Kerala’s 24×7 specialty care plan faces staffing and political hurdles

Kerala’s plan to provide round-the-clock specialty care in general and district hospitals is facing delays, with the pilot at Punalur taluk hospital struggling to retain enough specialist doctors. The initiative, announced by the Health Minister last month, aims to offer 24×7 services in General Medicine, General Surgery, Orthopaedics, Anaesthesia, Paediatrics and Gynaecology in the first phase.

Officials said the idea was to redeploy doctors with postgraduate qualifications, who work as assistant surgeons in peripheral hospitals, to Punalur. But the proposal met with resistance from local political leaders and residents, who demanded that doctors sent from their areas be returned. Several PG doctors pulled from institutions in Yeroor, Neendakara, Thevalakkara, Mayyanad, Kundara, Pathanapuram and Nedungolam could not be retained at Punalur because of local political intervention, officials said.

The Kerala Government Medical College Officers’ Association (KGMOA) has pointed to a shortage of doctors in the Health Services. It says there are 799 vacancies, including 300 in the specialty cadre. The association argues that round-the-clock services cannot be provided through working arrangements alone without creating new posts.

The government has maintained that it studied patient loads across institutions and that judicious redeployment of specialists from hospitals with lower patient loads would be enough for now. It also said some senior residents from Kollam Government Medical College could be used on a working arrangement basis to provide specialty services at Punalur.

Later, the government reassured the KGMOA that specialty services would initially be provided from 8 a.m. to 8 p.m., with teleconsultation from 8 p.m. to 8 a.m. It also said a minimum of nine specialist doctors in each medical specialty would be ensured in all hospitals so that 24×7 specialty services could run smoothly.

That target is yet to be met. At Punalur, there are only two or three PG doctors in each specialty against the promised nine. A Health department official said the scheme could run if at least six specialist doctors were available in every specialty. "Even that has not happened, and the pressure from local political leadership could not be overcome. As for doctors, none are keen on seeing this initiative work and are unwilling to step out of their comfort zone," the official said.

A similar plan in Malappuram to start 24×7 specialty services at Tirur and Nilambur by temporarily redeploying doctors from Manjeri Medical College has not materialised, reportedly due to non-cooperation from doctors.

KGMOA State president P.K. Sunil denied that government doctors were resisting the initiative because it would affect private practice that they are legally allowed to do after work hours. "Only about 30% of government doctors have the so-called lucrative private practice. The basic issue is that unless the human resource shortage is resolved, this plan will not work. We are not resisting the initiative, but when a specialist is moved from a periphery hospital, there will be local protest," he said.

Creating new posts is not straightforward. The Finance department is in no position to approve such proposals, officials indicated. During the previous government’s term, the Health department secured only 202 posts out of the 1,520 it sought, and that too after prolonged negotiations.

The Health department has now submitted a proposal for the creation of 1,120 posts of specialist doctors and 520 posts of casualty medical officers. The outcome will determine whether Kerala can move closer to its promise of round-the-clock specialty care beyond medical college hospitals.