The Crippling Shortage of Doctors Causing Obstacle to health
The Crippling Shortage of Doctors Causing Obstacle to health Care Delivery in the State
To compound the malaise, the health practitioners in private set ups are concentrated mostly in Kohima and Dimapur and understandably so because of the better facilities not only in terms of health care services, but also other factors such as educational facilities for their children
The WHO standard of health care prescribes a ratio of 1
doctor for 1000 population. Nagaland fares poorly on this score. To compound
the malaise, the health practitioners in private set ups are concentrated
mostly in Kohima and Dimapur and understandably so because of the better
facilities not only in terms of health care services, but also other factors
such as educational facilities for their children. That leaves the rest of the
population to be served by health care professional in government service. With
the emphasis of Indian Public Health Services (IPHS) standard to be applied in
all health centres across the country, Nagaland fares dismally, and the biggest
crisis staring in the face is the acute shortage of qualified health care
professionals with doctors being one of the most pressing need at the moment.
Revisiting COVID-19 pandemic and the shortage of health care
professionals
COVID-19 pandemic glaringly exposed the brutal truth of the
need of more doctors, nurses, technicians and other allied health care
professionals. Having understood the practical realities facing the department,
the government of Nagaland had created several posts in various categories in
the medical department to meet the COVID exigency and of which 123 posts in
various ranks were created for doctors to manage the COVID pandemic. Seeing the
overwhelming burden of the pandemic and the need for additional manpower, even
retired doctors were called to offer their services and true to their
profession, many retired senior officers willingly stepped in to offer their
services as a calling to a greater humanitarian service without any
remuneration and despite being in a vulnerable age to the disease. Not only
that, even interns and clinical student in MBBS were requested to offer their
services, to which there was barely any response to the distress call. Public
memory can be so short but the crisis at that critical point in time must not
be forgotten. The acid test of dedication and sincerity came when the people
who cared and who cared not to serve the people in particular and the
government in general was glaringly exposed when COVID-19 special recruitment
for the newly created vacancies was conducted.
It was also observed that many able and qualified young
doctors not in government service either chose to stay in the safety of their
homes or opted to prepare for competitive exams even as the pandemic crisis
continued. In such crisis and extraordinary circumstance, those who responded
to the government’s call to serve through the COVID special recruitment drive
were assured special considerations. The empathy of the government to offer a
special recruitment deserves much appreciation. Extraordinary times require
extraordinary measures and COVID pandemic was one such time for the government
as well as the health care professionals. It called for ordinary health care
professionals to do extraordinary task, risking their lives and the comforts of
home to go on a vicious cycle of ‘COVID duty- quarantine-duty’ with barely any
time to spare for their families and to be with them. What was even worse than
the physically demanding duty is the emotional stress weighing heavily on their
minds of the possibility of never seeing their families again should they
contract the disease and perish in the line of duty. Over time, many of those
recruited also resigned for one or another reason including further studies,
leaving the rest to serve the government and the people till date on the
assurance of a special consideration for their extraordinary service in a time
of great distress and need. They were then hailed as heroes. If there were some
decency of moral obligation, a debt of gratitude is owed to them just as the
government found it justifiable to compensate them with a one-time dispensation
of recruitment but for the court cases slapped on the Department that is not
only preventing their recruitment but all other recruitment, thereby leading to
a crippling shortage of manpower in service.
COVID recruitment drive was never a backdoor recruitment
Many have been made to believe that COVID recruitment was a
backdoor appointment. By definition, a backdoor appointment is when a company
hires someone without following the standard recruitment process without
general advertisement. In such cases there is favouritism, nepotism and
employee referrals.
On the contrary, the COVID special recruitment was conducted
with the approval of the Cabinet, openly advertised, meticulous scrutiny of
documents and eligibility carried out and interviewed by very qualified and
competent officers. There had been no violation of meritocracy, no lack of
transparency, and no political influence for recruitment. It must not be
forgotten that the circumstances and time constraints did not permit the normal
exam and viva-voce spread across several months. It should be taken into
consideration that many qualified candidates feared to join so as not to risk
their lives by serving COVID patients. To ensure the continuation of health
care delivery services which forms a part of the Essential Services Maintenance
Act (ESMA), the government had assured special considerations for the COVID
recruited health care personnel to retain their services. If the government is
empowered to ensure the essential services through ESMA, then in a way it is
also reversely bound by the same Act to ensure the delivery of essential
services to provision of adequate manpower.
Debilitating shortage of manpower can lead to collapse of
health care delivery
It is an observed fact that there has been no recruitment of
doctors through NPSC for the last 4 years, whereas doctors continue to retire
when they reach the present stipulated age of superannuation. As of July 2024,
of the sanctioned posts, 435 are in position, of which 322 are regular
employees and 113 are COVID appointees. Of these, 45 are either on study leave
or attached to NIMSR, not accounting those who expired while still in active
service, or are debilitated due to ailments. Statistics shows that in the next
4 years, 68 will retire. There are 229 health centres inclusive of District
Hospitals, PHCs, and CHCs where the existing manpower are deployed. As of July
2024, there are 57 PHCs functioning without Medical Officers and the health
care delivery is therefore virtually collapsed in the rural areas due to lack
of doctors. The man power augmentation through NHM has not been sufficient. At
the current rate of retirement without fresh recruitment, the health care
delivery services will collapse sooner than later.
Nagaland In-Service Doctors Association (NIDA) has long been
raising the impending shortage of doctors in active government service, and the
remedial measures suggested being the extension of service, and the creation of
more posts to cater to the ever expanding health care demands.
A recent independent field study of various health centres
across Nagaland by the Nagaland State Human Right Commission (Law Wing) headed
by a reputed and learned Judge also made the observation of the acute shortage
of doctors in the field everywhere and suggested the extension of service to
mitigate the manpower crisis.
Non recruitment adding to acute shortage of doctors
Various NGOs have raised their frustration at the shortage
of doctors in health centres in their jurisdictions following transfers and
many of whom could not be substituted owing to lack of doctors. Remedial
measures of addressing the grievances have become limited to shifting the
manpower only to cause a resultant shortage from where they were transferred
out. With no adequate manpower for replacement, it has become a matter of
shifting the buck and it stops at the table of the Directorate who is equally helpless
without further recruitment as the senior continues to retire every few months.
It is learnt from reliable source that owing to the court
case filed by the Nagaland Medical Students’ Association (NMSA), protesting
against the government’s assured relaxation and consideration of the
COVID-recruited health care personnel, the NPSC is not in a position to
advertise any recruitment until the pending court case is disposed. It is an
administrative fact that hundreds of posts cannot be requisitioned for simultaneous
recruitment. It is also a fact that there exist more vacant posts than the
number of COVID contractual doctors, and that the special recruitment is being
sought from the pool of posts created during the pandemic for COVID pool and
not from the general vacancies. In the light of the given circumstances, NMSA’s
court case delaying any recruitment proves counter-productive for their members
for the fact that as time keeps ticking, many graduates will gradually inch
towards over age for active recruitment through NPSC.
While recruitment is the prerogative of the government, it
is hoped that the government will not forget those COVID warriors who stepped
in to fill the manpower crunch to augment the health care delivery. It is also
hoped that the judiciary will show merciful justice to these COVID warriors who
are now dragged to the dock for an anticipatory leniency in their recruitment,
without depriving others of their rights while also taking into consideration
of their humanitarian services in the desperate hour of need during COVID
pandemic. And in doing so, provide relief to all parties so as to initiate
further NPSC recruitment to address the acute shortage of manpower, and without
which, those left to run the affairs of healthcare of the State are helplessly
left to face the brunt of public ire.
