-month contract.

Meanwhile, there’s also a 28% vacancy in sanctioned MBBS doctors and Medical Officers (MOs) posts, also as 27% vacancy in sanctioned posts of ANMs within the State. The vacancy in sanctioned posts of dentists also stands at 27%. there’s a 24% dearth within the number of sanctioned Lab Technicians. the smallest amount number of vacancies at 9% is in sanction posts for workers nurses.

‘State govt updating recruitment rules’

To this, Principal Secretary (Health) Jayanti Ravi said, “We have given an enormous thrust towards medical manpower since December 2019, well before Covid-19. One big drive to streamline hiring is to update recruitment rules of 800 cadres, a number of which had not changed for quite 40 years.”

On vacancies of health personnel across the board, Dr Jayanti Ravi said, “We have multiple schemes now for specialists just like the CM Setu. Further, we’ve sought appointments for nearly 6,000 posts to be filled and have sent this demand forth to the Gujarat Public Service Commission (GPSC) and other bodies. We expect this to refill posts across the health sector in Gujarat.”

On specialists intrinsically , the Principal Secretary said, “The government had taken a policy decision to permit specialist doctors to hitch public service on 11-month contract albeit they continue with private practice.” However, the notification for this was issued only during the onset of Covid-19 because the public healthcare system required more doctors to hitch the workforce.

“We are increasing seats for specialists. We now have about 500 DNB seats aside from 3,000 general specialist seats,” added Dr Jayanti Ravi. Whether this may increase public health manpower, however, is left to be seen.

Gujarat has faced massive problems with medical students who are bonded to rural service. Mirror had on February 17, 2020, reported ‘86% medical students in Gujarat refused rural service in five years’ as they chose to relinquish their medical bond amount to the state reciprocally for skipping the mandatory rural service even when Gujarat faced massive shortfall of doctors. The Principal Secretary said, “The government was trying to leverage with them and had changed the policy last year wherein the bond amount has been increased and time had been hamper from three years to at least one year.”

Notably, after the Health Commissioner issued orders for 925 MBBS graduates of 2020 to seem for bond service across Gujarat, only 80 of 143 in Ahmedabad had come forth after being served notices.

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