EDITORIALS

Doctors for Rural Areas

Is the opposition to the BSc in community health course in the interest of the rural population?
Parliamentary Committee on Health recently asked that the government abandon its proposal to introduce a new educational course that will train healthcare providers for rural areas. The committees suggestion appears in tune with the Indian Medical Associations (IMA) shrill cries that this new course, the BSc in community health, will create half-baked doctors and with the general response of the MBBS doctors lobby that the government would be playing with the lives of the rural population. This is a strange argument considering that Indias rural population already suffers untold misery due to the abysmal paucity of medical practitioners. According to the Rural Health Statistics 2011, rural India has a shortage of 76% of doctors, 53% nurses, 88% specialist doctors, 85% radiographers and 80% laboratory technicians. The sub-centres fall far short of the required number and out of those in existence nearly 25% operate without water and power. More importantly, more than 50% of doctors enrolled for rural postings are absent from their positions. The governments effort to get MBBS doctors to practise in rural areas has been a long-standing project that has been unsuccessful for decades. Its efforts to get medical students to do a mandatory stint in rural areas have also been unfruitful. In 2007, the union health ministrys move to make a years rural stint mandatory for MBBS graduation had led to countrywide protests by students as well as doctors. The proposed course has also drawn the ire of another section of doctors the AYUSH (ayurveda, yoga and naturopathy, unani, siddha, homoeopathy) practitioners who are nding themselves without employment in large numbers. Many of these doctors point out that theirs too is an alternative course and while they are serving in rural areas, their service and pay conditions are miserable and complaints are ignored by the government. Many of the senior members of the IMA accept that doctors as well as students consider it professionally and socially unfullling to practise in rural areas on the ground that the conditions of work and living are unacceptable. If this fact is taken in conjunction with the one that Assam and Chhattisgarh have

successfully implemented the scheme of rural medical assistants (RMA s) who have earned praise from many quarters, why the opposition to the BSc in community health? Is it, as it seems to be increasingly evident, based more on turf and prestige issues rather than genuine concern for the cause of medical education? In Chhattisgarh, the RMA s are posted in the PHCs (along with AYUSH doctors) and in the health sub-centres. Their functioning and the abilities of the RMA s to deal with commonly prevalent diseases and health conditions have won the admiration of many health activists. In March this year, Union Minister for Health and Family Welfare Ghulam Nabi Azad told the Rajya Sabha that the government in consultation with the Medical Council of India (MCI) had drawn up the BSc (community health) course, earlier known as the Bachelor of Rural Health Care (BRHC) course. Graduates would be middle-level public health professionals appointed to primary health sub-centres. In fact, the government and the MCI were responding to the Delhi High Courts directive to prepare such healthcare givers for rural India. This idea has also received approval from health activists and been endorsed by the Planning Commission. But considering the opposition of the IMA and now of a Parliamentary Committee as well will this proposal move forward in the lifetime of this current government? The Parliamentary Committee and the IMA have suggested more medical colleges in rural areas and once again a years stint in rural areas for MBBS students. However, even the students in the rural medical colleges prefer to serve in urban areas rather than staying back. Overall, however, apart from improving the medical and service infrastructure in rural areas, the government will have to focus on reining in the blatantly commercial nature of medical education and the increasing privatisation of public health services. An elitist course with a completely unregulated fee structure and a situation in which allopathic medicine is seen as a lucrative career is hardly conducive to making its graduates volunteer for service in resource-poor and needy environments.

Economic & Political Weekly

EPW

april 13, 2013

vol xlviII no 15