The Punjab government’s recent initiative to empanel private specialists in public health facilities, offering ₹100 per OPD patient and ₹1,000 per emergency call, has sparked off a debate. While the administration views this as a solution to the chronic shortage of specialists, the Punjab Civil Medical Service (PCMS) Association sees it as a step toward privatisation. This experimental approach highlights a deeper systemic failure: The erosion of a once-robust secondary healthcare tier.
Punjab’s healthcare structure is built on three levels, each facing distinct challenges. Primary care comprises sub-centres and primary health centres (PHCs), many of which have been rebranded as Aam Aadmi Clinics (AACs). While they handle basic OPD services, they remain detached from broader national health programmes.
Community health centres (CHCs) and district hospitals are the backbone of the secondary care system, intended to provide 24×7 specialist services. However, most CHCs lack the mandated four basic specialists of medicine, surgery, gynaecology, and pediatrics. Even district hospitals frequently operate without essential staff like radiologists or anaesthesiologists.
At the tertiary care level, medical colleges handle complex cases but remain deficient in super-specialist services.
Legacy of disinvestment
The decline of secondary healthcare can be traced back to 1995. A ₹418-crore World Bank loan led to the renovation of 150 facilities but introduced user charges, shifting the burden to patients. In 2012, the government withdrew support from 50 facilities, claiming it would focus on providing “total quality” in the remaining 100. Instead, this resulted in the closure of several high-performing CHCs.
Furthermore, the morale of PCMS doctors has been systematically undermined. Policies such as denying non-practicing allowances during post-graduation and recruiting new doctors on basic pay, at times less than Group-D employees, have alienated the medical fraternity.
Four failed roads to recruitment
The government has attempted four methods to fill specialist vacancies, but each is plagued by administrative or financial hurdles.
The in-house pipeline that forms the backbone: Traditionally, the state sponsors regular medical officers for three-year specialist courses. These doctors serve rural areas, manage emergencies, perform post-mortems, and handle VVIP duties. Despite being the system’s backbone, they face heavy administrative burdens and legal battles at their own expense.
Contractual NHM recruitment: Recruited through the National Health Mission, these doctors lack job security. Many already run private nursing homes, leading to poor long-term retention.
Walk-in interviews: Introduced a few years ago, this method failed because the offered salaries were barely ₹5,000 more than those of MBBS doctors. The scheme has since been abandoned.
Re-employing retirees: The government recently tried rehiring retired senior specialists. However, the pay structure, where the pension is subtracted from the total salary, and the lack of civil service benefits resulted in a dismal turnout. Only 15 specialists were recruited against 100 advertised posts.
Private sector gamble
The latest scheme to hire private doctors ignores the fundamental differences in work culture between the public and private sectors. Public health specialists don’t just see patients; they manage national programmes, medico-legal cases, and emergency protocols. Expecting private practitioners to seamlessly integrate into this high-pressure, bureaucratic environment for a nominal fee is optimistic at best.
Beyond magic remedies
The Punjab health authorities have yet to conduct a professional study to understand why specialists are fleeing the public sector. Instead of seeking “magic remedies” and ad-hoc arrangements, the state requires a long-term strategy.
To restore the public health system, the state government must return to the pre-1995 practice of regular, predictable recruitment of MBBS doctors and support staff on a permanent basis. Without job security, competitive pay, and a supportive work environment, the “brain drain” from public hospitals to private practice will only accelerate, leaving the state’s most vulnerable citizens without care.
The writer is a retired civil surgeon. Views expressed are personal.
