Monday February 18, 2019

24 Percent Rise in Rural Women accessing Government Hospitals between 2004 and 2014 in India: Report

Overall, there was a six per cent rise in dependence on public healthcare for out-patients and seven per cent for in-patients over the decade ending 2014

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Rural women, Wikimedia

Dec 7, 2016: There was a 24 percent rise in rural women accessing public healthcare between 2004 and 2014, according to a new report by Brookings India, a think tank, significant in a country where half the rural population uses private healthcare, which is four times costlier.

Overall, there was a six per cent rise in dependence on public healthcare for out-patients and seven per cent for in-patients over the decade ending 2014, said the Brookings report, which analysed National Sample Survey Office (NSSO) data over this period.

An in-patient is formally admitted for at least one night to a hospital, while an out-patient visits a hospital, clinic, or associated facility for diagnosis or treatment.

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For out-patient care, 74.9 percent of ailing patients (who sought care) exclusively accessed a private facility in 2014, compared to 79.7 percent in 2004. The biggest decrease was seen among rural women, as we said. While 78.2 percent of them sought private care in 2004, 70.4 percent did in 2014.

The percentage of in-patients seeking public care increased from 42.3 percent in 2004 to 45.4 percent in 2014; the percentage of rural women accessing public care rose from 45.1 percent in 2004 to 56.1 percent in 2014.

“The number of people seeking private healthcare, however, might be an underestimation, as NSSO surveyors are instructed to mark all those who went to both government and private facilities as ‘only going to government facilities’,” said the Brookings report.

Indians spend eight times more in a private hospital than a government hospital, according to an analysis of National Health Accounts (NHA) 2013-14 data by The Hindu newspaper.

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Despite the decline in exclusive dependence on private care, 29 of every 1,000 Indians pointed to the unsatisfactory quality of healthcare, the most commonly cited reason for not accessing a public hospital.

Long waiting periods at government health services appears to be an increasing bottleneck in seeking public care. In 2004, 6.8 of every 1,000 cited this as a reason for not using a public hospital; it rose to 18.6 in 2014.

Of 930,000 doctors in India, 11.4 percent (106,000) work for the government. This means there is one government doctor for every 11,528 people, according to the National Health Profile 2015.

Public-health centres across India’s rural areas — 25,308 in 29 states and seven Union territories — are short of more than 3,000 doctors, the scarcity rising 200 per cent (or tripling) over 10 years.

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The number of people not using medical services fell from 15.1 in every 1,000 in 2004 to 12.4 in 2014, which implies an 18 per cent increase in Indians seeking some form of healthcare.

There was an increase, however, in the proportion of people not seeking services, as they felt their ailment wasn’t serious enough, and more women than men report not using healthcare due to the same reason — the gender gap has widened over the decade.

More Indian men are likely to be admitted to hospital during the last moments of life than women — 62.5 per cent to 37.5 per cent, as IndiaSpend reported. For every 1,000 men whose death is certified by medical professionals, the corresponding figure for women is 600.

The number of people not using healthcare due to financial reasons reduced from four of every 1,000 in 2004 to 0.7 in 2014, said the Brookings report, possibly a result of rising incomes or use of publicly-funded health-insurance schemes implemented over the last 10 years by the central and state governments.

About 12 percent of the urban and 13 percent of the rural population got health insurance through the Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) or similar plans. (IANS)

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Chronic Doctor Shortage Affecting Delhi Government-run Hospitals

In addition, the private sector is also contributing to providing health care services in Delhi along with Non-Profit Organisations and Charitable Institutions

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Chronic doctor shortage affecting Delhi government-run hospitals. VOA

By Somrita Ghosh and Nivedita Singh

Delhi government-run hospitals, which serve not only the local population but also the neighbouring states, are struggling with a chronic shortage of doctors and are making recruitments on contract or ad-hoc basis to tackle the crunch.

While in Centre-run hospitals like AIIMS, Safdarjung and Ram Manohar Lohia, doctors have the benefit of practising till the age of 70, under extension of service and on a contractual basis after retirement, no such scheme is yet to be implemented in the hospitals run by the Delhi government which face about a 30 per cent shortage of doctors, officials said.

“Out of the total sanctioned posts of 4,644 doctors, about 1,400 posts are vacant,” an official of the Delhi Health Department told IANS on the condition of anonymity.

The official admitted that the services are being affected due to this shortage.

“The functioning is obviously being affected. If we have more doctors, the work can be done in a better and effective way. The posts are filled up by the Central Government through UPSC and through this procedure, recruitment of about 350 doctors is underway,” the official said.

The procedure of appointing doctors, which is done through the Union Public Service Commission (UPSC), is complex and takes a lot of time. The doctors first have to clear the test conducted by the UPSC followed by an interview.

Vaccines
A doctor assists people looking for treatment for malaria at a health center in San Felix, Venezuela. VOA

“The test results are published after six to nine months. Then comes the interview part and the whole process takes around a year to complete,” a senior official in the Delhi government’s Directorate General of Health Services (DGHS), told IANS.

Explaining the reasons for the shortage, the official said many doctors, after completing their MBBS, opt for further studies or prefer joining the private healthcare sector due to its higher pay scale.

“All this is affecting the doctor-patient ratio in Delhi hospitals,” the DGHS official said adding, however, hospitals themselves can hire certain categories of doctors on an ad-hoc and contractual basis.

Speaking about the requirements, another Health official said the system is complex. “Some doctors are General Duties Medical Officers, some are non-teaching specialists, some are teaching specialists. The process of recruitment is on and we will have these people in place soon.”

“There are 37 hospitals under the Delhi government, some of them are operated by societies. The hospitals running by societies function in a different manner. They hire doctors for themselves. They have done that in past years, they will do it again, as and when required,” the official added.

Will the contractual system of hiring be extended to the Delhi government hospitals?

“The hiring of doctors on a contractual basis was approved last year in the Centre-run hospitals. However, the states are not obliged to follow it since they have their different process of hiring,” said a senior official in the Central Health and Family Welfare Ministry.

China, Vaccines
A child receives a vaccination shot at a hospital in Rongan in China’s southern Guangxi region on July 23, 2018. VOA

The Delhi health official informed that, unlike the Centre, nothing has been made official on similar lines in Delhi to deal with the doctor crisis.

“The Central government, to cope with the vacancies for multiple positions in different hospitals run by it, has approved the policy of appointing retired doctors on contractual basis up to the age of 70. In Delhi, doctors work till the age of 65 and we are considering to raise the age of working of doctors, we are thinking about this proposal,” the Delhi Health official said.

Last year, Delhi Chief Minister Arvind Kejriwal had ordered that all the posts must be filled on contract basis till the permanent hiring process is completed through several government agencies.

“Shortage of medical staff has always been an issue with the Delhi hospitals. While the UPSC is already following the appointment process, the Delhi government-run hospitals can appoint certain category of doctors on a contractual basis by advertising.

“Most of them hire doctors, as and when required, on a contractual basis. The recruitment process is underway in a number of hospitals,” the Delhi Health official further added.

This month, the UPSC announced vacancies for the post of ‘General Duty Medical Officer’ under the Department of Health and Family Welfare, Delhi.

As per the notification, UPSC has invited applications for as many as 327 posts out of which 13 posts are reserved for physically challenged persons, 63 for SC and 28 for ST category with a pay scale ranging from Rs 15,600 to Rs 39,100 along with other allowances.

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“Candidates shall work in the dispensaries and hospitals of the Government of NCT (National Capital Territory) of Delhi and shall be primarily handling patients of various types in these hospitals and dispensaries for medical care. However, they can also be entrusted with other work, including administrative and other related work, as per exigencies of the Public Service,” the notification stated.

Health care infrastructure and services in Delhi are being provided by a number of agencies apart from the Delhi government.

The three civic bodies, the NDMC and Delhi Cantonment Board, Ministry of Health and Family Welfare through its network of hospitals and other specialised institutions, the ministries of railways, defence and labour, and various Central government undertakings are also serving the people in the national capital.

In addition, the private sector is also contributing to providing health care services in Delhi along with Non-Profit Organisations and Charitable Institutions. (IANS)