Rationalisation move will strengthen Karnataka’s health system, not weaken it: Minister

Bengaluru: The health and family welfare department has decided on "rationalisation" of mother and child health (MCH) specialists, which will trigger a large-scale downgrading of community health centres (CHCs) in Karnataka.In an interview with TOI, health minister Dinesh Gundu Rao explained the goal of the move, what its outcome would be, and why people need not fear. Excerpts:
What's the objective of this exercise?To prevent maternal deaths. That's where this started. Why is Karnataka's maternal mortality ratio higher than those of Tamil Nadu, Kerala or Telangana? One major reason is delay in reaching services. An emergency happens, the woman goes to a taluk hospital, there is no facility, she is shifted again, becomes critical on the way, and by the time she reaches the district hospital, it is too late.There are concerns the move may leave gaps, especially given existing vacancies.This is a big change, so there will be resistance. In the long run, this will strengthen the system. We're already working on modifications to the Nov 7 order to include certain CHCs where services are necessary. The principle will remain the same, but adjustments are being made. Today, resources are not being used properly. In many CHCs, there is one gynaecologist doing hardly any work. Some centres do zero deliveries, some do 5-10 a month. At the same time, district hospitals are overflowing with deliveries and C-sections. Taluk hospitals after 4pm are almost dead because there are no doctors. That's where maternal deaths are happening.But CHCs serve a defined population. If specialists are moved out, won't people have to travel farther?Distance mapping is a key criterion. Any CHC in a distant or hard-to-reach area will not be touched, even if it is underperforming. We're redeploying MBBS doctors who are currently working in places where there's very little clinical work, including some extension centres and programme-based posts.You also mentioned changes to the specialist ‘triad' model. Could you explain that?The traditional triad is a gynaecologist, anaesthetist, and paediatrician. Without an anaesthetist, you cannot do C-sections, so a single specialist is not useful. If you have a proper triad, a CHC can do 60 to 70 deliveries a month, sometimes more. We're now allowing flexibility. Instead of only a paediatrician, a physician can also be part of the triad. In many places, a physician is actually more useful because they can handle a wide range of medical cases.When can we expect the revised order with modifications?Very shortly. Around 100 of our doctors who had gone for PG studies are returning, including about 40 specialists. We're deploying them too. I expect the modified order to be notified by Jan 10. Subsequently, the recruitment of 230 doctors, including specialists and MBBS doctors, will commence.