A large majority in India can still not voluntarily buy Health Cover from Private Sector & depends on PSEs
Why not start with Performance Audit of J&K H&ME Department for further betterment?
DAYA SAGAR
To some extent it appears that how far the common man without additional out of pocket expenses and community support is able to easily receive the health cover is not made the first subject of study by government for assessing the success of inputs made from public exchequer. Whereas, how far the new medical colleges reduce the shortage of doctors / availability of doctors for common man and how far increasing the MD/MS/ Super Specialisation seats ( particularly in private colleges ) helps the masses which mostly depend upon the services from the government sector / public sector ( particularly those in the distant / backward areas ) needs be kept in the immediate focus. No doubt in case the affairs are taken with real truthfulness scope could be generated through new institutions / increasing PG seats for availability of more specialist doctors.
One of the most frequently pulled out subjects is of that of health care infrastructure in respect of shortage of qualified doctors for which so often announcements / sanctions are made for new medical colleges in public sector / increasing the number of medical colleges in private sector as well as increasing post graduation ( MD/MS ) seats in the exiting medical colleges. Opening new medical colleges does increase production of doctors but the way affairs have shaped in J&K so far, it has been more for creating some employment opportunities for some retired doctors from J&K government medical colleges and less with focus on giving sound teaching faculty to the new youth entering the medical profession. One thing that is sure is that increasing PG seats in private / government medical colleges surely does more of good to the ‘benefit’ private college managements. No doubt while processing proposals for medical colleges and additional PG seats in private colleges statistics are quoted mentioning availability of doctors per thousand souls in India for justifying the lack of health care cover. Recently the PSC UT of J&K issued Notification No: 01- PSC (DR-P) OF 2020 Dated: 30-07-2020 inviting online applications upto 04.09.2020 for 900 posts of Medical Officers ( minimum qualification MBBS degree ) with service conditions like Jammu and Kashmir Probationer (Condition of Service, Pay and Allowances) and Fixation of Tenure Rules, 2020 S.O 192 dated 17.06.2020 and against that 2584 applications ( including many with MS/MD degrees) were received even with inferior terms of employment like no allowance and increment till probation (min 2 years) is removed, no transfer from the place / post first appointed for 5 years).
Other aspect that needs to be kept in view before the discussions are taken further is that as per the international health institutions / common cause studies have shown that more than 90 to 95 % of the ailing people/ common diseases could be even in general served only by allopathic doctors possessing MBBS degree from institutions served with adequate faculties and facilities. So in countries like Bharat, keeping in view population size, in case the government health infrastructure delivers / or is made to deliver to its installed capacity there would be some indirect generation of additional health cover in actual practice for the people from the existing manpower itself. Where as it is observed that even for normal route ailments which could be attended by even a MBBS doctor ( at the most MD) most of the patients do not prefer visiting a government hospital even in cities and go to private clinics or even private clinics of government doctors ( where private practice is allowed to government doctors by relaxation of conduct rules for civil servants) and that too even to doctors holding DM qualification. The position in J&K UT can be well imagined from the fact that even MBBS classes in AIIMS” Jammu are said to have been started but there is no AIIMS level hospital available for the residents of UT of J&K & UT of Ladakh and people are still running to PGI Chandigarh or AIIMS Delhi for dependable consultations/treatments.
Not only that let us have an intimate view of health and medical education sector even for the minimum needed efforts for effectively promoting the government ventures. The PM Narendra Modi’s flag ship programme Prime Minister Bhartiye Jan Aushadi Pariyojna ( started as back in 2008 by UPA Government ) which can save an average house hold of atleast a few thousands every year of undue expenditure on medicines & appliances due to prevailing practice of marking drugs with unfairly inflated MRPs but the JA Pariyojan has not that purposefully taken off conceptually as well as availability wise even after 14 years since even most of the government doctors in J&K do not prescribe medicines by chemical name ( but brand name) and the Jan Aushadi outlets are still not adequately near to the common man. Imagine had the Doctors prescribed even Paracetamol 650mg by chemical name and not by DOLO 650 ( DOLO MRP Rs.34.27 for 15 Tab and Jan Aushadi MRP is Rs.15 per 15 Tab ) how much of common man money would have been saved. Should not H&ME Department atleast now take implementation of prescription writing by chemical name on first priority and mobilise the “Prescription Audit ” cells ( that were created somewhere in 2017 when Mr. Bali Bhagat was Minister) which would save common man & even govt. of lot of money without spending anything additional from public exchequer. Is not there a need to investigate how far the policy as regards Prescription Audit has been carried and if not who should be held responsible for ?
It is not fair for governments to measure their performance only in what they spend from the state exchequer. Performance has to be measured from in how efficiently the material infrastructure and the government machinery delivers after the expenditure is made. January/ February 2014 UPA Government at Centre had sanctioned opening of 5 Government Medical Colleges in J&K and for that in 2016-17 & 2017-18, Rs 19203 Crore (Central Share) and Rs 5.70 Crore (State Share) was to have been released under Capex Budget during 2016-17 and 2017-18. J&K State Cabinet headed by Mehbooba Mufti on 04-10-2017 accorded sanction to the creation of 3375 posts for 5 colleges @ 575 posts per college. On 5th Oct 2019 Ministry of H& FW GOI accorded sanction to two more new GMCs for Leh and Udhampur districts at an estimated cost of Rs 325 crore each ( Rs115 crores for construction of GMC, Rs 80 cr for hostels and residences of students and faculty, Rs 70 cr for equipments and Rs 60 cr for the up-gradation of theexisting hospital for teaching and proposals for GMC Handwara were also under consideration of GOI. So in J&K 8 new government medical colleges were in line in 2020 in terms of the programme of GOI to establish 75 new medical colleges in India. Now in 2022 there are GMCs in Kathua / Rajouri/Doda/Anantnag but patients are still coming to private clinics/ GMC Jammu &Srinagar. Govt. is opening of GMCs and making them functional with contractual temporary faculty comprising mostly of retired faculty from Jammu / Srinagar GMCs, does not the status of quality of teaching one could imagine come under more question mark?
Why cannot J&K Government open appointment route for people from outside J&K? Why cannot Government take the young Doctors with PG/ Super specialisation ( agile & upto date with research) qualifications working in the field for new GMCs at lecturer level on regular basis through a summary appointment route ?
Hope LG UT of J&K Manoj Sinha also takes leads from the J&K PSC communication like PSC/Exam-WT/MO/2020/6 of 14-12-2020 addressed to Administrative Department J&K H&ME conveying that PSC could not find eligible candidates fulfilling requirements even for Rule-51 of PSC (Business and Procedure) Rules 2005 which also includes the minimum academic performance slated for public services and questions discussed here for taking remedial measures ensuring quality educational standards /guiding levels in the existing & new medical colleges keeping the interests of trainee students &J&K community they have to serve instead of opening more colleges and the colleges simply becoming a place for providing employment/ promotions to retired/ exiting faculty.
(The author is senior Journalist, social activist, analyst
J&K affairs can be reached at dayasagr45@yahoo.com).