AAP government must stop optics, better focus on constructive changes

Chandigarh: Close on the heels of AAP lawmakers caught reprimanding government officials in Ludhiana and Jalandhar, another controversy rocked the four-month-old Aam Aadmi Party (AAP) government in Punjab. 

The medical fraternity of the state is outraged after Punjab health minister Chetan Singh Jouramajra made the vice-chancellor (VC) of Baba Farid University of Health Sciences lie down on one of the soiled patient beds during his inspection of the university’s constituent medical college in Faridkot on Friday. 

Felt insulted by the minister’s act, VC Dr. Raj Bahadur resigned from the post a day later on Saturday as his admirers - from politicians to journalists to all weather experts - blamed the minister for “overstepping” and sought his apology.

This also prompted Amritsar’s Government Medical College director-principal Dr. Rajiv Kumar Devgan and medical superintendent, Dr. KD Singh, to resign from their posts.

In the first place, the key focus of the issue should have been on the pitiable condition of the state’s health institutes, so much so that patients are made to sleep on damaged and soiled mattresses despite the annual budget of the Punjab health department running into over Rs. 3,000 crores in the past several years. 

VC’s admirers spinned the AAP minister’s act in another direction, with the opposition milking it as another example of “high-headedness” and “cheap” PR stunt of the new AAP government in Punjab. 

But the issue in hindsight is much deeper than AAP’s optics or din over VC. Punjab’s health system is literally on its deathbed and the remedy is missing.

Only 29% come for treatment in Punjab govt hospitals

75th round of data of the National Sample Survey conducted between 2017-18 and released in 2019 revealed that just 29% of the state's 3 crore population goes to government hospitals for treatment. 

A whopping 66% of the state population are forced to go to private hospitals for treatment, while 5% are dependent on hospitals run by charitable trusts/NGOs, the data revealed.

As per the data, the percentage of the population seeking treatment in private hospitals is the same in both urban and rural areas of the state. This is despite the fact that 86% of the rural population and 80% of urban cities don’t have medical insurance at all India levels. 

This is giving way to a new problem of the debt crisis, especially among low-income group people.

In 2017, Bathinda-based Punjab Khet Mazdoor Union conducted a field survey about the debt on agricultural labourers in Punjab and found that 84% of 1617 families surveyed in six districts were under debt.

The average debt per family came to be Rs 91,437, which according to the union is a huge amount as per their financial standards. As many as 20% of them borrowed money for illness and treatment.

The central health insurance scheme for poor people, Ayushman Bharat, is said to have increased the insurance coverage among SC and BPL population. But the scheme is having poor implementation in Punjab. There are media reports of poor patients denied admission in a private hospital due to inordinate delay by state health authorities in clearing medical dues after treatment under the scheme.

What ails the health system in Punjab?

Responding to this, Dr. Akhil Sarin, president of Punjab Civil Medical Service (PCMS) Association, a body representing doctors working in the state health department, told NewsDrum, “We don’t have proper staff or adequate infrastructure in government hospitals in Punjab.”

Punjab’s health department, he said, is basically suffering systemic problems, and it is a built-up of the past two-three decades.   

He said Punjab has one of the finest hierarchy of health centers right from dispensaries to tertiary care hospitals but the system deteriorated over a period of time for a number of reasons. 

For instance, there is a huge 25-30% vacancy of medical doctors at all levels of medical care. The super-specialty strength of doctors is in negligible numbers. They can be counted on fingers.

According to him, the paramedical staff, who are the backbone of the health system whether for outdoor or indoor patient treatment massively, has been facing a similar shortage of staff. The diagnostic facilities are massively inadequate. There is always a shortage of medicine.

On how things can be improved, Dr. Akhil Sarin said, “If we have adequate infrastructure, proper diagnostic facilities and then enough trained staff besides proper hygienic conditions and patient care facilities, only then things can improve.”

The existing staff in government hospitals or dispensaries is already working under huge pressure due to manpower shortage. Giving his example, he said he is a specialist doctor. Besides his core duties of checking outdoor patients (OPDs) and doing operations, he has been conducting post mortems, medico-legal work, and other administrative work, which does not come into his preview. 

“Many of these works are being handled by MBBS doctors. But in my present posting, there is no single MBBS doctor. In almost three weeks in a month, I am busy in an emergency because of staff shortage, leaving me very less time to check OPD patients or do surgeries,” he added.

VC’s track record is not entirely unblemished but the new govt has a bigger task in hand

Dr. Raj Bahadur is a known spine surgeon. Notwithstanding the support, he is getting after the AAP health minister's act, his eight-year tenure as VC was not entirely unblemished.

Gurpreet Singh Chandbaja, president of Faridkot-based Bhai Ghanaiya Cancer Roko Society, told NewsDrum that there are numerous problems with the functioning of the government hospital attached to the medical university.  For instance, diagnostic facilities are in bad shape. Patient care facilities in wards and operation theatres are in miserable condition.

“We met VC Raj Bahadur several times but things did not improve. Since March this year, the poor working of the hospital was being highlighted prominently in district grievance committee meetings. But there was no visible improvement in the functioning of the hospital,” he added.

But members of the medical fraternity said VC can't be blamed for sluggish health infrastructure.

Amid this din, the AAP government is in damage control mode, trying to placate Dr. Raj Bahadur to withdraw his resignation.

But there is a clear message to the new AAP government in this controversy, which is - it can’t improve Punjab’s health scene with mere optics.

AAP, which formed the government for the first time in the state, can’t be certainly blamed for the follies of the previous governments.

"But asking VC to lie on the damaged and soiled patient mattress can’t solve the problem either. There is a proper procedure in place to oust the inefficient officials," said the several experts we spoke with.

"But bringing their follies in public without strengthening the public infrastructure is a worthless exercise, which will only end up haunting back the government as happened in VC’s case," the experts added.

AAP has a bigger task in hand by way of bringing constructive changes in the health system since one of the reasons behind the party's massive win in Punjab in March this year was its commitment to improving Punjab’s crumbling health infrastructure.

In its first annual budget for 2022-23, AAP increased its Health outlay by 23% to Rs.4700 crore.

But the budget allocation was found to be inadequate to improve the existing infrastructure by public health experts in Punjab, given that 80% of the budget goes into fixed expenditure including salary and pension.

Experts in Punjab have advocated allocation of at least 11% of the state Gross Domestic Product towards health, which at present is not more than 3-4%.

The AAP government would open 75 Mohalla clinics next month on August 15. But the PCMS Association welcomed the move with reservation. 

In a statement last month, it stated that Punjab already has a widespread network of health infrastructure till grassroots. It is good that the AAP government is expanding the health care services through Mohalla clinics, a concept it started in Delhi. 

But Punjab's government health sector can't be improved by ignoring improvements in existing health facilities, for which a separate blueprint is needed, it added.