Table 1 Summary of findings

Recruitment

 Explicit rules for recruitment done by OPSC for permanent positions.

 Open to all medical doctors with a maximum age limit of 32 years.

 DOHFW can do direct recruitment for temporary and ad hoc positions.

 DOHFW at the state level is responsible for all recruitments.

Recruitment was done as per the set rules.

OPSC exams were conducted annually.

Two thirds of doctors interviewed were aware of the recruitment processes. However, scoring and ranking system in OPSC exams was not clear to them.

Doctors interviewed preferred to join government service only after selection through OPSC.

Continue current recruitment policy through OPSC with more clarity on scoring and ranking system.

Recruitment on ad hoc basis should be stopped.

Deployment

 It is mandatory for each government doctor to serve at least 3 years in the KBK districts.

 No clearly delineated guideline for placement or transfer of doctors across primary, secondary and tertiary care facilities.

 Any doctor can be transferred across the state after 3 years of service in a single location.

 DOHFW at state level is responsible for deployment of recruited doctors.

Out of 56 doctors interviewed from non-KBK districts, 32 (57%) had never worked in KBK districts.

Two thirds of doctors interviewed remained in the same region (KBK or non-KBK) where they had started their service.

There were 3.0, 2.0 and 2.2 average transfers in the first, second and third decade of their service, respectively. This was less than the stipulated policy of minimum 3 years of service to be eligible for transfer.

Placements and transfers of doctors were done centrally.

Majority of the doctors interviewed were not satisfied with the current practice of placements and transfer.

Deployment based on clear and fixed criteria.

Designation of hard-to-reach areas should not be restricted only to KBK districts but also to other areas which are hard to reach.

District authorities should be allowed to deploy doctors based on local needs.

A time-bound and transparent transfer policy based on rotation.

Incentives

 Monthly hardship allowance of 8 000 Indian Rupees (around 20% of new entrant’s salary) for rural and 4 000 Indian Rupees for urban areas in KBK districts.

 Monthly allowance of 3 000 Indian Rupees for specialist doctors.

All the doctors interviewed from the KBK district were receiving hardship allowance. However, they perceived it as insufficient and ineffective.

Limited awareness among non-KBK district doctors interviewed on incentives given in KBK districts.

Hardship allowance in proportion with degree of remoteness and linked with performance.

Promotion:

 State-level Departmental Promotion Committee that is independent of DOHFW is constituted to look after the promotions of doctors.

 The criteria for promotion is based on vacancy, OPSC ranking, length of service and performance appraisal report.

 Doctors are to be designated as specialist after acquiring postgraduate degree.

 50% of postgraduate seats in government medical colleges are reserved for in-service doctors.

Around half the doctors interviewed were aware about the rules and process of promotion.

Delayed first promotion with quick promotions in later career. Majority of junior doctors interviewed were not satisfied with the slow pace of the promotion.

The average time interval in designating a doctor as a specialist after getting specialist degree was 7.5 (±6.3) years.

Out of 90 doctors interviewed, 49 had done postgraduation of which 31 had done through in-service quota.

The criteria for promotion should include numbers of years’ service in rural area and performance in addition to length of service and OPSC ranking.