Covid-19

Remuneration of health workers in India during pandemic

Frontline healthcare workers are facing multiple pandemic-related worries including balancing their professional commitment to helping others with a personal commitment to protect themselves and their loved ones. On top of this, they have been facing other issues like lack of job security, non-payment and delay of salaries. Last year, the situation over non-payment of salaries by the government was so grim that the Supreme Court had to intervene saying, “In war, you do not make soldiers unhappy.”

According to a Washington Post-Kaiser Family Foundation poll, roughly 3 in 10 healthcare workers have weighed leaving their profession. More than half are burned out. And about 6 in 10 say stress from the pandemic has harmed their mental health. The KFF/Washington Post Frontline Health Care Workers Survey was based on interviews conducted in English and Spanish with a nationally representative sample of 2,298 U.S. adults age 18 or older, including an oversample of health care workers.

Pay and Vacancy Position

There is a close linkage between pay and vacancy position. One of the key challenges in the public health sector is the need to attract and retain talent. Generally speaking, the private sector, where opportunities are rapidly expanding, tends to pay higher in areas of scarcity than in the areas of plenty. While job security, career prospects, work content, and emotional reasons to serve in this sector are important intrinsic motivators, pay continues to be an equally important factor for attracting and retaining talent in this sector. Also, pay becomes important in the present scenario of COVID-19, when the working condition is much more demanding and the hospital staff are generally overburdened because of the ever-increasing patient load.

Ahmedabad’s biggest COVID-19 facility, the Ahmedabad Civil Hospital reportedly tried to recruit nurses on a three-month contract at a salary of Rs 13,400 per month last year but few candidates turned out. “This [Rs 13,400 per month] is not commensurate with the risk associated with [COVID-19] work,” said Vanraj Chauhan, general secretary of the All Gujarat Nursing Union (AGNU). However, the hospital was able to hire later after incentives along with salaries were offered by the Ahmedabad Municipal Corporation (AMC).

 Last year in June, the Telangana government sought to hire 509 healthcare workers, including 88 staff nurses, five pharmacists and 59 lab technicians, on contract for a year. The salaries on offer were Rs 23,000 per month for nurses, Rs 21,000 per month for pharmacists and Rs 17,000 per month for lab technicians, as per the state’s notification. 

The existing gap between the healthcare professionals and hospitals/telemedicine platforms has also proved to be a major factor in keeping them away from exploring better opportunities. There are some online networking and job search platforms for medical professionals like doctors and nurses which help them explore the available opportunities and act as a bridge between them and hospitals or telemedicine platforms. For example, Bengaluru-based MedPiper Technologies, Inc matches verified Doctors and nurses with hospitals and telemedicine platforms. The platform helps pre-verified and peer-authenticated professionals and practitioners track job alerts, industry updates, research trends among others. The platform uses blockchain technology to enable the verification of profile credentials by peers, educators and employers, and match those verified profiles to job requirements.

Factors determining salary in a govt setting 

In the government setting, salary is determined as per established norms. Many factors are taken into account while determining salary – entry-level qualification, basic job content and responsibility–to name a few. Principles of pay determination in government may take into account elements of equity and compression ratios– minimum to maximum salary levels–as well. Unlike the private sector, where the salary of professionals may get periodically calibrated depending on many factors, including the forces of demand and supply, general working of the economy etc; in the government set up, a regular increase in the salary is ensured in the form of annual increments along with compensation for inflation. The doctors in the Central Government are also covered under DACP (Dynamic Assured Career Progression) which facilitates their assured promotion up to the SAG (Senior Administrative Grade) level.

Delayed salaries

There were several reports last year during lockdown about some states delaying payment of salaries to healthcare workers. The central government had told the Supreme Court in July 2020 that Maharashtra, Punjab, Karnataka and Tripura were yet to follow directives on timely payment of salaries to healthcare workers who were at the frontline and fighting the pandemic. The court directed the Centre to issue necessary directions for releasing salaries of doctors and frontline healthcare workers engaged in COVID-19 duty on time. “If the states are not complying with the directions and orders of the Central government, you are not helpless. You have to ensure that your order is implemented. You have got the power under the Disaster Management Act. You can take steps also”, the court had told the Centre.

Incentives

Under the Pradhan Mantri Garib Kalyan Package, last year the Centre had announced some benefits for healthcare workers fighting the pandemic. An additional incentive of Rs. 1000/- per month was being paid to ASHAs in view of their significant contribution towards COVID-19 pandemic related work. Besides this, States/UTs had been asked to ensure the provision of safety measures like masks and sanitisers for ASHAs. Further, the State/UT Governments had also been given the flexibility to provide an incentive to health workers and staff engaged in COVID duties as per their context and policies, from the resources made available under the India COVID-19 Emergency Response and Health System Preparedness Package.

Moreover, life insurance benefits had been extended to all healthcare workers, under the ‘Pradhan Mantri Garib Kalyan Package Insurance Scheme for Health Workers Fighting COVID-19’ announced on 30 March 2020. The Ministry of Health and Family Welfare had collaborated with the New India Assurance (NIA) Company Limited for providing the insurance amount based on the guidelines prepared for the scheme. This insurance scheme provided a life insurance cover of Rs. 50 lakh to healthcare providers, including community health workers, who may have to be in direct contact and care of COVID-19 patients and therefore are at risk of being infected. It also included accidental loss of life on account of COVID-19 related duty. The scheme also covered private hospital staff/ retired/volunteer/ local urban bodies/contract/daily wage/ ad-hoc/outsourced staff requisitioned by States/ Central hospitals/autonomous hospitals of Central/States/UTs, AIIMS & INIs/ hospitals of Central Ministries drafted for COVID-19 related responsibilities.

In Telangana, the state government provided a one-time incentive to employees of the health and medical departments, including sanitation staff, under the Telangana Chief Minister’s Special Incentive plan in April 2020. This has since been extended. Gujarat too relied on one-time incentives for doctors and nurses in government hospitals. “The AMC has brought in an incentive programme where doctors receive Rs 25,000 per month in addition to their salaries, and nurses and other medical staff get an additional Rs 15,000 per month,” Ahmedabad Civil Hospital’s superintendent Prabhakar said. When the Rajasthan state government faced difficulties in recruiting lab technicians to join the state’s COVID-19 labs in April, it chose to recruit them at more than double the pay grade under a different title.

Centre’s role

Under the VII Schedule of the Constitution of India, Health is a state subject. The Centre has concurrent jurisdiction only in a few areas. Although it is the responsibility of the State Governments to provide for health care, the Central Government plays a vital role in supporting State Governments and coordinating their efforts towards achieving the targets of national health policies. The Ministry of Health and Family Welfare also looks after Central Government hospitals, the Central Government Health Scheme and a host of other central institutions.

The Indian healthcare sector has become one of the important sectors–both in terms of revenue and employment. The Indian healthcare industry is growing at a tremendous pace due to its strengthening coverage both in the public and the private sector. However, despite the rapid growth, this important sector in India is also characterized by many weaknesses.

India’s total health expenditure as a percentage of GDP was about 3.6 per cent for FY20 – comparable to many emerging economies. However, this is fairly low in terms of per capita health expenditure. Furthermore, India’s public spending on health as a proportion of GDP–estimated at around 1.29 per cent – is among the lowest in the world. The severity of the situation can be better understood by the fact that India ranks 170 out of 188 countries in domestic general government health expenditure as a percentage of GDP, as per the Global Health Expenditure database 2016 of WHO.

The Economic Survey 2020-21 has strongly recommended an increase in public spending on healthcare services to 2.5-3 per cent of GDP, as envisaged in the National Health Policy 2017. The health of a nation depends critically on its citizens having access to an equitable, affordable and accountable healthcare system and on the welfare of healthcare workers who provide tireless services to sick and ailing individuals. 

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