2013 Articles

Increasing the Availability of Specialist Services in Rural India

Bajpai, Nirupam; Dholakia, Ravindra; Vynatheya, Jyothi

The lack of availability of specialist services, due to both a shortage of specialist doctors in appropriate locations (specifically in the fields of paediatrics, anaesthesia, and obstetrics) and poor infrastructure or management practices, is a pervasive concern throughout rural India. Many strategies have been employed to combat this issue both in India and abroad, including a) attempting to increase the number of specialist training vacancies, b) providing incentives to attract and retain specialists, c) initiating compulsory rural postings, d) engaging in public/private partnerships, e) providing supplementary training to medical officers, f) task-shifting specialist services to nurses, g) creating new cadres of health professionals, and h) using information communication technologies to fill the gap. Primary research in this study first attempts to examine the contributing factors to the low availability of specialist services within the local context of the ten surveyed districts and from stateand nation-wide insights. Data indicates that the key causal factors are insufficient number of sanctioned positions, private sector pull from public sector human resources, inappropriate location postings of specialist doctors, absenteeism, lack of confidence, and poor infrastructure. The problem is multifaceted, spanning human resource and governance issues. During primary research, through qualitative discussions with 394 respondents in total, the viability and benefit of potential mitigating strategies were explored. Several ideas, such as creating new cadres of professionals, re-hiring retired specialists, engaging visiting doctors from higher level facilities, task shifting, and mobile camps were deemed either unsuccessful in the past or not desirable for the future. Based on assimilation of findings from literature and primary research, a set of eight recommendations are put forth in this paper for consideration as strategies to improve the availability of specialist services in rural India. These strategies are discussed in detail in the paper and are outlined below: