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
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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
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Objectives
• Process of Recruitment/ Deployment
• Workforce Management Issues
• Compensation Package/ Incentives
• Support System
• Gaps between Provisions/Expectations
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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
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Do Peripheral Health Facilities have sufficient Doctors?
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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
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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
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Uttarakhand
• Sanctioned Positions of 1922 GDMO and 259 SMO
• 946 GDMO and 195 SMO available
• 976 GDMO and 64 SMO vacant
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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
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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
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Promotions/Grievances
• Limited scope of Promotions for Generalists
• Subjective Appraisals
• Grievance handling is lethargic
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Compensation/Incentives
• Comparative Anomalous Pay structure
• Rural/Difficult Area Allowance
• Perks: Telephone/Mobility/Insurance/LTC
• Non Practicing Allowance
• Residence/Security
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Physical Facilities
• Water supply - 24 Hours
• Electricity-24 Hours
• Generator/Inverter
• Ambulance
• Operation Theater
• Telephone
• Computer with Internet
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Equipments
• Functional Delivery & Episiotomy
• Functional OT light
• Functional OT table
• Boyle's Apparatus (for Anesthesia)
• Instruments for Surgery
• Sterilizer/Autoclave
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Training
• Induction versus In-Service Training
• In-Service versus CME
• Lack of Training Policy
• Exclusive project based training
• Several compartments
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Diagnostic/Therapeutic Facilities
• Laboratory Services
• X- Ray Machine
• Ultrasound Machine
• Medicines
• Blood Storage/Banking Facilities
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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
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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
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Thank you