Kerala’s highly acclaimed public health sector has often made headlines for its achievements. However, a closer look reveals several areas that need improvement, one of the most important being the shortage of staff.
This issue was highlighted by the recent CAG report, which noted a shortage of 1,160 doctors, 978 nurses, 716 paramedics, and 4,430 ‘other staff’ across government hospitals in Kerala.
In the case of doctor-to-population ratio on the basis of availability, only two districts – Pathanamthitta and Wayanad – fell under 1:4,000 or the ‘good’ category. Thiruvananthapuram, with a ratio of 1:5,158, was graded ‘poor’.
The CAG’s recommendations included:
* The government should assess the requirement of doctors and paramedical staff at different levels and regions and ensure the availability of human resources required as per the norms stipulated in Indian Public Health Standards/Aardram Mission.
* The government should take action to reduce the wide disparity in doctor to population ratio in the state by increasing the strength of doctors in the districts with the most adverse ratios.
While this issue has been discussed in the past, a few TNIE readers recently reached out to this reporter to highlight the issue of staff shortage, especially in the case of nurses, at the Thiruvananthapuram Government Medical College Hospital.
“There are very few nurses here. Even during peak hours at night, just two nurses are responsible for at least 40 patients,” says Suresh Kumar (name changed), who was recently admitted to the Yellow Zone at the hospital. “The situation remains the same even when there are several accident cases.”
This made TNIE zoom in on the premier hospital. Notably, the emergency medicine department here was recently identified as one of the five centres of excellence in the country by a NITI Aayog-ICMR study. Earlier, the Centre had designated the SAT Hospital of the medical college as a centre of excellence for rare diseases as well.
Now, coming to the issue of nursing woes, the standard staff nurse-to-bed ratio is said to be 1:6 in general wards, 1:4 in special wards, and 1:1 in ICUs. “We cannot expect the staff-to-patient ratio in government hospitals to match global standards. But the current ratio is far too high – it’s at least 1:50 here. The number of patients is only likely to increase by the day,” says a senior nursing officer at the medical college.
Requesting anonymity, she explains that the shortage affects both nurses and patients. “We are struggling here. That’s one reason why nurses often get a bad reputation, like being grumpy or insensitive,” she says.
“There are no additional staffers for tasks like blood collection, and this puts extra pressure on us. Nurses are supposed to focus on core duties such as administering injections and medicines, but we are often overloaded with other responsibilities. In ICUs, the standard should be a 1:1 nurse-to-patient ratio, but here, it’s closer to 1:8. This is an approximate figure, but the reality is indeed concerning.”
Despite the challenges, she insists that the Medical College ICU remains one of the best critical care units, with staff doing their best to provide quality care. Yet, she adds, conflicts arise due to the staff shortage. “There are times when, say, a patient with broken limbs or brain injury arrives after an accident, there wouldn’t be enough staff to immediately attend to the case,” she says.
Originally, Thiruvananthapuram Medical College had 1,952 allotted beds. However, during the pandemic, the number of beds was increased, but the staff strength remained the same. Similarly, new multi- and super-speciality blocks were introduced, yet additional permanent staffers were not recruited, sources point out.
Kerala Government Nurses’ Association general secretary T Subramanian concurs. “Over the past few years, the government has focused heavily on development projects in government hospitals. In Thiruvananthapuram Medical College alone, development worth over `700 crore has taken place,” he notes.
“As a result, there has been significant infrastructure improvement in our government hospitals, leading to more people opting for government healthcare facilities. That’s welcome. However, while the number of patients has increased, the staff strength has not grown proportionally. To manage the situation effectively, the current staff strength needs to be doubled.”
Staff shortage in medical colleges certainly affects patient care, says Dr Ajith Prasad J S, president of the Kerala Government Postgraduate Medical Teachers’ Association.
“The bed strength in the medical college has been increased as part of the government’s policy to ensure sufficient critical care space. However, the number of staffers has not increased accordingly,” he highlights.
“The government is still following the 1970 staff pattern, despite the rise in population and the number of patients. Staff members are being redistributed across different hospital administration needs, leading to a severe shortage in patient care.There aren’t enough staff in any particlar place. In ICUs, just 2-3 nurses manage 20-25 patients. Additionally, when new medical colleges are established, existing staff members are transferred there instead of hiring new ones. Currently, all staff are overworked, and the impact of this ultimately falls on the patients. The government must take necessary measures to address this, as nursing care is extremely important.”
Dr B S Sunil Kumar, superintendent of the medical college, denies the issue, stating that there is no staff shortage and that “adequate staff have been allocated to critical care and wards”.
Kadakampally Surendran, local MLA, also maintains that there was no crisis. “The medical college has a well-functioning critical care unit, and there have been no complaints about staff shortages that I am aware of so far. However, I will look into the matter,” he assures.