Dr Tasaduk Hussain Itoo
Health is an invaluable blessing for a human being’s life; without it, one can become uninspired, de-motivated, and unable to thrive for success. Health is the capacity of individual to adjust in changing life conditions to function not only in current situation but also to get ready for future, hence in underdeveloped nations the ideal health most often remain a vision. According to Lewis, human beings become the victims of many diseases. The patient is most often ill or injured and in need of treatment by a physician, a registered nurse, or other health care provider, in chronic situation, a patient is required to be admitted in a hospital for proper treatment and care.
As per Health Ministry data, there are 20,306 Government hospitals in the country. Rajasthan leads with 3,145 hospitals and Jammu and Kashmir stands at the number two with 2,812 hospitals. Going by the statistics, J&K has the higher number of health institutions in rural and urban areas than neighbouring Himachal Pradesh (160), Punjab (240), and Haryana (159). Uttar Pradesh, the most populous state, has only 831 hospitals.
Public hospitals in shambles :
Hospitals are of two types: public hospitals which are owned by Government and receive Governmental grants and private hospitals operated privately and mostly profit oriented. The standard of health services being provided are not according to the public expectations in both developed and developing countries.India inherited an undeveloped healthcare system at the time of its independence in 1947,essentially designed to stop the spread of large scale epidemic diseases. Further it is argued that although the health is now recognized as a fundamental right of human being all over the world. Hence due to the rapid population growth and lack of facilities in health sector, especially in rural areas of India , there is a reasonable demand for better health care because of consistent beneficiaries dissatisfaction from the existing facilities and services. Problems and difficulties faced by patients at public hospitals are ranging from unavailability of facilities to staff negligence.The reasons behind poor health services at public hospitals are limited governmental funding, lack of governmental interest in launching new healthcare projects and over burdened public hospitals. Moreover in public hospitals, the doctors, supporting staff and nurses are not taking pain to attend the patient or to provide individual care to the patients, take care of cleanliness, sterilization of equipments, and lack of feedback mechanism showed a low commitment level towards their responsibilities. Similarly,it is accounted that the frustrated attitude of public hospital staff towards patients, lack of staff cooperation, unavailability of medicines and blood for serious patients, unequal treatment on the basis of rich and poor, lack of staff, inadequate sterilization, lack of proper cooling and heating system for serious patients, poor condition of wards cleanliness, problem of accommodation etc. are the contributing factors towards increasing patients disparities at public hospitals.So it is pointed towards rejection of this fundamental right i.e. health, to millions of poor people, as the poor majority can not afford treatment at private hospitals.
References from J&K:
There is serious conflict of interest for those working at the Government Hospitals and at once doing private practices. While Government has banned private practices of SKIMS Soura doctors, but there is hardly any implementation of ban visible. The qualified doctors are trying to incline patients to their personal clinics instead of giving full attention to patients at their duty in public hospital. Also it is noticed that doctors in public hospitals spend very little time on patient’s checkup which is even less than a minute per patient.There is also a raising concern that patients in public hospitals especially tertiary hospitals are being attended at many times by junior intern doctors, who are not well-experienced yet in the field. As per a Medical Council of India(MCI) rule, “an intern doctor could not work or take decisions independently, he/she has to work under the guidance of a senior doctor whosoever may be a PG resident, a senior resident or a consultant.Thus, Government Hospitals badly erodes the healthcare of the poor and middle class patients who can not afford comfortable treatment at private hospitals.The doctor-patient ratio in Jammu and Kashmir is among the lowest in India and it is likely to remain so if the State Government continues with the traditional sluggish process of recruitment.GMC Srinagar alone has referred 500 vacant posts of doctors to recruiting agencies, said Principal GMC Srinagar, Dr. Samia Rashid. Compared to the doctor-patient ratio of 1:2000 in India—World Health Organisation recommends a ratio of 1:1000— J&K has one allopathic doctor for 3866 people, Central Board of Health Intelligence, New Delhi, has said.
In spite of the fact that Government Medical College Srinagar & Government Medical College Jammu, the state’s high level hospitals situated in the capital cities of Jammu & Kashmir are in dire straits due to the lack of beds,poor infrastructure, lack of doctors, unending crowd of patients, lack of medicines, lack of proper hospital management and ill attitude of doctors and staff is creating a huge problem for patients at Outdoor Patient Department (OPD) and Emergency Wards. Sometimes patients are advised either to be admitted to private wards or wait their turns to get bed or are sometimes seated two to three patients on single bed.
This shows that majority of the public hospitals beneficiaries are poor, also agreed on visiting public hospital for treatment because of poverty and on less expensiveness of treatment. This could be because of the nature of free treatment at public hospitals and expensive treatment in private health sector. Analogous finding is indicating that high charges of private hospitals push poor patients to public hospital which are in alarming condition. Findings are in consonance that due to the lack of facilities and increased workload, hospital staff are frustrated towards patients and some staff members show disappointed behavior and lack of cooperation with patients during treatment.It is also argued and noticed that doctors and other staff come late, doctors/ staff leave hospitals early, and doctor don’t take extra work load for the patients.This could be one of the major causes of public dissatisfaction from the Government hospital’s treatment due to absentees of hospital staff, ranges from sweepers to physicians. Doctors/ staff do not treat common patients well and it is being argued that they give more preference to known/ relative patients.In government hospitals the doctors, nurses and supporting staff are not taking pain to attend the patient or to provide individual care to the patients. Thus rendering hundreds of patients of the state to seek medical help in other parts of the country every year.
Recommendations
In order to overhaul these problems, the Government needs to increase the health sector budget and to initiate rural health programs to ensure access of poor people to good quality of health services in society. Poor patients should be provided medicines free of cost, doctors and other hospital staff are suggested to give proper attention to patients equally without any discrimination.Government needs to provide all the necessary equipments and facilities to public hospitals at district levels and incentives for staff to make the treatment environment more conducive for doctors to facilitate them while treating the patients. In order to ensure good governance at public hospitals,a proper feedback and complaint mechanism and monitoring system needs to be installed and known to the public in every district of the society.
The first priority for achieving Universal Healthcare, should be “a determined effort to strengthen our public health systems.” Primary health care must be improved, starting with sub-centres, the first health post for the community. By staffing them with well-trained non-physician health care providers, both facility-based and outreach services can be provided without being doctor dependent. District hospitals too should be strengthened to provide high quality secondary care, some elements of essential tertiary care and training to different categories of health care providers.This would also help in relieving unending crowds in tertiary care hospitals.
The second priority should be to improve the size and quality of our health workforce. Without this, the promise of Universal Healthcare(UHC) will remain an empty entitlement. Since primary health care is our first priority, resources must be devoted to the production of competent and committed community health workers for the frontline, mid-level health workers or AYUSH doctors for the sub-centres, and general and specialist nurses as well as non-specialist doctors for primary health centres. More specialists are needed for higher levels of health care including the district hospitals. New nursing and medical colleges should be preferentially set up in districts which presently have very few, linking them to tertiary-care hospitals. Public health competencies must be increased through inter-disciplinary education which is aligned to health system needs. Improved management of all of these human resources must involve better incentives for recruitment and retention, cadre review and creation of well defined career tracks.
The third priority should be to provide essential medicines and diagnostics free of cost at all public facilities. At the same time, referral linkages and patient transport services should be improved to integrate primary, secondary and tertiary health care in the public system. Difficult to reach areas and vulnerable population groups should receive special attention, even as the principle of universality must be applied while designing health services.
The fourth priority must be to put in place the necessary public systems for Universal Healthcare. Regulatory systems need strengthening — from hospital accreditation to health professional education and from drug licensing to mandatory adoption of standard management guidelines for diagnosis and treatment of different disease conditions at each level of health care. A state inter-operable Health Information Network is needed to improve governance, accountability, portability, storage of health records and management. Community participation must be supported to actively engage people in the design, delivery, monitoring and evaluation of health programmes. And finally, larger investments should be made in health promoting programmes in other sectors such as water, sanitation, nutrition, environment, urban design and livelihood generation.
(The author is associated Acharya Shri Chander College of Medical Sciences & Hospital, Sidhra Jammu)
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