Ailing healthcare services in Uttarakhand's hilly areas forces migration to urban centres; lack of doctors cripples hospitals

Rahul Singh Shekhawat | Feb 8, 2019 | 6 min read


“Isn’t it ironic that in a ‘devibhoomi’ (as Uttarakhand is called) people’s lives are ‘Ram bharose’?” asked Indresh Maikhuri.

The 42-year-old social activist and political worker from Karnaprayag of Chamoli district is referring to the over 40 per cent doctor posts, which include 80 per cent super-specialist ones, lying vacant. 

As per a report by the Rural Development and Migration Commission, eight per cent people have migrated to urban areas due to lack of medical facilities in Uttarakhand’s hilly region. The fact that doctors born and brought up in the hills are not ready to serve in its remote areas has become a matter of great concern.

“Our state turned 18 just a few months ago, and yet, we do not have enough doctors in health centres here, especially in the remote hilly areas. Sure, government hospital buildings look swanky and modern; what, however, is the point of that if the number of people being treated and cured is abysmally low? That's why more and more families are migrating to the urban areas,” he rued.

“This sorry situation extends to all government hospitals in Garhwal division — right from Rudraprayag to Srinagar, every hospital has been transformed into a mere referral centre instead of providing treatment. Even Srinagar’s government medical college faces this problem, due to insufficient specialists. In such a scenario, the poor are living ‘Ram bharose’, while those who have money are shifting to Dehradun and other better connected areas."

Maikhuri added, “Just a few days ago, a woman in Karnaprayag died because she didn’t receive the right treatment. And she isn’t the first either. There have been several cases of pregnant women delivering their babies on roads and in other unsterile conditions.”


From Garhwal to Kumaon

While Maikhuri’s revelations do paint a dark picture of what’s happening in the hilly districts, government hospitals in the plains fare no better. “The largest government hospital in the state is Doon Medical College Hospital in Dehradun, where thousands of patients from the hills are sent for treatment. One would expect at least that facility to have its act together, but alas! The hospital has courted controversy over lack of sufficient services often. Just last year it ran out of oxygen for the 18-odd patients affected by a chlorine gas leak and sent them packing to a private hospital. This year, a woman’s dead body was found in a toilet on the premises, while nine women had to deliver their babies in torch- and candlelight, because the power was out and the hospital didn’t have a generator. I myself have seen a person carrying his dead family member on his shoulder after the hospital failed to provide him with a stretcher. If this is the situation in the capital, you can imagine how it must be in the remote areas,” he said.

Though Maikhuri mainly highlighted the situation of health services in Garhwal, those in Kumaon division aren’t in a better shape either. A combined health centre (CHC) in Gangolihat town, Pithoragarh district, is facing a shortage of not only doctors but also paramedical staff. And while the Pithoragarh district hospital is the only one with an ICU, locals say it’s a showpiece and doesn’t have sufficient staff.

Govind Singh Bisht, 61, a native of Almora district’s Patia village in Kumaon division, said, “My village is in the Takula Development Block. I don’t see much difference in Uttarakhand from the time it was a part of Uttar Pradesh. The whole point of a separate state was to give locals from the hills more facilities and a better life, but not much has changed. Our district headquarters is 15-20 km away from the village. We had to go there all the way for treatment during my childhood, and we have to even now; the only difference is earlier we went in palanquins, now there is a road. Small mercies!

“I don’t know on what basis the chief minister is making claims of having made enough doctors available. Not just government hospitals, even primary health centres, CHCs, and district hospitals are being operated on a public-private partnership (PPP) mode.”

Bisht added, “I used to work in a bank; I am retired now and have shifted to Almora. I ache for my native place; I wanted to spend my retirement there in peace. But with it lacking basic amenities, I can’t go back.” 


A crippling crunch

Navin Karki, chief medical superintendent (acting) of the Gangolihat CHC, said only four of the nine sanctioned doctor posts and one of the eight paramedical staff vacancies have been filled. “Not just that, a doctor was selected and appointed under the State Public Service Commission, but the medico still hasn’t reported to work. We finally had to alert our seniors about it,” added Karki.

“Then, there are X-ray machines but no technicians to operate them. This manpower shortage is severely hampering hospital operations; we are doing our best to manage with the available resources.”

Data provided by Uttarakhand’s Department of Health and Family Welfare shows that only 1,640 doctors have been appointed against the 2,710 sanctioned posts. With over a thousand vacancies, the burden of providing proper healthcare has fallen on private clinics, which a majority of the locals can’t afford. 

While the poor condition of healthcare services is a problem in several states in India, it’s exceptionally grave in Uttarakhand, where efforts by successive governments to attract medical practitioners to serve in the hills have failed.


Government’s defence

This manpower shortage has forced the state government to run more and more hospitals on the PPP mode. Recently, the first CHC at Doiwala (CM Trivendra Singh Rawat’s constituency) in Dehradun district was handed over to the Himalayan Hospital Trust. Similarly, MoUs to transfer two CHCs in Devprayag as well as the Tehri district hospital onto the PPP mode have been signed. All this indicates that the government believes it alone can’t fill the vacancies.

Rawat, who holds the responsibility of the Department of Health and Family Welfare, claimed that 1,137 doctors have joined since he took charge (17 months), compared to the 1,133 hired in the last 17 years. “At least 17 out of 21 doctor posts in every district hospital have been filled. Also, telemedicine centres have been started in various government hospitals, and the air ambulance service is being launched,” he said.

However, only the district hospital in Nainital, where 20 of the 24 vacancies have been filled, backs Rawat’s claims. And this too, it’s suspected, was done only after a high court order on the same.

Nonetheless, the government has been trying to mitigate the situation. It has brought in the Transfer Act 2017, which is unique to the hill state. Classifying postings in two areas, sugam (accessible) and durgam (remote), the Act stipulates mandatory transfer of those posted in sugam areas for more than four years to durgam areas. But it remains to be seen if the Act will be successful in ushering in better healthcare services to the hills.

Pic-1 Building of CHC at remite Gangolihaat in Pithauragarh

Pic-2 building of Bageshwar's district hospital 

Pic 3 & 4 District Hospital in Tehri, government had given on PPP mode

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