Doctors respond to SOS, recast healthcare in Maoist-affected areas
MUTUAL PROGRESS Promises of advancement in career with good pay packets, benefits and facilities ensure that doctors line up for postings in these dangerous areas
“I am Dr Ayyaj, a medical graduate who joined an Indian Administrative Service. Currently working as District Collector, Bijapur (Chhattisgarh). My district is predominantly tribal, densely forested and Naxal-affected…We are developing district hospital as a state-of-art facility. Need post-graduate doctors and general duty doctors. Specially looking for radio(logists), anasthaesia and paed(iatrician)s. Other disciplines are also welcomed.”
Bijapur district collector Ayyaj Tamboli’s SOS shared on WhatsApp and Facebook on September 6, got 116 responses – 50 from specialists and 66 from general practitioners. “Of the doctors who responded, 50% are visiting Bijapur before deciding, the rest have queries about salary, facilities for family etc, that they want resolved before deciding,” says Dr Tamboli.
“Most doctors who’ve applied are from other states, mostly Maharashtra and Andhra. Once the road to Bhopalpatnam (town bordering Maharashtra and Telangana) is ready by next summer, connectivity to Maharashtra, Andhra and Telangana will improve and we’ll get more doctors as these states as they have a surplus.”
These three states account for around a fourth of India’s close to 53,000 MBBS seats — Andhra has 27 medical colleges and 3,800 seats, Telangana has 20 medical colleges and 2,750 seats, and Maharashtra has 48 medical colleges and 6,245 seats. HOW THEY DID IT The SOS is one among a clutch of initiatives the Chhattisgarh government began in April this year in partnership with the Public Health Foundation of India (PHFI) to get doctors and medical staff to live and work in districts torn by left-wing extremism. Till October 9 this year, 168 lives were lost to left wing terror, including 33 civilians, compared to about 90 deaths this year in the current unrest in Kashmir.
“We’re not changing but twisting the rules of the game to improve healthcare delivery in underserved districts,” says Subrat Sahoo, principal secretary, health department, Chhattisgarh.
“More autonomy to district collectors and access to flexi-funds such as National Health Mission (NHM) and district mineral funds (DMF) have made it possible for them to offer specialists salaries that are two-and-a-half to three times of what they’d get elsewhere,” says Sahoo.
“Specialists earn between `2 and `2.5 lakh a month, depending on their specialty,’ says R Prasanna, director of health services. A paediatric and general surgeon, for example, was offered `2.6 lakh – `1.59 lakh from NHM and `1.1 lakh from DMF.
Money is not enough, the administration soon realized, so they followed up on other incentives.
“We examined why civil servants and army personnel adjust easily in remote districts and identified infrastructural and social support as key issues to help them adjust,” says Prasanna.
So Sukma and Bijapur gave doctors a brand new transit hostel to live in and access to the same facilities as the district administration. “The contract said they would be relieved in two years, they got incentives for career advancement, such as 3 marks per year for PG and priority in training programmes overseas, and other support, such as help with school admission for their children and job placement for their spouses, depending on their qualification,” says Prasanna. DOC IN THE JUNGLE The results are showing. Over the past two months, 84 superspecialists and medical officers have signed up to work in Sukma and Bijapur, where there are mine-clearing vehicles and CRPF camps every 5 km of NH-43, but no private hospitals or clinics.
Six months ago, vacancies were higher than the number of serving officers in the health centres.
On March 31, 42 of the 55 sanctioned posts of superspecialists and medical officers were vacant at Sukma, and at Bijapur, 56 of the 67 posts had no takers. Within six months, the vacancies are down to 18 in Sukma and 20 in Bijapur.
The district hospital at Sukma, home to 2.6 lakh people, mostly tribal families, got its first gynaecologist this month when state-awardee Dr Aruna Naidu,
THIS IS ONE AMONG A CLUTCH OF INITIATIVES CHHATTISGARH GOVERNMENT BEGAN IN APRIL THIS YEAR IN PARTNERSHIP WITH THE PUBLIC HEALTH FOUNDATION OF INDIA
44, moved from her Secunderabad home in Telangana.
In neighbouring Bijapur last month, Dr Kushal Madhukar Sakure and Dr Arun Chaudhry, both 28 years old, moved from Aligarh to run the gynaecology and obstetrics unit at the district hospital.
Dr Tamboli says that getting radiologists and anaesthetists to live and work in Bijapur is a challenge, but since surgeries have more than doubled in both hospitals, these specialists are on call from Jagdalpur district hospital — the last “safe” town three hours away by road.