Nagaland In-service Doctors Association
The WHO standard of health care prescribes a ratio of 1 doctor for 1000 population. Nagaland fares poorly on this score. To compound the malaise, the health practitioners in private set ups are concentrated mostly in Kohima and Dimapur and understandably so because of the better facilities not only in terms of health care services, but also other factors such as educational facilities for their children. That leaves the rest of the population to be served by health care professional in Govt service. With the emphasis of Indian Public Health Services (IPHS) standard to be applied in all health centres across the country, Nagaland fares dismally, and the biggest crisis staring in the face is the acute shortage of qualified health care professionals with Doctors being one of the most pressing need at the moment.
Revisiting COVID -19 pandemic and the shortage of health care professionals:
COVID -19 pandemic glaringly exposed the brutal truth of the need of more doctors, nurses, technicians and other allied health care professionals. Having understood the practical realities facing the department, the Govt of Nagaland had created several posts in various categories in the medical department to meet the COVID exigency and of which 123 posts in various ranks were created for doctors to manage the COVID pandemic. Seeing the overwhelming burden of the pandemic and the need for additional manpower, even retired doctors were called to offer their services and true to their profession, many retired senior officers willingly stepped in to offer their services as a calling to a greater humanitarian service without any remuneration and despite being in a vulnerable age to the disease. Not only that, even interns and clinical student in MBBS were even requested to offer their services, to which there was barely any response to the distress call. Public memory can be so short but the crisis at that critical point in time must not be forgotten. The acid test of dedication and sincerity came when the people who cared and who cared not to serve the people in particular and the Government in general was glaringly exposed when COVID -19 special recruitment for the newly created vacancies was conducted.
It was also observed that many able and qualified young doctors not in govt service either chose to stay in the safety of their homes or opted to prepare for competitive exams even as the pandemic crisis continued. In such crisis and extraordinary circumstance, those who responded to the Government’s call to serve through the COVID special recruitment drive were assured special considerations. The empathy of the government to offer a special recruitment deserves much appreciation. Extraordinary times requires extraordinary measures and COVID pandemic was one such time for the Govt as well as the health care professionals. It called for ordinary health care professionals to do extraordinary task, risking their lives and the comforts of home to go on a vicious cycle of ‘COVID duty- quarantine-duty’ with barely any time to spare for their families and to be with them. What was even worse than the physically demanding duty is the emotional stress weighing heavily on their minds of the possibility of never seeing their families again should they contract the disease and perish in the line of duty. Over time, many of those recruited also resigned for one or another reason including further studies, leaving the rest to serve the Government and the people till date on the assurance of a special consideration for their extraordinary service in a time of great distress and need. They were then hailed as heroes. If there were some decency of moral obligation, a debt of gratitude is owed to them just as the Government found it justifiable to compensate them with a one time dispensation of recruitment but for the court cases slapped on the Department that is not only preventing their recruitment but all other recruitment thereby leading to a crippling shortage of manpower in service.
COVID recruitment drive was never a back door recruitment:
Many have been made to believe that COVID recruitment was a backdoor appointment. By definition, a backdoor appointment is when a company hires someone without following the standard recruitment process without general advertisement. In such cases there is favouritism, nepotism and employee referrals.
On the contrary, the COVID special recruitment was conducted with the approval of the Cabinet, openly advertised, meticulous scrutiny of documents and eligibility carried out and interviewed by very qualified and competent officers. There had been no violation of meritocracy, no lack of transparency, and no political influence for recruitment. It must not be forgotten that the circumstances and time constraints did not permit the normal exam and viva-voce spread across several months. It should be taken into consideration that many qualified candidates feared to join so as not to risk their lives by serving COVID patients. To ensure the continuation of health care delivery services which forms a part of the Essential Services Maintenance Act (ESMA), the govt had assured special considerations for the covid recruited health care personnel to retain their services. If the Govt is empowered to ensure the essential services through ESMA, then in a way it is also reversely bound by the same Act to ensure the delivery of essential services to provision of adequate manpower.
Debilitating shortage of manpower can lead to collapse of health care delivery
It is an observed fact that there has been no recruitment of doctors through NPSC for the last 4 years, whereas doctors continue to retire when they reach the present stipulated age of superannuation. As of July 2024, of the sanctioned posts, 435 are in position, of which 322 are regular employees and 113 are COVID appointees. Of these 45 are either on study leave or attached to NIMSR, not accounting those who expired while still in active service, or are debilitated due to ailments. Statistics shows that in the next 4 years, 68 will retire. There are 229 health centres inclusive of District Hospitals, PHCs, CHCs where the existing manpower are deployed. As of July 2024, there are 57 PHCs functioning without Medical Officers and the health care delivery is therefore virtually collapsed in the rural areas due to lack of doctors. The man power augmentation through NHM has not been sufficient. At the current rate of retirement without fresh recruitment, the health care delivery services will collapse sooner than later.
Nagaland In-Service Doctors Association (NIDA) has long been raising the impending shortage of Doctors in active Govt service, and the remedial measures suggested being the extension of service, and the creation of more posts to cater to the ever expanding health care demands.
A recent independent field study of various health centers across Nagaland by the Nagaland State Human Right Commission (Law Wing) headed by a reputed and learned Judge also made the observation of the acute shortage of doctors in the field everywhere and suggested the extension of service to mitigate the manpower crisis.
Non recruitment adding to acute shortage of doctors:
Various NGOs have raised their frustration at the shortage of doctors in health centers in their jurisdictions following transfers and many of whom could not be substituted owing to lack of doctors. Remedial measures of addressing the grievances has become limited to shifting the manpower only to cause a resultant shortage from where they were transferred out. With no adequate manpower for replacement, it has become a matter of shifting the buck and it stops at the table of the Directorate who is equally helpless without further recruitment as the senior continues to retire every few months.
It is learnt from reliable source that owing to the court case filed by the Nagaland Medical Students Association (NMSA) protesting against the Government’s assured relaxation and consideration of the COVID recruited health care personnel, the NPSC is not in a position to advertise any recruitment until the pending court case is disposed. It is also an administrative fact that hundreds of posts cannot be requisitioned for simultaneous recruitment. It is also a fact that there exist more vacant posts than the number of COVID contractual doctors and that the special recruitment is being sought from the pool of posts created during the pandemic for COVID pool and not from the general vacancies. In the light of the given circumstances, NMSA’s court case delaying any recruitment proves counter-productive for their members for the fact that as time keeps ticking, many graduates will gradually inch towards over age for active recruitment through NPSC.
While recruitment is the prerogative of the Government, it is hoped that the Govt will not forget those COVID warriors who stepped in to fill the manpower crunch to augment the health care delivery. It is also hoped that the judiciary will show merciful justice to these COVID warriors who are now dragged to the dock for an anticipatory leniency in their recruitment, without depriving others of their rights while also taking into consideration of their humanitarian services in the desperate hour of need during COVID pandemic. And in doing so, provide relief to all parties so as to initiate further NPSC recruitment to address the acute shortage of manpower, and without which, those left to run the affairs of healthcare of the State are helplessly left to face the brunt of public ire.
