The Punjab authorities’s latest initiative to empanel non-public specialists in public well being amenities, providing ₹100 per OPD affected person and ₹1,000 per emergency name, has sparked off a debate. Whereas the administration views this as an answer to the power scarcity of specialists, the Punjab Civil Medical Service (PCMS) Affiliation sees it as a step towards privatisation. This experimental strategy highlights a deeper systemic failure: The erosion of a once-robust secondary healthcare tier.
Punjab’s healthcare construction is constructed on three ranges, every going through distinct challenges. Major care includes sub-centres and first well being centres (PHCs), a lot of which have been rebranded as Aam Aadmi Clinics (AACs). Whereas they deal with fundamental OPD companies, they continue to be indifferent from broader nationwide well being programmes.
Neighborhood well being centres (CHCs) and district hospitals are the spine of the secondary care system, supposed to offer 24×7 specialist companies. Nevertheless, most CHCs lack the mandated 4 fundamental specialists of drugs, surgical procedure, gynaecology, and pediatrics. Even district hospitals continuously function with out important workers like radiologists or anaesthesiologists.
On the tertiary care degree, medical schools deal with advanced instances however stay poor in super-specialist companies.
Legacy of disinvestment
The decline of secondary healthcare could be traced again to 1995. A ₹418-crore World Financial institution mortgage led to the renovation of 150 amenities however launched person fees, shifting the burden to sufferers. In 2012, the federal government withdrew assist from 50 amenities, claiming it could give attention to offering “complete high quality” within the remaining 100. As a substitute, this resulted within the closure of a number of high-performing CHCs.
Moreover, the morale of PCMS medical doctors has been systematically undermined. Insurance policies equivalent to denying non-practicing allowances throughout post-graduation and recruiting new medical doctors on fundamental pay, at occasions lower than Group-D staff, have alienated the medical fraternity.
4 failed roads to recruitment
The federal government has tried 4 strategies to fill specialist vacancies, however every is stricken by administrative or monetary hurdles.
The in-house pipeline that varieties the spine: Historically, the state sponsors common medical officers for three-year specialist programs. These medical doctors serve rural areas, handle emergencies, carry out post-mortems, and deal with VVIP duties. Regardless of being the system’s spine, they face heavy administrative burdens and authorized battles at their very own expense.
Contractual NHM recruitment: Recruited by way of the Nationwide Well being Mission, these medical doctors lack job safety. Many already run non-public nursing properties, resulting in poor long-term retention.
Stroll-in interviews: Launched just a few years in the past, this methodology failed as a result of the provided salaries have been barely ₹5,000 greater than these of MBBS medical doctors. The scheme has since been deserted.
Re-employing retirees: The federal government lately tried rehiring retired senior specialists. Nevertheless, the pay construction, the place the pension is subtracted from the entire wage, and the dearth of civil service advantages resulted in a dismal turnout. Solely 15 specialists have been recruited in opposition to 100 marketed posts.
Personal sector gamble
The newest scheme to rent non-public medical doctors ignores the elemental variations in work tradition between the private and non-private sectors. Public well being specialists don’t simply see sufferers; they handle nationwide programmes, medico-legal instances, and emergency protocols. Anticipating non-public practitioners to seamlessly combine into this high-pressure, bureaucratic surroundings for a nominal payment is optimistic at greatest.
Past magic treatments
The Punjab well being authorities have but to conduct knowledgeable research to grasp why specialists are fleeing the general public sector. As a substitute of in search of “magic treatments” and ad-hoc preparations, the state requires a long-term technique.
To revive the general public well being system, the state authorities should return to the pre-1995 follow of normal, predictable recruitment of MBBS medical doctors and assist workers on a everlasting foundation. With out job safety, aggressive pay, and a supportive work surroundings, the “mind drain” from public hospitals to non-public follow will solely speed up, leaving the state’s most susceptible residents with out care.
The author is a retired civil surgeon. Views expressed are private.
