Suggestions to improve healthcare system in J&K

Prof (Dr) Sanjay Kumar Bhasin
Although there are hardly any lacunae in the observations and recommendations of the High-Powered committee for overall improvement in healthcare delivery system and medical education in JKUT, yet in view of wide range of suggestions a priority needs to be decided to accomplish the targets that are to be set by the decision makers on the basis of these recommendations. My main points in this regard are:
Teaching Institutions not Treatment Centers: Producing quality graduate (MBBS) and postgraduate (MD/MS and MCh/DM) doctors is the sole responsibility of Medical Institutions in addition to research and tertiary healthcare. Unfortunately, these medical institutions have been relegated to the positions of healthcare delivery centers rather than becoming Institutions of Excellence for Medical Education. Lack of proper infrastructure and equipment, forced burden of patient care due to unnecessary referral from Sub-district and District hospitals, has directly affected the academics and research work. Overcrowding coupled with associated factors make doctors handicapped in providing quality services to the patients at Sub District and District hospitals, leading to more and more referrals to the Medical Colleges.Downhill course of Medical Education not only in JKUT but whole of the country needs to be interrupted immediately to avoid collapse of medical education. If we fail in this endeavor, not only medical education but the overall patient care shall badly suffer.
Lack of Qualified Faculty versus Less Emoluments: As off now two old GMCs are having less shortage of faculty vis a vis new GMCs that are struggling to get qualified and experienced manpower. This issue is of getting best teaching faculty even for AIIMS/PGIMER has become a great challenge in the era of Corporatization of Health sector in India.Less Pay/perks being offered to the medical/ paramedical manpower also keep medical man power away from joining Government sector. At contemporary posts/ experience/ qualifications there is huge gape of pay/perks between corporate hospitals and Government hospitals. The faculty serving in GMCs in JKUT has to suffer not only in terms of financial disparities but also incentives and even getting Government sponsorships for attending State/National conferences not to talk of international conferences. The files go on lingering in the power corridors and in majority of instance either rejected or the approvals comes too late by the time the conference is over. This is a big stumbling block in the skill development and keeping pace with the recent advances.
Medical Equipments and Other Goods: purchase of new and good quality medical equipment to cope up with the growing trends in medical science has always remained a great problem in already established GMC’s. Even repair of the equipments requiring very small amounts passes through tedious official process, the purchase of new equipment worth crores may become easy but repair of worth crore rupees equipment needing few thousand rupees become so tedious that the concerned department sometimes abandon the idea of getting it repaired.The concept of purchasing of L-I severely compromises with the quality of the product. The concept of L-I should be abandoned in purchases for Medical Department.
Suggestions: All the recommendations of the committee should be implemented in a phased and time bound manner with top priority to following:
* Autonomy to the Medical Institutions: For smooth running of medical institutions, they should be given greater autonomy without much Political & Bureaucratic interference and influences. High powered Institution councils need to be established with medical persons of highest integrity and qualities as members of the council including Dean/Principals of all medical institutions and all HOD’s. The annual budgets should be kept at the disposal of the council with revamping of already placed accounts and Planning Department. The Principalshould be a Clinician whereas; Dean should be from the non clinical department with seniority cum suitability as criteria for selection. They should be supported by qualified Superintendents and Administrative Officer who should be replaced in phased manner by the healthcare expert administrators. The process of imparting administrative training to senior most faculty members should be started so that in due course of time they take the responsibilities of healthcare administrators. All the HoDs should be given financial powers in the form of a recurring Imprest money so that they can fulfill day today needs of the department. As off now, each departmental head has to run behind clerks in PMC Office or MS office to get paper rolls, tags, files and other petty items. Adhoscism at any level in medical institution should be discouraged and all Medical Colleges needs to be brought under the domain of a Medical University. This should be priority area one.
* Pay Perks and other incentives: Enhancement to pay perks at par with the AIIMS/ PGI/SKIMS should be on top priority of the Government that shall definitely encourage the new entrants in the faculty vis a vis abolishing Lecturer post. The Professor, Associate and Assistant Professor shall be put in the Grade Pay of 10000, 8700 and 7600 respectively while creating at least 10 posts of Senior Professor in the Grade pay of 12000, that shall be added attraction. Approval for attending conferences shall rest with the PMCs and incentives in the form of Academic allowance and Book allowance shall be started immediately. In the event of saturation at a particular level due to non-availability of higher posts, Dynamic Career Progression Scheme benefit should be extended to the concerned faculty so that he should not feel financially and otherwise dejected. Every Faculty member should be equipped with a laptop and internet facility vis a vis doing audit of the research they are doing.
* Upgrading Old GMCs as PGIMER and Establishing a Medical University: The then Chief Minister of Jammu & Kashmir had announced establishment of Medical University in the state on 18th December 2016; that has to see light of the day. The GMC Jammu & Srinagar shall be designated as PGIMER with greater autonomy and every effort shall be put in strengthening both specialty and superspeciality departments with more qualified faculty, paramedics and equipmentin these GMCs. An exercise to start leftover super-specialties and emergency medicine department should be immediately undertaken.
* Ban on Private Practice of Teachings Faculty: Private practice by Government doctors always remained an issue of hot debates and controversies since long and now the committee has also recommended ban on this and rightly so. In the larger interest of research, academics, and better patient care, PP should be banned forthwith vis a vis appreciably enhancing pay and perks of the faculty. Isolated ban may create a peculiar situation for the government.
Conclusion: All the recommendations of expert committee are in the larger interest of research academic, teaching and patient care that needs to be taken seriously and implemented in a phasedbut time bound manner to avoid further deteriorations in the healthcare delivery system of the JKUT.
(The author is Hony. Secretary, JK Chapter of Association of Surgeons of India Member Secretary, Institutional Ethics Committee, GMC Jammu)