Even as farmers in western India fear another drought because of the long-delayed monsoon, villagers across rural Maharashtra are grappling with another crisis.

For the past five days, around 12,000 government doctors in 33 of Maharashtra’s 35 districts have been on strike, bringing the rural healthcare system to a grinding halt, making it one of the most widespread strikes in the state.

Going by the 2011 census, this would mean nearly 6.1 crore people in the state have little access to medical help. The state government has now roped in doctors from the National Rural Health Mission to handle emergency cases.

The strike has been organised by the Maharashtra State Gazetted Medical Officers Organisation, or MAGMO, a union that represents government medical officers posted in primary health centres and other rural hospitals and dispensaries. The union has been demanding better working hours, salary increments and permanent jobs for ad hoc doctors since 2010, and have been on short strikes twice before – once in 2011 and once last month.

This strike, however, has been the organisation's biggest, in terms of the number of health centres involved. According to the protesting doctors, the strike is currently affecting 1,818 public health centres, 503 Ayurvedic dispensaries, 485 rural hospitals, 85 sub-district hospitals and 33 district hospitals across the state. Collectively, these health centres tackle an average of 500,000 out-patient department cases, 100,000 admitted patients and 15,000 medico-legal cases every day.

“We know that patients are also protesting against our strike, but we have been fighting for four years and want the government to listen to us,” said Dr Rajesh Gaikwad, the president of MAGMO, who has been on a hunger strike at Azad Maidan in Mumbai since July 1.

One of the doctors’ main demands is that 789 doctors and 32 dentists, who have been working in ad hoc positions for several years, should be given permanent posts and corresponding salaries. They also want 1,700 senior medical officers, who were given permanent positions in 2009 and 2010 after more than a decade of service, to be paid retrospective increments to their salaries.

The state health ministry, however, is in no mood to address these demands. “When these doctors were made permanent, they had signed an undertaking that they were joining as fresh recruits and would not demand arrears,” said Maharashtra health minister Suresh Shetty. “The arrears they are asking for would cost the exchequer at least Rs 172 crore, which is no small amount.”

Another major concern for protesting doctors is the issue of work hours. As of now, doctors at primary health centres claim they work for nearly 24 hours a day, even though their main shift is supposed to be for eight hours.

“As doctors, we always need to be on call for emergencies, but in rural areas, people come to primary health centres at odd hours even for minor problems, and we have to see them,” said Dr Sachin Jadhav, one of the 200 doctors who have travelled to Mumbai to protest at Azad Maidan.

While the health minister claims work hours is a negotiable issue, the government is all set to clamp down on the protesting doctors. On July 5, the ministry plans to dismiss all the doctors who are on strike and begin recruitment for new doctors to fill the posts. “Healthcare is an essential service, so we will take legal action if these doctors don’t end their strike,” said Shetty.

Meanwhile, caught in the midst of this tussle between doctors and the state government, patients across the state are growing desperate. “We are getting calls from patients back home, because they have nowhere to go for medical help,” said Dr Praful Gorde, a medical officer posted in Amravati district’s Melghat taluka.

Gorde says there are 17 villages in Melghat, which are all dependent on 11 primary health centres with 40 doctors. All of them are currently on strike. “Private doctors and dispensaries can be found only in cities or towns,” he said.

While the health minister claimed the government has rolled out 900 ambulances to deal with emergencies across the state, they are not likely to reach remote, inaccessible villages very easily.

“In these places, villagers are entirely dependent on government health care,” said Gorde. “The public is important to us. Even our own relatives have been affected by this strike. But we have been agitating with this government for four years, and want our demands met before a new government takes over.”