Improve facilities at Primary Health Centres first: Doctors

THIRUVANANTHAPURAM: Doctors in the state are up in arms against the government decision to upgrade Primary Health Centres into Family Health Centres without improving the infrastructure facilities and providing adequate manpower. Kerala Government Medical Officers Association (KGMOA), the premier organisation of health department doctors, has asked the government to put in place all facilities before announcing up gradation of PHCs .

While the OP timings at the FHC have been extended till 6 pm, all that the government has provided is one additional doctor. The PHCs cater to 17,000 to 60,000 population.  While in some PHCs, there is a single doctor, in others there are two to five depending on the workload is more. Apart from outpatient services, these centres will focus on non-communicable diseases, depression, chronic obstructive pulmonary diseases and counseling clinics.

With the OP load being heavy, the doctors are not able to do justice to other responsibilities. The biggest casualty will be supervision of field activities which are crucial in carrying out public health initiative including awareness against dengue, malaria, leptospirosis, school health programmes, sterilisation, immunisation, TB elimination and palliative care programme. There is shortage of doctors to meet the responsibilities associated with clinical service and field activities.

"What we need is increase in manpower and improvement in infrastructure facilities. If you put additional burden on the existing system, it will collapse," said KGMOA state president K.A. Raoof. The NITI Aayog health index had indicated a decline in overall growth rate in health sector besides drop in vaccination coverage in children below one year, which is a cause of concern.

He said there was no point changing the board from PHC to FHC. "We are not against the concept of family health centres.  But installing chairs, providing drinking water, new rooms or changing the paint is not enough.  A minimum of 5 doctors are required in each FHC, three in morning and two in evening shift," Dr Raoof said.

He said the government needs to define the work of doctors especially those handling OPs. "A school teacher caters to 40 students, public health nurse 5000 patients and a clerk examines a minimum of 25 files daily. There is a defined structure for these services. But there is still no clarity on how many patients should a doctor see in OP. "At the moment doctors are spending less than a minute to examine a patient which is totally inadequate. A doctor needs to spend at least 7 to 10 minutes to provide quality treatment to patients," the KGMOA state president said.