Watch Your Own Back: Creating A Healthcare Workforce
By Sambit Dash
THE unprecedented crisis of a global pandemic has brought India to a standstill and its States to a point where their resources and capacities are stretched like never before. Odisha Government’s efforts in preparing for the coronavirus infection onslaught has been laudable.
Only time will tell how the State will be able to battle this pandemic, but in a post-pandemic world, the lessons drawn from experiences today should pave the way for a stronger healthcare ecosystem. One such lesson will be the creation of a robust Healthcare Professional (HCP) workforce.
Be it registering individuals who returned from foreign countries, advance four-month social pension payment and to paramedical staff, creating 1,000 bedded isolation unit, providing income to vendors and construction workers and crucially providing clear message to the people at large, Odisha has ticked most of the boxes in its preparedness checklist. While the mobilisation is commendable, largely attributed to a strong bureaucrat-run culture in the State, the elephant in the room – the serious shortage of HCPs cannot be unseen.
It was revealed in a Lok Sabha reply in August 2019 that there was a staggering 5,771 doctor post vacant in Primary Health Centres in the State. Odisha Government followed by sanctioning 2,000 more posts. Vacancies in PHCs, CHCs have long paralysed healthcare delivery in India and Odisha is not an outlier.
As a case in point, in a news report published a few days back, Bhadrak district was reported to have 139 doctor posts vacant with the 29 newly appointed doctors not having joined despite appointment. Shortage and absence of doctors, a serious problem, receive the limelight at the same time ignoring that healthcare workforce comprise multiple disciplines.
Acknowledging the problem
Firstly, there has to be a realisation that healthcare professionals are not just doctors. In a comprehensive healthcare setup, a laboratory technician, nurses, epidemiologists, physiotherapists, occupational therapists, clinical psychologists and a whole gamut of it are important cogs in the wheel.
While doctor posts get usually sanctioned, the shortage of other HCPs is staggering and is usually ignored. One-third of PHCs in India do not have a lab technician and about a fifth of them do not have a pharmacist.
Secondly, the planning of ramping up HCP workforce is a long term game and which needs constant focus. While the number of medical colleges have increased in the recent past in India as well as in Odisha, its result in addressing shortage of doctors would take time.
Tamil Nadu or Kerala, which have much better healthcare index, have one medical college in each district. Odisha has had a mixed response with private medical colleges; the panacea they were thought to be, have not been so. One needs to ponder where the gap lies.
Bridge the gap
Health is a State subject and as the Covid-19 crisis has shown, the war is to be fought at smallest units of administration and thus States should proactively take steps to protect their people. One way to raise the HCP number is to start bridge courses based on the need.
AYUSH professionals, dentists, nurses, allied health professionals and pharmacists should get an opportunity to practice limited allopathy; a move that could address lack of HCP especially in rural areas.
This won’t be anything unique. Maharashtra has had a one-year bridge course since 2016. Neighbour Chhattisgarh with its Rural Medical Assistants (RMA) is a well-studied example where these professionals have helped plug the gap and have competency equal to or better than MBBS graduates.
Courses that are unique to Odisha’s needs ought to be designed and delivered in a professional manner.
In this ongoing Covid-19 crisis, Ganjam district administration did well to roll out telemedicine facility. This is an example that should be followed across districts and well after the pandemic is over. And to do that, professionals need to be trained.
Bridge courses can bring to speed up students of healthcare to do this. Kerala rolling out telephonic counseling services in this pandemic is an excellent step. If Odisha is to develop such capacities it will take concerted long term effort.
Lessons to be learnt
Even though we are faced with an unprecedented situation, a one in a lifetime event for most, healthcare needs in a country like India and in a poorer State like Odisha, are not restricted to infectious diseases. Non-communicable diseases (NCD) are responsible for nearly 62 per cent deaths in the country and are a huge burden on healthcare. Fighting fire in healthcare requires a wide variety of HCPs and Odisha should proactively pursue policies that will create that workforce.
A lack of robust public health can come to bite bitterly in times like these and slowly at other times. Odisha has carved a niche for itself in disaster management, and its response to Covid-19 until now espouses confidence. However, the healthcare battle is a long drawn one, and the lessons learnt today should not be frittered away tomorrow.
(Sambit Dash teaches in Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal. He comments on public policy, healthcare and issues of social interest. He tweets at @sambit_dash).