In Maharashtra, rural incentives for doctors benefit mothers, children

In the Vidarbha region, the sub-district hospital at Arvi in Wardha has seen the number of women attending the ante-natal care OPD run by obstetrician Dr Neeraj Kadam jump from 60-70 per month a year ago to 650-660.

Connecting the dots from Gadchiroli to Sangli and Wardha, is an ambitious scheme launched in October 2017 by the Maharashtra Health Department to appoint specialists in rural areas, offering contracts with cash incentives.

More than a year later, the results are showing on the ground. Especially for women and children, because the rollout tied in with the Directorate of Health Services’s initiative to encourage institutional deliveries at rural areas and fill vacancies for specialists.

Officials say that of the 409 specialists enrolled by the state government so far under the rural incentive scheme, 167 are obstetricians, 160 anaesthetists and 82 paediatricians.

According to government data, 5.60 lakh normal deliveries and 1.64 lakh C-sections were performed across 248 First Referral Units (FRUs), which employ contractual and public health staff, from April 2018 to March 2019. In 2017-18, they saw 5.56 normal deliveries and 1.47 lakh C-sections (see box).

“These FRUs are basically health facilities that are identified at the tertiary level, where all emergency and essential services are available. These could be district, general, rural or sub-district hospitals or a women’s hospital,” says Dr Archana Patil, in-charge at the State Family Welfare Bureau and Additional Director of Health, Maharashtra.

Officials say the government initiative works for the specialists, too.

“Specialists were not willing to join government service on a regular basis, and that too in rural areas. Also, they were not happy with the pay structure. So the state decided to bring in specialists on a contract basis with performance-based incentives,” says Dr Satish Pawar, Additional Mission Director (Maharashtra), National Health Mission.

“Of the 409 specialists, eight earned over Rs 3 lakh per month, seven between Rs 2-2.99 lakh, 53 between Rs 1-1.99 lakh and 78 between Rs 50,000-1 lakh,” says Shridhar Pandit, state programme officer on maternal health.

Jadhao and Gadbail from Aheri together take home around Rs 4 lakh every month, while Hande and Kadam earn in the range of Rs 2-3 lakh. “We completed our post-graduation in Mumbai and shifted to Nagpur. While I was earlier travelling to peripheral areas in Nagpur, getting performance-based incentives at one location was appealing. Also, we have a one-year-old son… my wife and I decided to stay at Aheri so that we can be together,” says Jadhao, 34.

“I do not mind being placed anywhere in the state as there are really very poor people who do not get access to skilled surgeons. Nowadays, people come to our sub-district hospital from as far as 80-100 km away,” says Hande, 32, a farmer’s son from Parekarwadi village in Atpadi tehsil in Sangli.

“I quit as lecturer at Rajawadi municipal hospital at Ghatkopar to join the state’s scheme. We have started getting several referral cases, too. Recently, we assisted a 27-year-old pregnant woman with a ruptured uterus who was referred by a private hospital in Arvi. Earlier, such surgeries were rarely performed at the sub-district hospitals,” says Kadam, 42.

For the patients, access to quality care closer to home has come as a relief.

Kajal Dabhade, a 22-year-old old from Sonand village in Solapur, had initially registered for her first pregnancy at the rural hospital about 100 km away. “But then, we came to know about better facilities at Kavathe Mahakal. Since this was my first delivery, my husband and mother decided to shift me here in case there was an emergency. The decision was a good one because eventually I had to undergo a C-section, which went smoothly,” she says.

Making a difference

Status report of contractual specialists in Maharashtra in 2018-19:
1.98 lakh women registered for ante-natal care
17,426 deliveries via C-section
5,960 complicated deliveries
18,068 deliveries under anaesthesia
13,124 cases given emergency paediatric care
Source: Maharashtra Health Dept