Tragic deaths of several patients in a Thane civic hospital in a single night, neglecting maintenance of equipment like air-conditioning and refrigeration, carrying patients to distant hospitals or absence of specialist doctors at the time of an emergency are some of the more freuent complaints heard about the public hospitals across the country. Maharashtra, which prides in calling itself a progressvie state, has some achievements to its credit but much remains to do to make universal healthcare truly meaningful.
Paucity of resources in terms of funding, manpower and equipment is the reality in the health services sector in Maharashtra but there is no improvement in the situation despite assurances by every successive government. Chief minister Eknath Shinde’s recent visit to Mumbai’s KEM Hospital and the litany of grievances showered upon him by patients and their relatives is very eloquent. This is truly shocking since the hospital is among the more well-managed institutions in the state and India. Shinde directed the authorities to construct more facilities in the hospital on a war footing. However, why had not the health department of the government or the civic administration, which runs the hospital, taken this step earlier? Therein lies the rub.
It is in our nature to fight a fire only after it has started raging. Till then, we ignore the symptoms and forget about it after a few months. Of course, a glance at the all-India health services statistics also reveals the same malady. The country as a whole also spends much less on health services than international norms. According to World Health Organisation (WHO) recommendations, five percent of the GDP should be spent by a nation to achieve the objective of ‘Health for All.’ The Reddy Committee had recommended in 2011 that it should be at least three percent. The various expert groups appointed by the present government and its NITI Aayog have said that it should not be less than 2.5 percent. However, it has been officially admitted that it is nor more than 1.3 percent of the GDP. Maharashtra spends just two percent of state GDP on health. Even this amount is not fully utilized owing to various reasons. While almost 75 percent of this is contributed by the people, just about 25 percent is contributed by the government.
It is high time the state government’s health priorities are examined by an independent agency. Although it is urgently needed to strengthen the existing infrastructure, a growing tendency is detected among the rulers to announced new health benefit schemes and divert the funding for them. An obvious effect of such policies is that rural population suffers while the emphasis remains on the areas where the health services are comparatively better. Governmental spending on health insurance schemes only benefits major hospitals and various health insurance companies.
According to Rural Health Statistics (2021-22) published by the Union government, urban health centres and public hospitals in maharashtra have had vacancies as follows : 180 doctors, 100 specialists and 365 nurses. District hospitals had 286 posts vacant while sub-district hospitals lacked 329 doctors. As far as other medical staff was concerned, there were 1400 vacant posts. Primary health centres (PHCs) are considered a vital organ on the public health services machinery since the rural population’s first call generally is at PHCs. According this statistics, 721 Alopathic and 139 specialists posts were vacant. Hence, specialists like surgeons, those treating female ailments and pediatric issues were not available for a vast population. Called the backbone of the health infrastructure, PHCs and taluka hospitals had reported vacancies of 39 X-ray technicians, 329 pharmacists and 568 pathlogy analysts. Staff nurse sanctioned strenth had been increased to 4117 from 2575 (in 2005) but over 900 of thse posts have never been filled up.
The state government had sanctioned about 2000 posts way back in 2005 for running these services but later, for some unknown reason, the strength was reduced to 450. Even these were not filled up and at present, there are 140 vacancies. Auxiliary Nurses and Midwives (ANMs) are another important force which performs basic healthcare functions. Presently, more than 3450 ANM posts are lying vacant though only 333 vacancies existed in this category in 2005.
One major difficulty faced by medical personnel is the lack of very preliminary facilities. This applies equally to the staff in urban and rural areas. It is known that ANMs are required to attend to the patients at short notice. However, 16 of them are still without official accommodation. There is no water supply in 15 percent of PHCs. Separate toilets for men and women in 162 PHCs (out of 1853) are not provided. As per health organisation norms, urban areas in Maharashtra need 1216 PHCs, as per 2022 statistics. But in reality, only 686 are operating. Needs of the tribal population are always on the backburner. In the state, only 2076 tribal health sub-centres are operating against the required 3167.
On the positive side, Maharashtra has become the first state in India to introduce a universal healthcare policy. This was announced by Union health minister Mansukh Mandaviya earlier this month. The state’s Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) will be co-branded with the Centre’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to offer comprehensive health coverage. The revamped scheme will provide a cover of Rs. 5 lakh and will now cover 1900 different medical problems, up from the earlier 996. Under this improved scheme, 12 crore people in Maharashtra will be provided with a health cover. Previously, the MJPJAY scheme covered around 2.22 crore beneficiaries below the poverty line and held yellow or orange ration cards.
In addition to the expanded coverage, the state government plans to increase the number of empanelled hospitals and strengthen rural healthcare infrastructure. The Centre has allocated Rs.3000 crore for the purpose. Furthermore, each district in the state will have a 50-bed critical care unit equipped with oxygen, ventilators, and other critical care facilities, according to the plan. The government also intends to enhance access to affordable medicines through Jan Aushadhi Kendras, which provide generic medicines at subsidized rates. Currently, there are 600 such units, to be increased to 1000 to address the rising burden of non-communicable diseases and the associated long-term treatment expenses.
Under another plan, the state government has decided to make medical tests and treatment at public hospitals available free of cost. The decision is under the Right To Health. Free treatment will be available made available in PHCs, sub-district hospitals, women’s hospitals, district general hospitals, super specialty hospitals and cancer hospitals. Over 2.5 crore people obtain treatment in these facilities.
While all these efforts are ultimately meant to benefit the populace, the need of the hour is to repair and reinvigorate the health services infrastructure in Maharashtra.
A Column By
Dilip Chaware – Senior Editor
A media professional for 43 years, with extensive experience of writing on
a variety of subjects; he is also a documentary producer and book author.
