Drafting doctors to villages
With doctors unwilling to serve in rural areas, the health ministry has acted tough and cleared a proposal making it mandatory for MBBS doctors to serve a one-year rural posting to be eligible for post-graduate courses from 2014-15.
The situation in rural India is dire; statistics indicate a 60 per cent shortage of general doctors and 80 per cent shortage of specialists. The health ministry’s action is the only option available after various incentives and attempts at tailoring a rural community health course and a cadre of rural doctors failed.
However, what the statistics of doctor shortage mask is the equally poor condition of rural health infrastructure.
As on March 2011, rural India faced a shortfall of 35,762 sub-centres, 7,048 primary health centres, and 2,766 community health centres. The government also faces the daunting task of constructing buildings, supplying medicine and equipment, and staffing the centres with adequate number of nurses, assistants, lab technicians and pharmacists besides doctors. Though the National Rural Health Mission has improved public spending on health care, India’s spending on this count is a mere 1.2 per cent of its GDP compared to China’s 2.7 per cent.
The hypocrisy of a government which has failed the public health system — now seen as coercing the medical fraternity for not spreading out into rural areas — is noteworthy. A legal challenge would certainly be mounted against the government order. Equally remarkable is the health ministry’s dual-track policy.
From 2010, it relentlessly advocated creating a rural doctor cadre through a three-year course. Given names like Bachelor of Rural Medicine and Surgery and Bachelor of Science (Community Health) at various points in time, fears were raised that it would produce ill-trained professionals and reflected the state’s step-motherly treatment to rural areas.
Making rural postings mandatory follows the poor response to incentives like 50 per cent reservation in post-graduate (PG) courses and 30 per cent weightage in PG exams for undertaking three-years rural service. The high premium attached to PG courses will ensure that most MBBS doctors will join a rural posting. Their concerns about accommodation and well-equipped centres with support staff in rural area, and competitive remuneration should be addressed by the health ministry.
This “drafting” of doctors into rural service is unprecedented. The allusion to soldiers and preparations on a war footing is not misplaced. Like the hard life in soldiering, the extra year of rural service for doctors comes atop a gruelling 4.5-year MBBS course, a frenetic year of being a house surgeon, and the difficult preparation for PG exams. Over 30,000 medical graduates are produced every year. Even if one-third of this number enter rural areas, their impact would be revolutionary. But it is difficult to be optimistic considering the government’s track record. It first needs to lay the ground and the means for doctors to work their miracles in villages.
