24-hour specialist doctor services

Despite the strong presence of private hospitals in Kerala, a large section of the population, particularly the poor and middle-income groups, continues to depend on government hospitals for treatment. Primary health centres, district general hospitals and medical colleges have improved significantly over the years. Yet, specialist doctors have not been available round the clock at district general hospitals. The decision by Health Minister K. Muraleedharan to introduce 24-hour specialist services at these hospitals is therefore a welcome step.

The programme will begin at Punalur Government Hospital on September 1 and is expected to be extended across the state within six months. Specialist services in medicine, surgery, orthopaedics, paediatrics and gynaecology will be made available. This will ensure that people can access specialist treatment throughout the day at government hospitals closer to their homes.

The move could also help ease the pressure on medical colleges. If district general hospitals are equipped to provide specialist and emergency services throughout the day and night, many patients may no longer have to travel to medical colleges for treatment that can be provided at the district level. This would allow medical colleges to focus more effectively on their role as referral hospitals. The need for such a change is evident from the patient load at medical colleges. Major outpatient departments often see 500 to 600 patients a day, leaving doctors with limited time to examine each patient properly. Strengthening primary health centres and district hospitals is essential if this burden is to be reduced. A well-functioning network of peripheral hospitals would benefit both patients and medical colleges.

However, good intentions alone will not make the programme successful. The Kerala Government Medical Officers' Association (KGMOA), while broadly supporting the introduction of specialist services, has raised concerns about its implementation. These concerns deserve serious consideration rather than being dismissed as resistance to change. The most pressing issue is the shortage of doctors. Around 800 posts for doctors are vacant in the Health Department, including nearly 300 in the specialist cadre. Several speciality departments in district general hospitals have only three or four specialist doctors, while casualty medical officers are also in short supply. With patient numbers remaining high, expecting the existing workforce to provide round-the-clock services could put considerable pressure on doctors.

KGMOA has raised a valid question: if specialist doctors are assigned emergency duties throughout the night, how will they manage their daytime outpatient, inpatient and theatre responsibilities? The answer must lie in proper shift arrangements and adequate staffing rather than simply increasing the workload of existing doctors. The government should therefore create additional specialist cadre posts as part of the programme. Vacancies at primary health centres should also be filled through the PSC without delay. Equally important is the need to improve the service and salary conditions of doctors in government hospitals and medical colleges.

At a time when private hospitals are offering doctors highly attractive pay and service conditions, the government has a responsibility to retain those who continue to serve the public sector with dedication. Health Minister K. Muraleedharan has demonstrated his commitment to strengthening government healthcare, and there is little reason to doubt his determination to ensure that people receive quality treatment from government hospitals.