Tottering Orissa health system gasps for breath

The public health system in Orissa is on the brink of collapse. Most government hospitals in the state are running without doctors, para-medical staff, medicine and basic infrastructure. The outbreak of cholera in Koraput last year and the recent cases of anthrax-related deaths have already exposed the weak links in the health system. What's worse, at a time when the government is grappling with controversies like irregularities in the Rs 415-crore World Bank-aided Orissa Health Systems Development Project and the fake medicine scam, about 3,000 government doctors have threatened to quit their jobs. On February 18, government doctors across the state put in their papers en-masse demanding higher salary and more privileges. The doctors have given a time-frame of one month to the government to either consider their 18-point charter of demands or accept the resignation letters. Their demands include basic salary of Rs 12,000-Rs 16,500 per month at the entry level (subject to revision, as per recommendations of the Sixth Pay Commission), specialist allowance of 30% of the basic salary, in-service post-graduation study and housing accommodation for doctors from primary health centres to block headquarters and, above all, security to all doctors. The doctors demands are not illogical, say observers. With the population:doctor ratio touching a new low (roughly one doctor to 8,000 patients), the doctors in government hospitals have to bear the burden of a huge workload. Unable to meet the growing demand, these doctors end up facing public wrath. There have been many such incidents in various parts of the state. Moreover, these doctors see no reason why they should serve the government when higher salaries and better privileges await in the private sector. Amidst all this, it is the patients who have been suffering. Orissa is virtually running short of doctors, particularly allopathic, in recent years. There are 929 posts of doctors that have been lying vacant in various streams. Of these, 765 are for allopathic, 77 ayurvedic and 87 homeopathic doctors. The highest number of 31 vacancies in allopathy has been reported in Sundergarh district. Even though state health minister Sanatan Bisi has assured the people that the vacancies would be filled up, the fact is that adequate number of doctors are not available in the state. The few doctors who pass out from the three government medical colleges migrate to other states in search of higher compensation, promotional avenues, professional security and social status. There are 150 seats each in the three medical colleges and hospitals in the state, while in private medical colleges there are 300 seats. In a desperate bid, the state government is now considering enhancing the entry age limit of doctors for government jobs from 32 years to 45. It also proposes to raise the retirement age of government doctors from the present 60 to 62. Meanwhile, the state government has empowered the chief district medical officers to appoint on contract those MBBS pass-outs who have failed to make it in the Orissa Public Service examinations and have crossed the age limit. Retired doctors can also be appointed on contract basis till 68 years of age. An incentive of Rs 4,000 a month has been announced, besides salary, for doctors posted at the district and sub-divisional headquarters of KBK, Boudh and Gajapati districts. Doctors on rural stint in these districts get an incentive of Rs 8,000 a month. Contractual doctors in KBK, Gajapati and Boudh districts get Rs 18,000 a month while in the rest of the districts, the salary amounts to Rs 12,000 a month. "There is requirement of an additional 5,000 doctors in the state. From where will such a huge number of doctors come'? says Madhusudan Mishra, president of Orissa Medical Service Association (OMSA). He suggests that the state government should take immediate steps to retain existing doctors and provide them all the facilities. "The doctors demands will be taken up for consideration soon after the on-going Budget session is over', health minister Bisi said.