Shortage of doctors in rural health centers: Empirical evidence from Gujarat

Abstract

Background: Shortage of medical graduates and post graduates in the government sector, especially in rural areas is a major problem in India. Rural and remote areas of Gujarat are facing shortages of MBBS graduates and post graduates. About 25 percent of posts in the health and family welfare department are vacant. The worst affected is the class I positions where over 40 per cent posts were vacant. This study is an attempt to identify the motivating and de-motivating factors, in joining government service, among the medical graduates and post graduates in Dahod district of Gujarat. Methods: Questionnaires were prepared for two groups of doctors: those who are in government services; those who left the government services. The questionnaire included both item wise response and likert scale questions. 36 in-service medical professional and 19 private doctors participated in the study. Results: 44% of in service professionals from urban areas are working in urban areas, while 56% of them are working in rural areas. On the contrary, only 15% of the in-service professionals from rural areas are working in an urban area, with majority of them (84%) are posted in a rural area. In services doctors believe that job security is more in government sector as compare to private sector. Variables like work environment, accountability, career development, social recognition and remuneration is less than satisfactory in government service. Conclusion: The decision to practice in rural areas is the result of complex interaction between a number of factors including individual background, service infrastructure, human resource practices including opportunity for career growth, remuneration, and autonomy. The study provide strong indication that promoting students from rural background to pursue medical education through reservation or scholarship may go a long way in addressing shortage of medical professional in rural areas. Following motivational factors can help in retention of skilled man power in government: positive work environment, adequate remuneration/compensation, career development and a supportive health system, adequate compensation and working conditions. Time bound promotion can be one of the important factors for retention of doctors in government sector.