Karnataka's never-ending problems of medical personnel shortage, especially in rural areas, and promises by past and present ministers continue.
Karnataka High Court. (Creative Commons)
The Karnataka High Court has initiated a suo motu PIL, following reports of a critical shortage of medical personnel across the state.
On Tuesday, 7 November, the Bench — headed by Chief Justice Prasanna B Varale and Justice Krishna S Dixit — directed the High Court Registrar to officially register the matter as a PIL. The court has appointed advocate Shreedhar Prabhu as amicus curiae to aid in the case.
A report by the Federation of Indian Chambers of Commerce and Industry (FICCI), released this September, showed that there is a deficit of primary health centres in 454 locations across Karnataka, predominantly in rural areas. It detailed shortages, including 723 MBBS doctors, 7,492 nurses, 1,517 lab technicians, 1,517 pharmacists, 1,752 attendants, and 3,253 Group D workers.
A significant portion of the shortfall in nursing personnel — 39.1 percent — is reportedly concentrated in districts such as Bengaluru Urban, Belagavi, Mysuru, Tumakuru, Hassan, and Mandya.
The high court took cognisance of this issue after a news report based on the FICCI report was published in The New Indian Express titled “Karnataka short of 16,500 medical personnel: Report”.
Meanwhile, Chief Minister of Karnataka Siddaramaiah, on Tuesday, during the Karnataka Development Programme (KDP) review meet in Hassan, said that he would be taking action to fill all the vacant posts of doctors in the state.
Speaking about the vacancy of doctors in the district, Siddaramaiah said, “I will fill the vacant posts of doctors in all the districts of the state. Besides, many doctors are not in their central position. Any doctor should be in the hospital and they must work round the clock.”
The comprehensive FICCI report, which put forth 260 recommendations across various sectors, emphasised the urgency of addressing this healthcare crisis to foster the state’s ambition of building a $1 trillion economy.
While the FICCI report indicated adequate medical infrastructure in urban localities, it starkly contrasted the rural regions’ plight, where access to primary, secondary, and tertiary healthcare remains a significant hurdle. It also estimated a need for an additional 1,60,000 beds to meet the demands of the Ayushman Bharat — National Health Protection Mission (AB-NHPM).
Along with several other suggestions, it added that the state may urgently need to increase healthcare spending, as well as establish an execution engine to ensure current efforts are carried out while concentrating on new strategic initiatives to build a cutting-edge and reliable healthcare infrastructure.
“Karnataka has allocated five percent of its total expenditure on health, which is marginally lower than the average allocation for health by states (six percent). The state could aspire to target eight percent of the spend to healthcare by 2025,” the report noted.
The deficit of PHCs is seen highest in Kalaburagi, Vijayapura, Bagalkote, Belagavi, Dharwad, Ballari, Dakshina Kannada, Mysuru, and Bengaluru urban areas. The shortage of beds above 5,000 is seen in Kalaburagi, Vijayapura, Belagavi, Davanagere, Udupi, Dakshina Kannada, Tumakuru, and Bengaluru urban and rural areas.
Meanwhile, the medical personnel deficit is seen highest (above 1,000) in Belgavi, Bengaluru urban, and Mysuru.
As per the World Health Organisation, India’s doctor-to-patient ratio hit a record high of 1.2 doctors per 1,000 patients in 1991, however, as the population surged, the ratio dropped to about 0.7 in 2020.
A senior official from the state Health Department told South First, “Every health minister, as soon as they take charge, the first promise they make is to appoint medical personnel and provide infrastructure. By the end of their term, they somehow manage to get the money to build hospitals, but there is never money left to hire medical personnel — be it doctors, nurses, or Group D staff.”
It may be noted that after the Congress government came to power, Health Minister Dinesh Gundu Rao told the media that over 3,000 doctors will be recruited in government hospitals to overcome the shortage of health professionals, and that the recruitment would commence from October.
However, the senior official said, “Though each time requests are sent to the Finance Department for the hiring of medical personnel, we hardly get a handful sanctioned.”
While the shortage of medical personnel is being highlighted, interestingly, the Karnataka Cabinet has decided to make the one-year rural service for medical graduates optional.
Speaking about this to South First, Dr Sujatha Rathod, Director, Department of Medical Education (DME), explained that all MBBS medical graduates are required to register and serve one year of rural duty, as per the Karnataka Compulsory Service by Candidates Completed Medical Courses Act of 2012.
She stressed on the fact that all MBBS, postgraduate and super-speciality graduates under a government quota had to complete this service, irrespective of their merit score.
“Now, the students will be given rural service based on their merit scores and also, it will be optional,” Dr Rathod explained.
During this service, a stipend of ₹50,000 to ₹60,000 per month will be paid to these students. Interestingly, in the Cabinet, Law and Parliamentary Affairs Minister HK Patil had termed the posting of MBBS and PG medical students for rural service as a “waste of human resources” and a “burden on the government”.
Dr Rathod revealed that this compulsory service, designed to place fresh graduates in rural areas, is short-term and optional due to financial constraints of the government, affecting a long-term solution for the rural healthcare sector.
“Karnataka produces approximately 3,300 medical graduates annually. However, the sanctioned posts in medical colleges remain around 1,600. So, automatically, the government has to spend more money to first place all these 3,000-odd students and also pay them a stipend. Hence, it is being made optional,” she explained.
However, Dr Rathod agreed that these students might have helped in handling the patient population at the district hospitals attached to medical colleges. But she added that while the number of students opting for rural service could temporarily ease the shortage, it is not sufficient to meet the growing patient load.
A senior official from the DME told South First that when the National Medical Council (NMC) comes to check on fulfilment of requirements for college accreditation, they look only at the number of sanctioned posts and vacancies filled in the medical colleges. They don’t apparently look into the service component or vacant posts in the district hospitals attached to these colleges.
“NMC’s focus on teaching staff does not account for the service staff required based on patient influx, leading to further disparities in the system. For nurses, the public health standard is three nurses per bed, per shift — a ratio currently unmet, thereby stretching the existing workforce thin,” explained the official.
With a critical lens on the operational aspects, the official from the DME underlined the challenges in recruitment processes, where even justified requests for staff are often reduced by the Finance Department.
Group C and D employees, on the other hand, are increasingly being hired on a contractual basis, leading to a lack of job security and permanent positions.
The Karnataka government’s struggle with medical staff shortage is a multi-faceted issue, exacerbated by financial constraints and policy decisions.
“The high court’s attention to this crisis is a crucial step in addressing the lacuna in healthcare services, especially in rural areas. It remains imperative for the state to devise sustainable solutions to bolster its medical workforce, which is fundamental to realising the broader vision of health for all,” said a senior doctor.
Officials call for a reassessment of policies, with a clear emphasis on increasing sanctioned posts, refining recruitment processes, and considering the service requirements of hospitals to ensure adequate staffing and to uphold the quality of healthcare delivery in Karnataka.
The PIL is expected to serve as a catalyst for the necessary reforms to bridge the gap in healthcare personnel and facilities across the state.
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