WAYS TO CURE AILING PUBLIC HEALTHCARE IN TS : VANAM JWALA NARASIMHA RAO

WAYS TO CURE AILING 
PUBLIC HEALTHCARE IN TS

VANAM JWALA NARASIMHA RAO

THE HANS INDIA (26-01-2017)

Decades after the establishment of Osmania and Gandhi Hospitals in twin cities, for the first time the Telangana State Government issued orders for establishing four new 500 bedded multi-specialty hospitals in the city to cater to the healthcare needs of people from city and surrounding areas. These hospitals will come up one each at Victoria Memorial Hall Home LB Nagar, Rajendranagar, Pet Basheerabad and Miyapur. While this is an important milestone in the healthcare in the state, it is worthwhile to analyse few more aspects towards providing a better healthcare in the state-both in urban and rural areas.

Keeping in view some of the unique conditions in Telangana state it is of utmost significance to revitalize the existing government system of health care by providing adequate medical and health facilities as well as integrating at some point the non-government and private medical and health facilities. In any case, ultimately, on the long run it is only a technology based health care that would be able to address the medical and health needs of people. It is time to plan on those lines from now itself.  

NOT WITHIN REACH OF POOR

In Telangana like in other parts of the country, specialties and super specialties healthcare is available in private sector only or mainly and the entire primary care is done by government. Another problem in India in general and particularly to the middle class people is the huge costs for diagnostic services which are provided mainly by private centres. For instance a PET (Positron Emission Tomography) Scan costs anywhere around Rs. 20, 000 and an MRI (Magnetic resonance imaging) costs around Rs. 10, 000 and many more like that. These need to be provided by Government at affordable costs. It is also desirable that the government establishes its own polyclinics and also takes the help of private clinics enabling the patient to get treatment at affordable costs. It is high time that we study systems elsewhere and adopt them here.

EXPERT OFFERS SOLUTION

Dr AP Ranga Rao with his rich experience as an expert specialist doctor, administrator and consultant to several national and international health projects speaks about a practical model for Telangana state which if considered by government would go a long way in provision of required medical and health facilities both at urban and rural areas.

According to Dr Rao for health care delivery purposes the state can be divided into Four Zones. Hyderabad and RR districts with about 75-80 lakhs to be in zone one, 40+ towns in zone two with 60 lakhs population and 900 villages with 27 lakhs population in zone three which have at present some primary or secondary or tertiary care. These constitute in all about 47% of population. The fourth zone of 8100 villages with 186 lakhs population which accounts for 53% still depends on uncertified care of RMPs or ANMs.

Dr Ranga Rao says that as on today zone one is served by 2400 Specialists and 640 super specialists of various categories belonging to both Government and private sector in addition to the doctors with basic qualification of MBBS. Population in zone two too has access to primary and secondary care to 780 Specialists and 125 super Specialists of their choice. 27 lakhs (7.6% of total population) are living in the villages where a PHC is located (683 in number) who can hope to have round the clock access (If the doctor is posted and is staying in) to primary health care.

For the rest of population (approximately 1.86 crores constituting 53% of total population) living in 8100 villages the access to qualified primary health care is kilometres away. Out of them for 57 lakhs population it is beyond 5-10 kms and for 92 lakhs population it is more than 10 kms. They have to literally depend on the services of ANMs in the sub centres (If they are posted and staying) for a qualified care. In reality this 1.86 crore population is dependent on local uncertified long standing village practitioners of allopathic care or even otherwise.

NEED FOR MOHALLA CLINICS

In Hyderabad out of 80 lakh population nearly 25-30 lakhs live in recognized slums. One Anganwadi worker and one Aasha worker is supposed to serve about 1000-1500 population who probably may be made as a team and the Anganwadi centres or the nearby polling booth could be designated as Mohalla Clinics. Here twice in a week a dispensary or a clinic could be run where on the first day cases of maternity and child welfare, immunization etc could be attended to. On the second day lifelong diseases and chronic diseases could be attended to. The facility here may be limited to screening and collection of blood samples. All metro, rail stations and bus terminals may be used for running these clinics.

ROPE IN HOUSE SURGEONS AND PG STUDENTS TO RUN CLINICS

At the rate of say 1500 persons per clinic for the whole of Hyderabad the requirement would be around 5000. One doctor can serve three clinics to work on average 8-9 days per clinic. A maximum of 1750 doctors are required to cover all the clinics. These doctors can be drawn from out of the in-service house surgeons in addition to few doctors exclusively recruited for this purpose either as on a month or two months attachment. There would be enough of them, graduated from both government and private medical colleges. On an average every year 2500+ are admitted in both Government and private medical colleges and even if two thirds pass out every year the number of house surgeons available for Mohalla clinics would be anywhere near to 1650. Their job is to do a general medical check-up and attend to minor ailments and organize screening. This is in a way the primary health care centre. These clinics may to begin with be concentrated in slums where there is nearly 30 lakhs population.

There are at present 110 urban health centres in Hyderabad and it is adequate if their number is increased to say by another 150 where there would be a qualified doctor to serve as first referral centre. About 30-35 clinics may be attached to each urban health centre. PG medical students of various private and government medical colleges on rotation should take care of urban health centres which are supposed to be for secondary health care. On an average both private and Government hospitals put together there would be around 850+ PG students in Telangana. These are also to be specialist clinics in the areas of medicine, surgery, psychiatry, gynaecology, eye etc. as a first referral health care.

INVOLVE NON-GOVERNMENT SECTOR IN TERTIARY CARE

Both in the primary and secondary stages sample collections will be done and in the tertiary care diagnostic tests will be done. After the primary and secondary stage the third stage is the tertiary care hospital. Each of these numbering around ten in government sector should cover a population of say 5 lakhs which means another five are required. The tertiary level is also the speciality, multi speciality and super speciality hospital. In the third stage there has to be an integrated approach to enlist NGO run hospitals like Andhra Mahila Sabha, Mahavir and Saint Theresa and similar others as well as large number of private nursing homes, RTC, Railways, even Military hospitals.  In a way the Health Card system does the similar function and this may be further explored and extended.

RURAL AREAS

Coming to rural areas falling in zone three and four the present structure is beginning with 4863 Sub-centres, we have 683 Primary Health Centres (PHC), 114 Community Health centres (CHC), 31 Area Hospitals and then the 7 District Hospitals.  After the reorganization of districts it is only one third of the district headquarters we have district level hospitals and in rest of the districts mostly we have Area hospitals.

There are also 18 teaching hospitals out of which 10 are in Hyderabad and 4 in Warangal. In addition we also have 272 Ayurveda, 130 Homeo, 141 Unani and 24 Naturopathy Hospitals in the state. Thought may be given to integrate these. 

An estimated 2595 government doctors are supposed to be working in various capacities which means on an average about 13, 500 individuals per government doctor. The bed strength is 20, 400 and per bed population is 1716. In addition we have 35, 700 Anganwadi centres all over the state. In every district with medical colleges coming up year after year the services of house surgeons and PG students could be effectively utilized at primary care, secondary and tertiary care that is CHC/PHC, Area/district and teaching hospitals wherever they are.

PHCs thus could be effectively equipped with doctors. Here again as also in CHCs sample collections will be done and in the tertiary care that is district hospitals diagnostic tests will have to be done.

For 1.86 crores constituting 53% of total population living in 8100 villages the access to qualified primary health care is possible only either through Tele-Medicine or through FDHS (Fixed Date Health Services) scheme. FDHS Mobile Health Units that are designed to render two four-hours service each day in two habitations of 1500 population each covering 39 million people living beyond 3 kilometres of any health facility are to be strengthened. This service would regularly provide primary screening of pregnant women, growing children and patients with chronic diseases through appropriate laboratory investigations and providing medicines that are prescribed by competent medical officers. The service aims to create equity in health care by providing access to affordable and quality health services at the door steps of the poor and vulnerable sections of the state.

Telemedicine is the use of telecommunication and information technology to provide clinical health care from a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.

Probably if a thought is given to these ideas we may expect a new face of health facility in the state of Telangana. End