Determinants of performance of Doctors in the Public Health Systems (Preliminary Observations from three States of  India)...
Issues <ul><li>Human Resource is the most critical component in a Health Facility </li></ul><ul><li>Competence and morale ...
Objectives <ul><li>Process of Recruitment/ Deployment </li></ul><ul><li>Workforce Management Issues </li></ul><ul><li>Comp...
Methods Interviewing State Level  Officers including Secretaries and Directors Jharkhand Rajasthan Uttarakhand Dumka  Pala...
Do Peripheral Health Facilities have  sufficient Doctors?
Doctors in Jharkhand <ul><li>Out of 131 positions in Dumka, 95 were filled up </li></ul><ul><li>Only 30 available against ...
Doctors in Rajasthan <ul><li>8162 positions of Doctors in the Health Systems (200-11) </li></ul><ul><li>745 and 658 positi...
Uttarakhand <ul><li>Sanctioned Positions of 1922 GDMO and 259 SMO </li></ul><ul><li>946 GDMO and 195 SMO available </li></...
HRH Density <ul><li>Non- availability  of  adequate  HRH  is the  constraint  in  High Focus States  - WHO  recommends  HR...
Recruitment/ Deployment <ul><li>Filling up vacancies is a consistent challenge </li></ul><ul><li>PSC selection is a long p...
Promotions/Grievances <ul><li>Limited scope of Promotions for Generalists </li></ul><ul><li>Subjective Appraisals </li></u...
Compensation/Incentives <ul><li>Comparative Anomalous Pay structure </li></ul><ul><li>Rural/Difficult Area Allowance </li>...
Physical Facilities <ul><li>Water supply  - 24 Hours </li></ul><ul><li>Electricity-24 Hours </li></ul><ul><li>Generator/In...
Equipments <ul><li>Functional Delivery & Episiotomy </li></ul><ul><li>Functional OT  light </li></ul><ul><li>Functional OT...
Training <ul><li>Induction versus In-Service Training </li></ul><ul><li>In-Service versus CME </li></ul><ul><li>Lack of Tr...
Diagnostic/Therapeutic Facilities <ul><li>Laboratory Services </li></ul><ul><li>X- Ray Machine </li></ul><ul><li>Ultrasoun...
How far IPHS is a reality? Ranchi Jharkhand Estimated Population in 2010 35,02,364 3,40,75,853 PHC  (Actual/IPHS) 28/175 3...
Striking a Balance <ul><li>Sub-Centers loaded with female staff </li></ul><ul><li>Male Workers extinction </li></ul><ul><l...
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Determinants of performance of doctors in public health systems of three states in India-Shiv Chandra Mathur

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Determinants of performance of doctors in public health systems of three states in India-Shiv Chandra Mathur

  1. 1. Determinants of performance of Doctors in the Public Health Systems (Preliminary Observations from three States of India) <ul><li>Shiv Chandra Mathur </li></ul><ul><li>Executive Director, RHSRC-NRHM, Jaipur </li></ul><ul><li>and </li></ul><ul><li>Thamma Rao D. </li></ul><ul><li>Advisor, NHSRC-NRHM, New Delhi </li></ul>
  2. 2. Issues <ul><li>Human Resource is the most critical component in a Health Facility </li></ul><ul><li>Competence and morale of the Doctors as Leader of Peripheral Health Facilities determines the quality and effectiveness of health services </li></ul>
  3. 3. Objectives <ul><li>Process of Recruitment/ Deployment </li></ul><ul><li>Workforce Management Issues </li></ul><ul><li>Compensation Package/ Incentives </li></ul><ul><li>Support System </li></ul><ul><li>Gaps between Provisions/Expectations </li></ul>
  4. 4. Methods Interviewing State Level Officers including Secretaries and Directors Jharkhand Rajasthan Uttarakhand Dumka Palamu Ranchi Bikaner Bharatpur Jhalawar Sirohi Hardwar Dehradun nagar DH 1 1 1 1 1 1 1 1 1 1 CHC* 5 5 5 3 3 3 3 5 5 5 PHC 10 10 10 6 6 6 6 10 10 10 MO 30 29 32 10 10 10 10 30 29 32 Spel’s 10 11 8 10 10 10 10 10 11 8
  5. 5. Do Peripheral Health Facilities have sufficient Doctors?
  6. 6. Doctors in Jharkhand <ul><li>Out of 131 positions in Dumka, 95 were filled up </li></ul><ul><li>Only 30 available against 96 positions in Palamu </li></ul><ul><li>29 vacancies out of 101 positions in Ranchi </li></ul>
  7. 7. Doctors in Rajasthan <ul><li>8162 positions of Doctors in the Health Systems (200-11) </li></ul><ul><li>745 and 658 positions of Generalists were announced in budget in 2009-10 and 10-11 respectively </li></ul><ul><li>2991 vacancies – 1390 positions sent to RPSC, contractual appointments against the existing vacancies </li></ul><ul><li>DPC for Senior positions </li></ul>
  8. 8. Uttarakhand <ul><li>Sanctioned Positions of 1922 GDMO and 259 SMO </li></ul><ul><li>946 GDMO and 195 SMO available </li></ul><ul><li>976 GDMO and 64 SMO vacant </li></ul>
  9. 9. HRH Density <ul><li>Non- availability of adequate HRH is the constraint in High Focus States - WHO recommends HRH of 25 per 10,000 - in India variance in States is too wide - 10 in Bihar to 38 in Kerala </li></ul>
  10. 10. Recruitment/ Deployment <ul><li>Filling up vacancies is a consistent challenge </li></ul><ul><li>PSC selection is a long procedure </li></ul><ul><li>Contractual System accepted albeit insecurity continues </li></ul><ul><li>Postings and Transfers is always uncertain </li></ul><ul><li>Gradual acceptance to ISM at PHF </li></ul><ul><li>Deploying Specialists is now receiving attention </li></ul>
  11. 11. Promotions/Grievances <ul><li>Limited scope of Promotions for Generalists </li></ul><ul><li>Subjective Appraisals </li></ul><ul><li>Grievance handling is lethargic </li></ul>
  12. 12. Compensation/Incentives <ul><li>Comparative Anomalous Pay structure </li></ul><ul><li>Rural/Difficult Area Allowance </li></ul><ul><li>Perks: Telephone/Mobility/Insurance/LTC </li></ul><ul><li>Non Practicing Allowance </li></ul><ul><li>Residence/Security </li></ul>
  13. 13. Physical Facilities <ul><li>Water supply - 24 Hours </li></ul><ul><li>Electricity-24 Hours </li></ul><ul><li>Generator/Inverter </li></ul><ul><li>Ambulance </li></ul><ul><li>Operation Theater </li></ul><ul><li>Telephone </li></ul><ul><li>Computer with Internet </li></ul>
  14. 14. Equipments <ul><li>Functional Delivery & Episiotomy </li></ul><ul><li>Functional OT light </li></ul><ul><li>Functional OT table </li></ul><ul><li>Boyle's Apparatus (for Anesthesia) </li></ul><ul><li>Instruments for Surgery </li></ul><ul><li>Sterilizer/Autoclave </li></ul>
  15. 15. Training <ul><li>Induction versus In-Service Training </li></ul><ul><li>In-Service versus CME </li></ul><ul><li>Lack of Training Policy </li></ul><ul><li>Exclusive project based training </li></ul><ul><li>Several compartments </li></ul>
  16. 16. Diagnostic/Therapeutic Facilities <ul><li>Laboratory Services </li></ul><ul><li>X- Ray Machine </li></ul><ul><li>Ultrasound Machine </li></ul><ul><li>Medicines </li></ul><ul><li>Blood Storage/Banking Facilities </li></ul>
  17. 17. How far IPHS is a reality? Ranchi Jharkhand Estimated Population in 2010 35,02,364 3,40,75,853 PHC (Actual/IPHS) 28/175 330/1103 CHC (Actual/IPHS) 14/44 194/265 Medical Officers (Actual/IPHS) 72/350 1710/2205 Specialists (Actual/IPHS) 2/306 188/1852
  18. 18. Striking a Balance <ul><li>Sub-Centers loaded with female staff </li></ul><ul><li>Male Workers extinction </li></ul><ul><li>Job responsibilities to be defined </li></ul><ul><li>PMU reaching to the block </li></ul><ul><li>Referral linkages required </li></ul><ul><li>Balancing the National Health Program </li></ul><ul><li>Review UG Medical Teaching </li></ul>
  19. 19. Thank you

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