HWOs worried about future and health care delivery after GoAP’s recent decision

[Staff Reporter]
ITANAGAR, May 20: Health and wellness officers (HWOs) serving at various health and wellness centres (HWCs) across the state have expressed their apprehension over a policy decision with wide ramifications, particularly as it comes during the Covid-19 medical emergency.
The recent decision of the Government of Arunachal Pradesh (GoAP) to remove incumbent HWOs and engage new contractual staff nurses for the post has been decried as “unfair, against the tenets of natural justice and detrimental to the Ayushman Bharat programme of the ministry of health, GoI.”
The Ayushman Bharat programme seeks to provide inclusive health and wellness facilities to the local communities. Towards this end, the GoAP had upgraded 185 medical sub-centres into HWCs as a flagship initiative. Accordingly, nursing officers with BSc/GNM credentials had been appointed to the post of HWO.
In a letter to the state health secretary on 12 May last, a group of 13 HWOs, who have been recently requisitioned for Covid-19 duty at the Tomo Riba Institute of Health and Medical Sciences (TRIHMS) had stated their readiness to diligently work in combating the pandemic, but expressed their concern that the move may lead to their permanent removal from the post. This fear came true on 19 May when 58 new contractual nurses were appointed to their posts whilst the incumbent were engaged in Covid-19 duty.
Health Secretary P Partibhan on Tuesday stated that the transfer of HWOs was necessary in order to give employment opportunities to fresh contractual nurses.
“We started the programme in 2018-19 with a total of 38 regular staff nurses. Later, in 2019-20, in order to provide employment opportunities to all graduates we started engaging freshers. In continuation, we have gone for recruitment of another 110 staff nurses. In order to accommodate the freshers and to provide job opportunities to unemployed graduates it was decided to replace the regular staff nurses with fresh contractual nurses. This transfer is only to give fresh employment opportunities to freshers,” he added.
The secretary health further said that the 38 HWOs will be posted in nearby PHCs, CHCs and district hospitals.
However, the replaced HWOs say that the real reason cited by the government during their correspondence is that the incumbent HWOs are regular employees who draw relatively higher salaries than contractual employees.
The aggrieved officers refute the logic behind the alleged reason, asserting that regular employees are eligible for the post of community health officers (CHO) at HWCs as per the Aysuhman Bharat guideline. In Arunachal Pradesh, CHOs were re-designated as HWOs vide Order No. MNCD/HW/2017/33, dated 2, August 2018. Moreover, advertisements for the post by the MD, National Health Mission (NHM) too entitle regular employees.
The operational guideline of Aysuhman Bharat outlines career progression of HWOs up to the block and district level and was reportedly a motivation for many of the HWOs. The guideline does not exclude regular employees from within its ambit.
In addition to the attraction of career progression, the HWOs were also bound to service as HWOs by the health department.
Speaking to this daily, an incumbent HWO stated that all the HWOs were obligated to enter into a surety bond for an amount of Rs 1,50,000 (Rupees one lakh fifty thousand) which bound them to complete a certificate course in community health for nurses and pledge three years of service to the state health department and state health society.
“In honouring the terms of the bond, we have not been able to pursue better career paths and job opportunities. And now, the proposal to remove us before the expiry of the three years stipulated in the bond suggests a stance of dispensability and casual disinterest to our welfare after our services had been utilised under urgent circumstances,” the HWO said.
The HWOs allege that this also amounts to reneging on the terms of the agreement, since it binds both parties unless specifically mentioned.
The HWOs have termed the stated policy by the health secretary to frequently replace experienced/ regular HWOs as illogical.
“In the field of community health, building a network of contacts and instilling confidence is paramount. Removal of every batch of experienced HWO on attaining regular employment and reserving the post for new and contractual employees (in violation of guidelines) will mean that HWCs will permanently be headed by inexperienced leaders, thus adversely affecting productivity and the well-being of the local community,” the letter further reads.
It also informed that the HWOs have helped revive many non-functional sub-centres in far-flung areas and there have been no adverse reports regarding their performance.
“Within a period of one year we have built up an effective public health delivery system for the local community with time, effort and diligence. However, by appointing new and inexperienced nursing officers to the post of HWO, the department may run the risk of undoing all the progress made in the revival of many defunct HWCs.” They add that “the present move is detrimental to the Ayushman Bharat programme itself.”
Moreover, the HWOs, who are nursing officers by vocation, aver that fresh nursing graduates need to first learn the basic foundation of their vocation: bed-side nursing.
“Without the basic experience of actual nursing, how can inexperienced freshers be expected to perform as HWOs which is in large parts a management and programme implementation post?” they opine.
“Ayushman Bharat is a necessary programme for inclusive health and wellbeing, not a permanent training ground,” they assert.
“The HWOs are already engaged in various Covid-19 duties in addition to their normal duties at the HWCs. Under such circumstances, the uncertainty and mental disturbance of key Covid-19 workers during a medical emergency is insensitive, irresponsible and dangerous even,” they said.