With the generous Japanese tightening their purse strings and the government reluctant to support it financially, the hospital now has to resort to raising fees for sustenance. The TUTH is already well expensive than Bir Hospital, the other big public hospital in the country, but the hospital still makes a loss of well over Rs 100 million every year. [break]
“We have an expenditure of around Rs 470 million and the Tribhuvan University (TU) gives us just around Rs 110-120 million. We generate revenues of around Rs 200 million from the services we provide,” Head of Accounts section Tahal Bahadur Khadka sums up the sorry state of the hospital established in 1982.
“The TUTH has its share of problems, but it definitely should not be making loss,” concedes former TUTH Director Dr Mahesh Khakurel. Khadka says a whopping Rs 350 million goes on salaries and allowances for the staff, including residents.
“There is massive overstaffing in the hospital,” TUTH Director Dr Keshav Prasad Singh states. “TU keeps transferring staff to us. The trend has stopped a little ever since we requested them to not send staff without consulting us recently,” Dr Singh adds.
The five-member committee formed by the Ministry of Education to probe into alleged irregularities at the Institute of Medicine (IOM) following the 17-day strike from March 15 had also mentioned about the massive overstaffing in its report which further said, “The doctors and technicians have made the hospital a means of serving their personal interests by working at private clinics and hospitals during duty hours.”
TUTH is the customs of TU
Dr Khakurel blames the practice of giving 50 percent extra salary to the TUTH staffers and political interference for the massive overstaffing. “Getting transferred to the TUTH is akin to being posted at the customs for TU staffers,” Dr Khakurel claims.
The system of giving extra payment was started as a means of compensating the doctors for not practicing outside. But soon it was extended to all employees following pressure from trade unions and now it has become just a financial burden with the doctors and other staffers working outside despite taking the extra perks.
TU Vice-chancellor Dr Madhav Prasad Sharma denies unnecessarily burdening the TUTH with mass transfer of staffers but concedes the practice of extra payment may have led to overstaffing. “It is human tendency to try to seek transfer to lucrative postings,” Dr Sharma says.
The fact that TUTH provides 90 percent waiver on all facilities including medicines, which the hospital has to buy, for its employees and their family also act as a major attraction for staffers apart from adding a massive financial burden on the hospital.
“The hospital also has to give 50 percent discount on everything including medicines for all TU staffers working across the country,” Dr Khakurel adds.
Vice-chancellor Dr Sharma defended the 50 percent facility for TU staffers, comparing it with the facility to police, army and civil servants provided by their respective hospitals but said the hospital should stop the practice of extra payment.
“It should pay the extra money only to those who work extra time and not everybody. If only it were to do so, the problem of overstaffing will be solved,” he asserts. But Dr Khakurel argues that the hospital cannot do so due to intense pressure of the unions.
Dr Khakurel alleges that TU doesn´t give even the money allotted by the government. “They (TU) treat us as an earning institute and withhold the money meant for us,” he claims. But Vice-Chancellor Sharma vehemently denies the charge and claims TU always tries to help make the hospital better.
“The government doesn´t send money to TUTH separately. We provide money sufficient for salaries, allowance and provident fund of permanent staff according to the government regulations (which excludes the 50 percent extra payment),” Head of the Financial Administration Division of TU Shanti Raj Kayastha says.
But Dr Khakurel argues that TU receives budget from the Ministry of Finance based on proposals presented to the TU senate, including that by TUTH, but they provide just the salary and allowances.
TUTH doesn´t get enough tests
The hospital sees more than 1,500 patients daily, but there aren´t enough tests to match the flow of patients. “There is generally a big margin of profit in almost every test and if only we can get all the patients coming to us tested, it would greatly increase the income,” claims Chief of the Medical Records Department Kumar KC.
One has to wait for a long time to get bigger tests like endoscopy. Even routine blood tests and x-rays can´t be done after three in the afternoon as the technicians leave early while the reports can´t be obtained after five in the afternoon.
Dr Khakurel concedes that many doctors and technicians, who run and work at private centers outside the hospital, advise the patients to get the tests done elsewhere.
“The doctors and technicians deliberately delay the procedure to encourage patients to go elsewhere which suits the patients as they get their reports on time from elsewhere,” Dr Khakurel says.
The hospital hiked the fees by 20 percent last year including up to 100 percent for some of the tests, but, if anything it has further alienated the patients. “Instead of raising fees for tests, the hospital should focus on making the labs efficient to attract more tests,” KC states.
The way forward
Dr Khakurel, who served as director for over four years before retiring about two years ago, feels autonomy is the only way forward for TUTH. “We should get autonomy from TU and get direct grant from the government,” he says.
He also says the hospital would do well with a sense of ownership of staffers toward the hospital. “It´s sad to say that doctors and technicians do not work full time here and aren´t even sincere toward the hospital,” he concedes.
Vice-chancellor Dr Sharma claims that TU is considering giving autonomy to its prestigious institutes like the IOM. “With the overflow of staffers from TU ending after autonomy, we will be able to absorb the extra staff through our expansion to deal with the problem of overstaffing,” Dr Khakurel talks about the eventuality.
Despite all its financial problems, the hospital currently treats around 100 poor patients for free in the general ward. The hospital provides every facility including ventilators and medicines for these patients.
“If we control leakages and corruption and make optimal use of our resources, including staffers, we can provide free treatment to all patients in 300 beds of general ward with proper management,” he claims.
premdhakal@myrepublica.com
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