It is time to switch on the 'emergency code' for Kerala's much-feted public health sector.

The Comptroller and Auditor General (CAG) report on Public Health Infrastructure, which was tabled in the Kerala Assembly on January 21, has identified serious cracks in the healthcare system, particularly a manpower shortage.

On May 2023, the latest for which the CAG has figures, there was a shortage of 1,160 doctors, 978 nurses, and 716 paramedics in government hospitals across Kerala. The shortage of doctors is not significant in primary and secondary levels like primary health centres, women and child hospitals, taluks, and general hospitals. In these centres, the CAG report notes that the availability of doctors was around 94 per cent to 98 per cent of the sanctioned strength.

However, in tertiary-level hospitals (especially government-run medical colleges of all systems of medicine), the percentage of doctors against the sanctioned strength was in the range of 35 to 82 only.

"Acute shortage was observed in Homoeopathy Medical Colleges, where the regular doctors in position was only 35 per cent. Even after engaging 22 doctors on a contract basis, 36 per cent of the sanctioned posts remained vacant during the audit period," the CAG report noted.

The Kerala Government said in 2023 that against the sanctioned strength of 75 doctors, 61 doctors (24 regular, 10 on deputation and 27 provisional doctors) were engaged in Homoeopathy Medical colleges.

The shortage also lends credence to the opposition charge that the LDF government is reluctant to fill vacancies from the PSC list. "The vacancies of nurses, pharmacists and lab technicians reported to the PSC by the Homoeopathy Medical Colleges remained unfilled as no appointments were made during the entire audit period," the report said.

It is observed that against the sanctioned strength of 49,496 posts across the state under all categories of staff under DHS, 5,476 (11 per cent) posts remained vacant (March 2023). The district-wise shortage of all categories of staff ranged from 8-13 per cent.

The highest vacancy position (13 per cent), suggesting the traditional geographical imbalance, was observed in the northern districts of Kasaragod, Kozhikode and Malappuram.

Audit noticed a wide disparity in the sanctioned strength of doctors with respect to population across the state. While in Pathanamthitta district the ratio was 1:3,411, in Malappuram district it was 1:7,103; the best and the worst. However, sanctioned strength differs from actual strength.

But if actual doctor availability is considered, the ratio worsens. Therefore, the actual doctor availability will be 1:3,754 for Pathanamthitta 1:7,437 for Malappuram.

In between are: Wayanad (1:3930); Idukki (1:4315); Kottayam (1:4701); Alappuzha (1:4760); Kasaragod (1:4860); Thiruvananthapuram (1:5158); Kannur (1:5267); Ernakulam (1:5799); Kollam (1:6290); Thrissur (1:6293); Palakkad (1:6722); and Kozhikode (1:7245).

A doctor-to-population ratio below 4,000 is considered good; only Pathanamthitta and Wayanad qualify. Between 4,000 and 6,000 is considered "poor": Seven districts fall in this category (Idukki, Kottayam, Alappuzha, Kasaragod, Thiruvananthapuram, Kannur, and Ernakulam). Between 6,001 and 7,000 is considered "very poor"; Kollam and Thrissur fall under this. A ratio above 7,000 is "extremely poor"; Malappuram and Kozhikode fall under this.