Dr Satyajit Pattnaik
Covid-19 pandemic has exposed the chinks in our health care delivery system. Many experts have lamented the inadequacy in our public healthcare system. One important aspect of tackling the pandemic is strengthening the primary and secondary healthcare system (which comprises our primary health centers, community health centers and all hospitals up to the district hospitals). I would like to focus here on the tertiary healthcare mostly provided by medical college hospitals. For the proper functioning of primary and secondary healthcare system we need a strong back-up of tertiary healthcare system with adequate referral linkages. Tertiary health care consists of mostly medical college hospitals and specialty hospitals (both private corporate hospitals and public specialty hospitals). For now I will focus on medical college hospitals (MCH).
In Odisha the first medical college hospital was established in Cuttack in 1944. The next one was at Burla in 1959 followed by another in Berhampur in 1962. There were no new medical college hospitals for the next 43 years. The first private medical college was established in Bhubaneswar in 2005 followed by two more private medical college hospitals in Bhubaneswar in 2007. In the year 2012, another private medical college hospital started functioning in Rourkela. In the same year AIIMS was started operation in Bhubaneswar. In the year 2017, two government medical colleges were opened in Koraput and Bolangir followed by two more in Bolangir and Balasore in 2018. As of now we have 12 medical college hospitals in Odisha.
Medical college hospitals primarily serve three purposes. Firstly, to create more health workforce including doctors, nurses and a host of other equally important paramedical personnel such as physiotherapist, technicians and others. The second important function of a medical college hospital is to provide services to the people in the form of healthcare, including specialty and super specialty healthcare. The third is to undertake research in various fields.
We will first discuss the status of health workforce in Odisha. We have an acute shortage of health workforce. As per the NSSO (National Sample Survey Organization) report of 2017-18, there are 2.1 doctors per 10,000 people in Odisha as compared to the national average of 8.8 doctors for the same population. For the same 10,000 population, the total number of nurses and midwives available in Odisha is 7.6 compared to the national average of 17.7. A comparison with the neighboring state of Andhra Pradesh reveals that the corresponding density of doctors and nurses per 10,000 populations is 6.7 and 17.9 respectively. New medical college hospitals can help create more healthcare staff needed for improving the healthcare delivery in our state.
Odisha has a total of 12 medical college hospitals of which five are in the twin cities of Bhubaneswar and Cuttack. There is almost no tertiary care hospital in 21 out of 30 districts. Patients from these areas are referred for tertiary care to one of the medical college hospitals in other districts or to outside the state. As a result people inhabiting these districts face lots of hardship. Most of these districts are without any medical college hospitals and are also categorized as backward districts. If we take a look at the prevailing Covid-19 situation in Odisha, we have a little over 10,000 Covid beds in the entire state with a population of 4.76 crores. In comparison Andhra Pradesh, has a total of 48,000 (almost 5 times that of Odisha) beds for Covid patients with a population of just double that of Odisha at 9.25 crores.
Finally, medical college hospitals can give a significant boost to health and related research. State medical college hospitals can be part of many national and international health research projects. They can also help in generating more information and solution to some problems which are specific to our state.
In neighboring Andhra Pradesh there are 31 medical college hospitals (including 13 government-run MCHs). Every district has at least one medical college hospital whether in the government or private sector. Odisha government has recently announced that seven new medical colleges will be established soon. This is really a welcome step. But we need at least one medical college in each district, especially in the backward districts of western and southern Odisha. Establishment of more medical college hospitals will further boost the health infrastructure besides creating more number of doctors, nurses and other paramedical workforce.
The writer is a Professor of Community Medicine at GEMS Medical College & Hospital in Srikakulam, Andhra Pradesh.