Ways to cure ailing public healthcare in Telangana State

Decades after establishment of Osmania and Gandhi Hospitals in twin cities of Hyderabad and Secunderabad, for the first time, the Telangana government has issued orders for establishing four new 500-bedded multi-speciality hospitals in the city to cater to the healthcare needs of people from city and surrounding areas. These hospitals will come up at LB Nagar, Rajendranagar, Pet Basheerabad and Miyapur. While this is an important milestone in the healthcare in the state, it is worthwhile to analyse a few more aspects towards providing a better healthcare in the state – both in urban and rural areas.

Keeping in view some of unique conditions in Telangana state, it is of utmost significance to revitalise the existing public health care by providing adequate medical and health facilities as well as integrating at some point public and private medical and health facilities. In any case, in the long run, only a technology-based health care would be able to effectively address medical and health needs of people. It is time to plan on those lines from now itself.

Not within reach of poor
In Telangana, like in other parts of the country, specialties and super specialties healthcare is available only in private sector and the entire primary care is provided by the government. People have to pay through their nose for diagnostic services which are provided mainly by private centres. For instance, a PET (Positron Emission Tomography) Scan costs anywhere around Rs 20,000 and an MRI (Magnetic resonance imaging) around Rs 10, 000. These need to be provided by the government at affordable costs. It is also desirable that the government establish its own polyclinics and take the help of private clinics to provide affordable treatment to patients. It is high time to adopt best practices prevalent elsewhere.

Expert offers solution
Dr A P Ranga Rao, a specialist doctor and administrator, who is consultant to several national and international health projects, suggests that for health care delivery purposes, the state can be divided into four zones. Hyderabad and RR districts with about 75-80 lakhs to be in zone one, 40+ towns in zone two with 60 lakh population and 900 villages with 27 lakhs population in zone three which have at present some primary or secondary or tertiary care. These constitute in all about 47% of population. The fourth zone of 8,100 villages with 186 lakh population which accounts for 53% still depends on uncertified care of RMPs or ANMs.

Dr Ranga Rao says that as on today zone one is served by 2,400 specialists and 640 super specialists of various categories belonging to both government and private sector in addition to the doctors with basic qualification of MBBS. Population in zone two too has access for primary and secondary care to 780 Specialists and 125 Super Specialists of their choice. 27 lakh (7.6% of total population) people are living in the villages where a PHC is located (683 in number).

They can hope to have round-the-clock access (If the doctor is posted) to primary health care. For the rest of population (approximately 1.86 crore constituting 53% of total population), living in 8,100 villages the access to qualified primary health care is kilometres away. Out of them, for 57 lakh population, medical care is beyond 5-10 km and for 92 lakh population it is more than 10 km away. They have to literally depend on the services of ANMs in the sub-centres (If they are posted and staying) for quality care. In reality, this 1.86 crore population is dependent on local uncertified long standing village practitioners of allopathic care or even otherwise.

Need for Mohalla Clinics
In Hyderabad, out of 80 lakh population nearly 25-30 lakhs live in recognised slums. One Anganwadi worker and one Asha worker are supposed to serve about 1000-1500 population. They probably may be made as a team and the Anganwadi centres or the nearby polling booth could be designated as Mohalla Clinics. Here twice a week a dispensary or a clinic could be run where on the first day cases of maternity and child welfare, immunisation etc could be administered. On the second day, chronic diseases could be attended to. The facility may be limited to screening and collection of blood samples. All metro, rail stations and bus terminals may be used for running these clinics.

Rope in House Surgeons & PG students to run clinics
At the rate of say 1,500 persons per clinic for the whole of Hyderabad, the requirement would be around 5000 clinics. One doctor can serve three clinics to work on average 8-9 days per clinic. A maximum of 1,750 doctors are required to cover all the clinics. These doctors can be drawn from among in-service house surgeons in addition to few doctors exclusively recruited for this purpose either as on a month or two months attachment. There would be enough of them, graduated from both government and private medical colleges.

On an average, every year over 2,500 students are admitted in both government and private medical colleges and even if two-thirds pass out every year, the number of house surgeons available for Mohalla clinics would be anywhere near to 1,650. Their job is to do a general medical check-up and attend to minor ailments and organise screening. This is in a way akin to a primary health care centre. These clinics may, to begin with, be concentrated in slums which account for nearly 30 lakh population.

There are at present 110 urban health centres in Hyderabad and it is adequate if their number is increased to say by another 150 where there would be a qualified doctor to serve as first referral centre. About 30-35 clinics may be attached to each urban health centre. PG medical students of various private and government medical colleges on rotation should take care of urban health centres which are supposed to be for secondary health care. On an average, both private and government hospitals put together there would be around 850 PG students in Telangana. These are also to be specialist clinics in the areas of medicine, surgery, psychiatry, gynaecology, eye etc. as a first referral health care.

Involve non-govt sector in tertiary care Both in the primary and secondary stages sample collections will be done and in the tertiary care diagnostic tests will be done. After the primary and secondary stage the third stage is the tertiary care hospital. Each of these numbering around ten in government sector should cover a population of say 5 lakh, which means another five are required.

The tertiary level is also the speciality, multi speciality and super speciality hospital. In the third stage, there has to be an integrated approach to enlist NGO-run hospitals like Andhra Mahila Sabha, Mahavir and Saint Theresa and similar others as well as a large number of private nursing homes, RTC, Railways, even Military hospitals. In a way, the health card system does a similar function and this may be further explored and extended.

By Vanam Jwala Narasimha Rao