Quality healthcare at affordable rate is unavailable at govt. institutions in Ernakulam owing to shortage of hands and facilities

Despite an impressive network of government hospitals, quality healthcare at affordable rates continues to evade a majority of the people in Ernakulam. This is largely because of a severe shortage of medical staff and widespread misgivings about their capabilities.

The district is a microcosm of government healthcare infrastructure in the State, which on paper is manned by 4,383 doctors and 7,924 nurses. But vacancies are aplenty and sanctioned posts hardly meet the requirement of a population of more than three crore. The district which is said to be better serviced has 115 institutions with sanctioned posts of 489 doctors, 726 nurses and 180 head nurses. But vacancies number 74 each for doctors and nurses.

A lack of flexibility in funds utilisation, especially of late under the National Rural Health Mission regime, and political interference have also played a role in stalling improvement in services and infrastructure at various government institutions.

The economically weaker sections of society suffer the most because healthcare at private institutions is practically closed to them on account of their prohibitive cost.

Though healthcare in government hospitals appeared to forge ahead for a while and came to be described as part of the Kerala model of development, there is now no sign of service delivery going up a notch, leaving private players to rake in the moolah.

The only exception to the rule is the District General Hospital in Ernakulam, which has facilities to match the best of private institutions but is fighting a lone battle to keep up quality service.

Its achievements have been officially recognised and it is the only large hospital in the State to get accredited by the National Accreditation Board for Hospitals.

The Women and Child Hospital in Thiruvananthapuram and Chertala Taluk Hospital also have been recently accredited in different categories.

The other government hospitals lag. The Women and Child Hospital in Mattancherry is a casualty of utter lack of drive and vision on the part of the authorities. The hospital did not have sufficient infrastructure and manpower. But it took five years for the authorities to complete the two-storeyed building to house the operation theatre, labour room and post-operative ward.

The building and equipment have cost Rs.1.72 crore and when it was inaugurated on February 28, the building was found to have developed leaks.

The building is yet to get water and electricity connections. But Dominic Presentation, MLA, who provided some of the funds for the structure, told The Hindu that the building’s leaks had been plugged and rectified and it would be ready by September 1.

Lack of hands run through the system. In the Fort Kochi Taluk Hospital, there are only nine doctors on the rolls while the actual requirement is 13.

Only four of these doctors man outpatient wings daily while the others attend to two or three outpatient wards a week.

The nursing services strength is equally dismal with six of the 30 posts lying vacant. Four of the 24 nurses at the hospital attend duties here on working arrangement, which means that they are actually posted elsewhere but work at the taluk hospital because of the requirements here.

With 600 to 700 people arriving daily to the OP wing, the hospital superintendent and its resident medical officer have to pitch in to manage the rush. Even the infrastructure needs much improvement as there are only 150 beds here against the officially sanctioned 240.

The cheerless story of inadequate hands does not end in Ernakulam. There is only one anaesthetist for the whole of Kasaragod district, says O.S. Shyamsunder, president, Kerala Government Medical Officers’ Association.

There are 1,600 posts of specialists across Kerala against the actual 1,200 working, he said. Mr. Shyamsunder pointed out that there was a severe shortage of specialists in medicine, surgery and anaesthesia.

The shortage of doctors and nurses gets a little murkier with the ‘working arrangement’, of which there are 2,500 at present in the State, says former Health Minister P.K. Sreemathi.

Under the working arrangement deal, a health department personnel posted in a hospital goes to work in another establishment because that establishment requires her or his services. These arrangements, at least on paper, are not permissible beyond three months. But they continue in several instances and the arrangement is widely misused to secure favourable postings and can even lead to legal tangles, said a senior official of the health department.

But working arrangements are necessary in many cases because a hospital may have a surgeon and not an anaesthetist. In some cases there may be a gynaecologist in a hospital and not a paediatrician or vice-versa.

The rural areas present a different picture because people look for holistic service delivery.

For example, diagnostic facilities improve the chances of people opting for government institutions against private clinics, said a medical officer at a Community Health Centre.

Health service delivery in the rural areas is also susceptible to a lot of political pressure. There have been instances where doctors were forced to take up post-mortem after 5 p.m. because of political pressure though the rules forbid them from doing so.

Ms. Sreemathi says the number of people going to private hospitals and the medical colleges can be reduced substantially if primary healthcare institutions provide proper service.

Because of the current break down in service delivery at the primary institutions, medical colleges are under great pressure, she says.

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