Vikas Sheel Secretary Department of Health and Family

Vikas Sheel, Secretary, Department of Health and Family Welfare Government of Chhattisgarh 1

Who are the “Unreached” ? • People living in remote/tribal/inaccessible areas – doctor in PHC, extension staff at SHC (MPWANM) • Women in rural areas – no lady doctor at PHC • People living in urban slums – lack of urban health extension services • Senior citizens – lack of geriatirc care

Human Resource Situation in Jan 2009 Post Sanction Regular Vacant existing staff Addl req as per IPHS norms Total required Annual output in the state Specialist 701 248 453 0 453 50 Medical Officer 2147 1109 1038 0 1038 200 Staff Nurse 935 866 69 1442 1511 760 MPW (Male) 4776 2224 2552 0 2270 160 MPW (ANM) 5526 4618 908 4776 5684 360

Strategies in Chhattisgarh To increase availability of Specialist doctors : Ø To post Specialist only at CHCs & DHs - No Specialist at PHCs Ø To treat PGMOs as specialist doctors and post them in lieu of vacancies of specialist Ø To further prioritize and re-appropriate specialist (+PGMOs) to DHs and CHCs (first fill FRUs) Ø Performance based incentives – translate physical presence into service delivery Ø Increase intake of Em. OC & LSAS-and post only at FRU Ø Incentives to doctors and staff under RSBY. Ø 3 year compulsory rural service for Post graduates

Strategies in Chhattisgarh To increase availability of Doctors – Ø PHC to be managed by 1 AYUSH +1 RMA q RMA posted at each PHC. q 1 regular post of AYUSH created at PHCs in tribal district (399 posts) 297 appointed. Ø Pooling of MBBS doctors at CHCs (doctors posted at PHC to be head quartered at CHCs) – 5 doctors per CHC against 3 per CHC earlier. Ø 2 nd MO at any PHC only if all PHCs have at least 1 MO – to refuse postings in PHCs around cities. Ø 2 year compulsory rural service for MBBS graduates Ø CRMC - Doctors serving under CRMC scheme Ø Post AYUSH doctor in lieu of MBBS doctors 338.

Processes – re appropriation of doctors • Listing of Specialist doctors (& PGMOs) – surprise !! – We had 369 more specialist doctors – 121 posted in PHCs. • Also an institution where the number of doctors posted is more than the number of sanctioned posts, has surplus doctors. • Listing of vacancies – prioritize – e. g. FRUs. • Listing of surplus specialists & doctors – on last in first out (LIFO) principle. • Posting on the basis of counseling with minimum term to be 3 years – to avoid transfers

Processes – re appropriation of doctors • Option to join CRMC is given. • If a doctor doesn’t take part in counseling then he is posted as per priority. (Loses eligibility for CRMC also) • No Specialist doctor or PG Medical Officer or Medical Officer will be relieved from the place of posting unless a suitable substitute is posted in that facility – Collectors told to take care of their resource (specially in remote areas).

Strategies in Chhattisgarh – to improve availability of Health staff Nurses: – Created new Post at PHCs level -721 - 213 nurses appointed. – Increase training capacity – increased from 760 to 1886 ANMs : – Create post of second ANM at Sub centre level – 300 second ANMs at SHC – Increase training capacity – increased from 360 to 960. MPWs(Male) : – Increase training capacity – increased from 160 to 700. – Explore options of other trained paramedics for appointment – 1700 PMCs available.

Posts in District Hospitals Before Total posts Paediatrician Anaesthesia Gynaecologist Surgery 17 17 Posts in FRUs 11 6 7 11 vacant 6 11 10 6 Before Total posts Paediatrician Anaesthesia Gynaecologist Surgery In position After 39 39 In position 17 17 15 13 13 14 33 37 35 35 Total posts 39 39 In position 17 18 26 11 vacant 2 4 4 3 After In vacant position 6 2 4 4 Total posts vacant 22 21 13 28 Total available 90 44+10 77 57

Outcome (so far) Indicator District hospitals with all specialists Operational FRUs Multi skilled doctors (LSAS & Em. OC Certified) PHCs without any doctor PHCs with 1 staff nurse SHCs without ANM & MPW Jan 2009 June 2010 5/18 11/18 9 30 8 DHs + 1 CHC 13 DHs + 17 CHCs 0 10 (LSAS) 161 0 0 213 > 400 0

Outcomes -State Training Infrastructure Jan 2009 Facility Govt. Pvt. Total June 2010 seats Govt. Pvt. Total seats SIHFW 1 0 1 HFW-TC 1 0 1 Dist. TC 6 0 6 14 0 14 B. Sc. Nursing 1 10 11 500 4 26 30 1430 GNM-TC 4 2 6 260 4 11 15 456 ANM-TC 7 1 8 360 13 12 25 960 MPW(Male) TC 3 0 3 160 5 24 29 850

Strategies for “Reaching the Unreached” Increasing availability of Services : • Fixed day services for woman through lady doctors at PHC – – RTISTI We have 136 specialists, 135 MOs, – 1 ANC by a doctorRMA 363 RMAs & 145 Ayush lady doctors – – To start on 1 st August. Total - 779/721 Mobile Medical Units – yet to start Health checkup camps 108 – EMRS – to start in August. Referral transport – 164 new ambulances PHC wise Fixed day service for family planning & cataract surgeries • Urban poor – Urban Mitanin & Revamp City dispensaries • • •

Future strategies • Revision of staff setup – including reppropriation of posts – specially specialist doctors • Separate the clinical and public health cadres. • Promotion policy (CMHOCS) – change qualifying criteria – minimum 3 years of service in CRMC. • Recruit post graduate doctors as specialists on clinical side – recruit at per need. • Recruit ANM from Mitanin – training after recruitment.

Thank You State Health Mission Chhattisgarh

CRMC – Objective To bring in health sector reforms and provide health services in difficult and remote rural areas of state by taking the services of working, retired employees of department of Health and Family welfare as well as from private sector as Specialist Doctors, Medical Officers and Staff Nurses in the health Institutions in those areas.

Chhattisgarh Rural Medical Corps- Innovation in reaching the unreached and providing quality care with equity, Placement movement to the Centre, from the most remote difficult area PHCs 440 PHC 66 CHC most remote &difficult areas I Zone 31 CHC in remote &difficult areas II Zone Normal areas, 18 District Hospitals 276 PHC 46 CHC I Zone

Key features of CRMC • • • Monthly Incentive Honorarium Group Insurance scheme Compensation in the event of loss of life due to naxalite violence Relaxation in qualifying service period for admission in PG Course – also reservation of seats for those serving in CRMC Retention of government accommodation in urban areas for their family Leave Travel Concession Assurance of posting in general area after the tenure is completed – transfer policy of the state government does not apply to CRMC employees. Automatic extension after retirement (only for clinical services). Transfer with mutual consent.

Performance Evaluation CRMC – Minimum parameters developed for output from District Hospital, Community Health Centers and Primary Health Center. – No increment in third and fourth year, if performance does not meet the minimum benchmarks in the first & second year. – In such case contracts of staff in concerned institution will terminated after 2 years for the reason of non performance. …. Back

Sr. No Designation Incentive for 1 st and 2 nd year Incentive for 3 rd and 4 th of service year of service Hardest Institutions Hardest Hard Institutions 1 Specialist 15000 10000 18000 13000 2 PGMO 10000 8000 12000 10000 8000 5000 10000 7000 3000 2000 4000 3000 2000 1500 3000 2500 Medical Officer Rural Medical 4 Assistant Nursing 5 Sister 3 6 Staff Nurse • Mobility support for ANM – Rs. 500 pm … Back

Compensation Package • Monthly compensation package : (a) Fixed monthly incentive in addition to the salary. (b) increment every two years in the monthly incentive package. • Group Insurance Scheme - Insurance compensation to cover death or permanent disability due to accidents

• Compensation in case of Naxal attacks: – Rs. 10 lacs to an officer/staff in case of death due to Naxal attacks while on duty. – Free treatment to Officer/staff in case of injury due to Naxalite violence. • Eligibility Exemption for admission in Post Graduate Programme – After 3 years( normally only after 5 year) of service in the Chhattisgarh Rural Medical Corps, MBBS doctor will be eligible for Post Graduation Course. – Special educational leave – Compulsory two year service after completion of the course.

Compensation Package • Government residential facility – Choice of retaining the Government residential facility if they had it in their previous posting for the sake of family. • Residential option at duty area – Option to avail the residential facility at head quarters of their respective blocks. • Leave Travel Concession (LTC) – Leave Travel Concession similar to the employees to Central Government norms.

Service Period Contract Period – 4 years service - 2 years in most difficult areas and 2 years in difficult areas. • Extension of contract period – Extension of service for a further period of 2 years if staff applied after 4 year of contract period – Written information to Mission Director before 3 months of expiry of service contract. • Contract after Retirement – If a staff working under CRMC opts to continue even after retirement, intimation has to be given 3 month in advance from the date of retirement. • – In such cases maximum period of 4 years of service contract will be given in CRMC before completion of 65 years of age which ever will be first.

Transfers and Termination • The general transfer rule of state government will not apply to CRMC. • Transfer with mutual consent – Exchange of places and transfer can be done by mutual consent. – Staff coming from general category Institution to CRMC institutes it will be deemed as a new contract. • Termination of contract before contract period – If any candidate applies to move out of the place of posting before completion of 4 years of service, Commissioner Health will be the final authority for transfer / reshuffling, . – Compulsory to deposit equivalent amount of 1 month’s incentive to state health society in case such application for opting out is accepted.

Staff Under CRMC Sl. No. Name of Post Sanctioned Post In position Already under Agreement 1 Specialist + PGMO 578 86 71 2 MBBS 1264 657 445 3 Staff Nurse + Nursing Sister 1008 409 326 4 RMA 472 465 437 3322 1617 1279 Total

Rationalization Process/ Strategy • In the whole process of the rationalization of human resource, high priority is given to Specialist doctors. • No specialist doctor or PG Medical Officer will be posted at the PHC level. • All the specialist doctors or PGMO posted in PHCs will be compulsorily posted in the district hospital or Community Health Center as per the vacancies. • Posting of PGMO against the regular post of specialist in case the post remain vacant after rationalization of specialists • In case post remains vacant even after rationalization of Specialist doctors and PGMO in their specialization - nominations are invited from the newly selected eligible specialist from the Public Service Commission.

Thank You, on behalf of people of Chhattisgarh, Vikas Sheel, Secretary, Department of Health.

Rationalization of Existing skilled Human Resource(Relocation of specialists from non FRU CHCs & PHCs to Identified FRUs) Total FRUs Sr. No. Cadre Total No. 1 st round 2 nd round Total Number 1 PGMO Surgery 4 2 6 2 PGMO 3 3 6 Gynecologist 3 CHILD Specialist 1 1 2 4 PGMO Pediatrician 6 3 9 5 PGMO Anesthesia 3 0 3 6 Em. OC Trained 2 4 6 7 LSAS trained 1 2 3 TOTAL 20 15 35

New recruitment through PSC, posting done under the rationalization strategy. District Community Health Primary Health Hospital Centre/ Civil Hospital Centre Total OBS/Gynaecology 6 5 0 11 Surgeon 2 0 0 2 Medicine 1 5 0 6 Paediatrics 4 8 0 12 Anaesthesia 5 3 0 8 Ophthalmic 4 0 0 4 ENT 5 0 0 5 Radiology 2 0 0 2 PSY 1 0 0 1 Radiotherapy 1 0 0 1 Skin 1 0 0 1 Orthopaedic 4 2 0 6 Pathology 2 0 0 2 Total 38 23 0 61 Specialist MBBS doctors have been given posting at PHC level facilities.