Uttarakhand healthcare crisis: Citizens face shortage of doctors, crumbling infrastructure as BJP's PPP model fails to deliver

Rahul Singh Shekhawat | Apr 9, 2019 | 5 min read


Mrs. Reena a Tehri resident says I was pregnant and in the condition worsened due to miscarriage and my husband took me in to the district hospital last month's,  in Tehri. After seeing the catualy, I was referred to the Higher Center. After which, we were going to Dehradun,  got admission in a missionary hospital at Chamba and got  treatment. This is the situation in Tehri district hospital where neither proper doctor nor an ultrasound machine was functional.


By Rahul Singh Shekhawat

A pregnant lady delives her baby in the toilet. Doctors perform deliveries using a torch or candles to light up the delivery room. There are no oxygen points for two dozen patients suffering from chlorine inhalation. This is the condition at Doon hospital, Uttarakhand’s biggest government health care centre located in the state’s capital Dehradun. One can imagine, then, the state of health care centres in the remote hilly areas.

The opposition Congress has been demanding that the state needs a full time health minister, the portfolio currently managed by BJP chief minister Trivendra Singh Rawat himself. But that by itself is unlikely improve the crumbling rural health infrastructure, which has seen about eight per cent of the hill population migrating to the plains towns.

The problem of an acute shortage of doctors is one major factor, largely because of their unwillingness to serve in rural areas. Ravindra Thapliyal, Director General of The Health and Medical Services said of the total 2727 sanctioned posts, only 1589 doctors are permanent appointees in various government hospitals. “Another 456 doctors have been appointed on contract with 681 posts lying vacant,” said Thapliyal. Most posts of super specialist doctors are vacant in almost every hospital in the hills for a long time.

The other factor is the BJP government’s decision last year to convert government run district hospitals and rural health centres, especially those in the hills, into a public-private partnership (PPP) model. Thapliyal justified this move saying it would provide better healthcare to the people. “Any problems will be sorted out soon,” he assured.

So far, five hospitals, including the district Hospital, Tehri and Coronation Hospital situated in the capital, and the Combined Health Centres (CHC) , Devprayag and Baleshwar in Tehri and Doiwala in Dehradun, have been handed over to private parties to be run on PPP mode. The complete cluster of CHCs in Tehri in particular have been handed over to the Swami Ram Himalayan Trust Hospital (SRHTH) in Jollygrant in Dehradun district. With the process to convert district hospital, Pauri and CHCs in Ramnagar, Nainital and Bhikiyasain, Almora, in the pipeline.

But hopes of the PPP model delivering better health care services have been belied. “After conversion to PPP mode, the district hospital has become a referral centre to send patients to their main SRHTH hospital,” said J P Pandey, an advocate residing in Tehri. “There are serious questions about the state government's intentions. Ever since the district hospital was given in PPP mode, health services have worsened. The SRHTH has not replaced the government doctors who were redeployed. In fact, the situation when the hospital was run by the government was not as bad as it is now”.

Sudama Joshi, also a Tehri resident, said the promises made at the time of PPP conversion have not been kept. “We were told that the Tehri hospital would get senior doctors, surgeons and other specialists,” said Sudama. “This has not happened. The district hospital should not be made a referral centre. If the situation in the hospital does not improve, it will be an issue in the coming Lok Sabha polls”.

“When the government doctors left, the Jollygrant Trust was to bring in its own doctors as replacement,” said Ramesh Dangwal. “The trust did not do so. Patients are either being referred to their main hospital or are just wandering around Tehri and not getting proper treatment. The 108 emergency number ambulance services, a critical service needed in the hill areas, is also not available due to lack of funds”.

Jahid Anjum, an activist based in Doiwala, the CM’s constituency said earlier, Doiwala’s CHC hospital had physicians and experienced surgeons. “The people were told that PPP mode would lead to modernizing the hospital and bring in specialist doctors. But since it was given on PPP mode, intern PG doctors are running it and OPD here sends patients to the Himalayan Hospital in Jollygrant. CM Rawat has given the worst gift to the people of his assembly constituency”

Jahid organised a protest and staged a dharna for 45 days when the process of converting this hospital to PPP mode was on. “The government has mortgaged our CHC to the Swami Ram Trust Himalayan Hospital,” said Jahid. “The government’s intention is to promote private hospitals. In such a situation treatment will cost more, which not everyone can afford”.

Dr. J D Rana, retired additional director in health and medical department charged the government with giving away priceless infrastructure to private organisations and paying them a huge amount of money. “I don't think these private organisations are ensuring doctors and other facilities in the manner specified in the MoU” said Dr. Rana. “There will be no worthwhile improvements till the government ensures accountability and transparency. Our district hospitals are not mere health care centres but they are the face of our government system. Having served in the health and medical department, I can say there is a need to reconsider the PPP model and look at other options to upgrade and improve healthcare facilities”.

The earlier Congress government too had tried the PPP model, but it had kept the district hospitals out of this. “Government hospitals are the only hope for weaker sections who cannot afford private treatment,” said Karan Mehra, MLA from Ranikhet and deputy leader of the opposition. “It is unfortunate that this government is determined to promote private organisations. We will put this sensitive issue before voters in the upcoming polls,” added Mehra.


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