In my view certain aspects of our profession needs urgent attention, some of them needs improvement, some needs big & bold new ideas and some needs better implementation. I shall put forward these points for debate & discussion in order to form a collective opinion . Please do ponder over these matters and register your views, opinions, apprehension or criticism. Help others to form their understanding of these issues ........
1. Staff Pattern
The staff pattern as it exists today is out dated (its dated as back as the 1960s). In no ways does it reflects or relates to the existing ground realities of health care needs in Kerala. This it true in the case of almost all categories of officials be it doctors, specialists, paramedics, ministerial staff, field staff, other hospital staff or any other wing of the department. Indian Public Health Standards (IPHS) for PHCs, formulated and put forward by Government of India (Ministry of Health and Family Welfare) is a welcome change in this direction. It indeed is a silver lining in the dart horizon. As administrators we need to understand these standards and try our best to get them implemented for the smooth and efficient functioning of our health care facilities.
2. UPGRADATION OF BLOCK PHCs TO CHCs
IPHS -
PATTERN FOR PHCs
|
DESIGNATION
|
EXISTING POSTS
|
RECOMMENDED
|
REMARKS
|
|
Medcal Officer
|
1
|
3
|
At least 1 lady doctor
|
|
AYUSH Practitioner
|
Nil
|
1
|
Any ISM as per regional preference
|
|
Staff Nurse
|
1
|
5
|
Some PHCs don’t even have 1 post at present
|
|
Pharmacist
|
1
|
2
|
To maintain 24 x 7 services
|
|
Lab Technician
|
Nil
|
2
|
Block PHCs have 1 post presently
|
|
Accounts Manager
|
Nil
|
1
|
For professional management of accounts preferably computerized accounting
|
|
Clerks
|
1
|
2
|
|
|
Health Educator (HI)
|
1
|
1
|
|
|
Health worker (Female) LHI
|
1
|
1
|
|
|
Health Asst (JHI)
|
2
|
2
|
|
|
Class IV
|
4
|
4
|
Includes H/Attender, PTC & Peon
|
|
Driver
|
1
|
1
|
For institutions with vehicle
|
|
Total
|
13
|
25
|
|
It was one of the stated objective of NRHM to standardize health care institutions. One of the major objective of this plan was to upgrade all BPHCs to CHCs in order to maintain them as first referal units and to provide specialist health care at CHCs using specialist doctors. However, five year down the line this dream is yet to be fulfilled. This is far too important an idea to be dropped or neglected. All BPHCs should be elevated to CHCs which provides OP, IP ( 30 bed hospitals as per IPHS & BIS), OT, Casualty, Lab, Pharmacy and Community Health services . To achieve this cherished dream, considerable amount of infrastructure needs to be built up, both in terms of buildings, equipment, instruments, drugs and manpower augmentation. Mere change of names of institution will not do the trick.
We do understand that the above objective would need huge investment of money, and would be a time consuming process. While we wait to see the dawn of such a day, we can put alternative plans in place as a transitionery mechanism. One of such idea is to implement POLYCLINICS in all the BPHCs awaiting upgradation.This would ensure availability of service of specialist doctors at all blocks in the state. The service may be made available on a rotation basis of basic specialities. which means one specialist each per day per BPHC would ensure round the week availability of almost all specialities (except super specialties) at the door steps of the poor and needy people of the state, who look upon the state to assist them with health care and a decent life free of disease and ill health.
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