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Monthly Archives: August 2014


Some health-policy trends worth emulating for DMHP-Kerala.

The following are recent trends in the health sector of Kerala. These are directions which are worth emulating for DMHP.

  • The DMHP is understaffed. It comprises of a 4-5 member team for a district -while programs like the palliative program for each district has anywhere from 100 -200 staff. The Kottayam district palliative program that I am aware of (see training program @Kottayam) has more than hundred community nurses supported by about 7 doctors from the health dept. One feature of the staff remuneration is that only the doctors are permanent staff of the government while all the community nurses are employed on contract – which essentially means less salary, no perks and other benefits and no permanency of tenure. It is know that such an arrangement leads to poor staff motivation, translates to poor quality of care and high staff attrition. The community nurses of the palliative program have organised themselves and constantly lobbies for change. The government has also taken cognizance of it. There is a possibility of regularizing this cadre.

Report 1 (Indian express Aug 11th, 2014, Kerala), click here for full report


The lesson to be learned for DMHP is that the DMHP could also aspire for such permanent cadre. As of now only permanent personal in DMHP are health service doctors who join program on deputation-all other staff are on contract including doctors in CHMP (NRHM version of DMHP)

  • Creating a permanent cadre is a tough ask for the government because of the financial implications. Kerala has had moratoriums on fresh recruitment of staff and it is known that financial ministry is averse to creation of new posts. There is high chance that the chief minister’s assurance to the nurses will remain on paper as just a promise. One potential way it can be achieved in a smaller scale is by re-designation and redeployment of existing and vacant or redundant posts. See this happening in the context of creating new departments in medical colleges.

Report 2 (The Hindu Aug 17th, 2014, Kerala) Click here for full report.


Lesson for the DMHP is that it can easily aspire for permanent cadre by doing away with the deputation system while designating existing vacant posts  as special cadre for out-of-hospital care. Redeployment of mental health professionals who are concentrated in  mental health centers should be explored as a policy option. Such transition should be made attractive to the early adopters via incentives drawn from innovative  financing using DMHP money. 

  • Strengthening District hospital cancer care units in mission mode is a recent development. This is happening in addition to well developed cancer care institutes, medical college oncology departments and a successful community cancer care program in the form of well staffed palliative care program.

Report 3 (Mathrubhoomi, Aug 17, 2014, Kerala) See full report here.


Lesson for DMHP is that most District hospital Psychiatric units are not functioning optimally. This is despite the fact that we have a fairly good functioning institutional care in MHCs, medical college psychiatry departments and emerging community programs (DMHP/CMHP) in all districts. I am aware of at least 3-4 district hospitals which do not have a psychiatrist.  Other district hospitals which have only one psychiatrist provides just nominal OP care with hardly any IP care. With innovative funding from the DMHP coffers, district hospital Psychiatric units could be invigorated like the  Sukhuratham- Project for cancer care in district hospitals.

(More trends will be added in future)

Added on 22-09-2014

Less than 2 months after the chief-minister had promised the palliative care contract staff that their services could be regularised, the state has puunged into a financial resource crunch. The finance minister has said that there are 30,000 extra employees working with the gov and their would be gradual removal of personell and no new creation of post in this fiscal year!

See here. An excerpt –

Kerala government adopts austerity measure; rules out creation of new jobs, 7.5 thousand jobs to be scrapped

DC CORRESPONDENT | September 23, 2014, 05.09 am ISTIST

Thiruvananthapuram: As part of the intense belt-tightening measures, the state government has decided not to create any new posts, institutions or agencies during this fiscal year, till March 31, 2015.

The finance department will also abolish 7,500 or 25 per cent of the total surplus staff of 30,000 before the end of this fiscal.

What’s more, no expenditure proposals for this fiscal will be entertained after November 15. Special workshops will be held during October for the clearance of files and departments have been asked to get sanction for their expenditure proposals during these workshops.

“Where post creation is unavoidable, it will be done only after examination by two committees,” additional chief secretary (finance) K.M. Abraham said. First the proposal will be put to a committee headed by the expenditure secretary, a representative of the General Administration department and the head of the concerned department. If the proposal is cleared by this committee it will be sent to the consideration of another committee led by the additional chief secretary (finance).