Restore DMER’s centrality in purchase of medicines and recruitment of staff

Mumbai: The steep death toll over the weekend at the government hospital at Nanded, arising mainly from shortage of medical staff and medicines, has brought into focus the role of the Directorate of Medical Education and Research (DMER). Since 2014, a series of measures has curtailed the role of the once-powerful institution, resulting in serious lacunae in the state’s healthcare system.

Until 10 years ago, DMER was the nodal body for the purchase of medicines and equipment for all government-run hospitals in the state with a handsome budget of around ₹6000 crores. “The DMER used to set the rate contract and the suppliers for medicines, and accordingly, hospital deans would order and purchase them as per requirement,” said Dr Pravin Shingare, former director DMER.

However, in 2013, the-then public health minister decided to clip the DMER’s powers and created two purchasing authorities, DMER and the director of public health. This often resulted in different prices for the same set of medicines and equipment because the contractors would be different, resulting in a slew of departmental inquiries. In 2015, the government, then led by Devendra Fadnavis, decided to appoint an altogether separate corporation for medicine and equipment purchase under Haffkine on the lines of Tamil Nadu Medical Services Corporation (TNMSC), which single-handedly looks after the purchase of medical equipment and drugs in public facilities.

“We decided on Haffkine Bio-Pharmaceutical Corporation Limited to purchase 2500 types of medicines and equipment for government medical colleges and all other hospitals working under various departments. The government even finalised an administrative structure to run this corporation but to date, there have been no full- time appointments made,” said Shingare.

An official from a government medical college said, speaking on the condition that he not be quoted, that deans were empowered to spend only 10 percent of the budget for purchases, while the remaining 90 per cent of the budget was automatically transferred to Haffkine for a particular institution’s requirements. But this is only on paper. “We keep sending our budgetary monies to Haffekine but don’t ever get either our equipment or the medicines on time.” On Friday, the government revised the deans’ purchasing power to 40 per cent. After the deaths at Nanded, the state has also granted district collectors the authority to utilise 100% of the medical funds available with the District Planning Development Committee (DPDC) for purchase of drugs. The deans can now approach the collector if they require drugs and equipment without waiting for higher approval.

However, Dr Abhay Shukla, national convenor of Jan Swasthya Abhyan, a network of civil society organisations and people’s movements focused on public health, termed Friday’s decision as knee-jerk saying centralised purchase was a better option. “Multiple purchasing agencies increase the cost of buying medicines, and also increase corruption. We need to go back to a centralise purchase system as it was with the DMER,” he said.

Cutting power of appointments too

Though new medical colleges have been started in the state in the last five years in Satara, Nandurbar, Sindhudurg, Alibaug, and Osmanabad, taking Maharashtra’s tally to 26 state-run medical colleges, there is a shortage of professors at most places. “While medical seats were increased, medical colleges were added, the system forgot to create new posts and hire manpower. Every time there is a National Medical Commission (NMC) inspection, faculty from other government medical colleges is hurriedly brought in to show full strength and to sail through the inspection,” said a senior doctor at one of the medical colleges, requesting that he not be quoted.

“It has become a pattern we are transferred in the middle of a term so government colleges can sail through National Medical Commission (NMC) inspections. This affects not only the teaching process but also our family life.” Lack of timely promotions, private practice being disallowed, and shortage of medicines and diagnostic equipment at government hospitals were reasons why many doctors, despite best intentions, left the public healthcare system, he added.

While the recruitment of medical teachers happens through Maharashtra Public Service Commission, long departmental processes and potential court cases lead to inordinate delay in each round of appointments. Until 2019, the DMER had the power to temporarily give promotions and recruit medical teachers but even this was taken away, said Dr Shingare. “People who were promoted during my tenure were demoted after my retirement,” he said adding that one way to ensure there was no gap in recruitment would be to restore the DMER’s powers recruit and promote.