Shortage of General duty medical officers (GDMO) affects the effective management of government health facilities and thus, affects the quality of health care across Tumkur district in southern Karnataka. The Community Health Centres (CHC) and Primary Health Centres (PHC) are the worst hit facilities while the problem is doubled by creating more centres with limited available resources. As a result of this, patients with minor illnesses are also going directly to First Referral Units (FRU) such as CHCs, Taluka hospitals or District hospital where the hospitals are already overloaded with patients.
A GDMO in India is a MBBS graduate. At the primary and secondary level of health services, he/she is mainly responsible for the preventive and promotive work under the national programmes such as Reproductive and Child Health programme, Immunization programme, Revised National Tuberculosis Programme, etc. He/she needs to attend to patients in the outpatient department, inpatient wards and casualty. In the PHC, he/she is additionally responsible for the administration of the PHC and management of the periphery like supervising the staff, monitoring the reporting systems of services provided, financial performance, etc. In Taluka hospitals and the District hospital, the presence of GDMOs allows specialists to attend to cases and conduct operations/procedures within their speciality.
From the above mentioned role and responsibilities, we can therefore understand the importance of having adequate number of GDMOs at the various levels. Now we can see how shortage of GDMOs badly affects not only the functioning of facilities but also the quality of health care available to the community. This is the scenario in Tumkur today but is similar across other districts in Karnataka also.
According to the district records, in 2011, there are 147 total sanctioned posts out of which 133 are filled while 14 are vacant. According to Indian Public Health Standards, there should be at least 407 GDMOs in Tumkur across all facilities(not including AYUSH doctors).This means that the State health department needs to create 260 more posts for GDMOs and recruit at least 274 more doctors. The State health department is trying to bridge this gap through appointment of contractual AYUSH doctors instead. However, the AYUSH doctors are not provided with adequate orientation on their job responsibilities and in some cases, nil. As a result of this, even if they are available at the facilities, they are unable to take an active part in managing these centres. At the end of the day, only the poor patients suffer either by going to private practitioners if they have some money or by staying at home and worsening if they do not.
Thus, there is an urgent need to develop strategies to address this issue. The strategy may be to: i) rethink creation of new PHCs or CHCs, ii) reorganise the PHCs depending on needs of the population rather than numbers, iii) recruit GDMOs on contractual basis to fill in gaps for short term, iv) address the issue of fresh MBBS graduates joining the private sector, or v) address the friction rate of doctors leaving government service to join the private hospitals.
–Arupa & Tanya
