Rajasthan: Nagging problems remain

Rajasthan is one of the states where problems in healthcare have always been bigger than the vision and perspective of different governments.

In the last 15 years since the announcement of the first national health policy, significant progress has been made in health sector but Rajasthan continues to be an underperformer as compared to other states of the country. Basic problems like scarcity of doctors, paramedical staff, infrastructure, slow supply management of drugs and politics of vengeance continue to persist for very long.

For the last many decades, scarcity of doctors has been a major issue in both rural and urban Rajasthan. Out of 10,000 posts in government hospitals, around 2,500 posts of doctors and 1000 post of specialist doctors are vacant.

Shortage of 35,000 paramedical staff is enough to create a dent in the basic medical framework in the state. According to official figures, the state still needs 700 more primary health centres (PHCs) and 200 community health centres (CHCs) to cater to the entire population of the state. Tribal areas are the worst hit where people do not get easy access to basic medical facilities and doctors too are unwilling to work there.  

With such basic constraints, heath indicators like Infant Mortality Rate (55) and Maternal Mortality Ratio (318) are also higher than the national average. The recent outbreak of swine flu prodded the state government into action which led to the start of the recruitment process of 700 new doctors. Besides, the government has announced `one year MBBS course’ to produce more doctors and heavy incentives to retain them in far flung rural and tribal areas.

“Achieving millennium development goal (MDG) this year remains a distant dream. Claims have been tall but ground realities are different. Among many parameters of MDG, you will have to bring down MMR and IMR to 109 and 27, respectively, which is difficult,” said Dr Virendra Singh, retired superintendent of SMS hospital. Free medicine scheme must have been strengthened as it showed massive improvement at ground level, he added.

Several ambitious schemes like free medicine scheme that started by the previous Congress government have been in the limelight for its weak execution by the new state government. While the government plans to merge free medicine with food security, irregular supply of free medicines is also a major issue.

In hospitals, patients are getting half of the sanctioned free medicine due to weak supply chain but hundreds of people have died so far due to swine flu and snake bite as government could not ensure enough stock of medicine on time. Following such constraints, incidents of death due to malnutrition, seasonal diseases, Congo fever, swine flu and Scrub Typhus have also increased in last few years.

Private sector, PPP

Rivalry between political parties have also dented healthcare in Rajasthan. In previous tenure, BJP focused on promoting private sector and public private partnership in health sector while the Congress stressed on announcing social security schemes. After shift in power, the new dispensations slowed down implementation process of schemes announced by their predecessor.

The emergence of private health sector in last 10 years has been both a bane and boon to the state. While private sector offers value to the money of its customers, the cost of treatment is five to eight times more than state-run hospitals. The government hospitals in big cities of Rajasthan have best of the doctors and infrastructure but private hospitals are running to their full capacity due to services and easy access to medical staff including doctors.

The government-run hospitals are generally tagged with laidback attitude of para-medical and other staff, cleanliness, over-crowded wards, lack of proper care and availability of free medicine and difficult access to doctors. In last three years, there have been numerous incidents across the state where patients and relatives have bashed up government medical staff for their negligence which was followed by state wide-strike by resident doctors and other staff.

There has been frequent demand by the people’s representatives to bring the private heath sector in direct control of government. “All the infrastructure facilities like land, power and water are provided to private hospitals by state government at nominal price. But none of the governments so far has ever nailed the private hospitals and clinics,” said Dr Radheshyam Joshi, a retired doctor.

The presence of AIIMS in Jodhpur has not changed much except that the people from western and southern Rajasthan now prefer Jodhpur for treating any critical illness instead of coming to Jaipur, he added.

Still, several initiatives like human organ transplant service, much awaited health insurance facility by state government and running PHCs on PPP mode are likely to make a major difference in the healthcare sector of Rajasthan.