Doctors for rural India

Doctors for rural India

Context:

• Nearly 600 million people in India, mostly in the rural areas, have little or no access to health care.

State of rural health care today:

• A widespread disregard for norms
• Perpetual failure to reach targets and an air of utter helplessness are what mark the state of rural health care today.
• The country is short of nearly five lakh doctors.

The contours

• A few years ago, the Union Health Ministry put forth a proposal to train a new cadre of health professionals.
• Under this plan, these professionals, after undergoing a short term, course in modern medicine, were to serve the health needs of the rural population, with a focus on primary care.
• In the 1940s, primary care physicians — who were trained under short-term courses, and termed Licentiate Medical Practitioners (LMPs) — would deliver quality services in the rural sector.
• However, the Bhore Committee (1946) recommended abolishing them in the idea that India would produce enough MBBS doctors.

Bhore Committee:

• The committee made recommendations in connection with the public health system.

Way ahead:

• Starting a short-term course in modern medicine can provide an opportunity to design a medical curriculum that is much more relevant to the nation’s needs.
• Its entry requirements could be based less on sheer merit and more on an aptitude for medical service and preference should be given to applicants from within the community.
• A provision for learning in the vernacular languages can be made.
• LMPs should be adequately trained in their file and have a well-defined role in health care.
• Rural population would be made to feel like second class citizens by appointing a lower tier doctor to treat them. This can be put to rest by not letting LMPs replace MBBS doctors but instead work in a subordinate capacity.
• LMPs be employed in sub-centres where they perform both clinical and administrative functions at the sub-centre level. This would allow easier access to primary and emergency care.
• Keep the post of medical officer for MBBS doctors, thereby deterring any competition between the two cadres of physicians.
•  Inpatient facilities at PHCs should be scaled up.
• Training to new recruited medical officers in basic clinical specialties.
• PHCs should deal with cases referred to them by sub-centre LMPs and also supervise their work.

Advantages:

• With LMPs working at the grass-root level, a single PHC would be able to handle a bigger population, allowing for more resources to be concentrated on individual PHCs for manpower and infrastructure development and also for increasing the remuneration of medical officers.
• Quality emergency and inpatient attention can be made available at the PHC-level.
• Today, less than a handful of PHCs provide inpatient care of significance.
• Concerns about the clinical and administrative incompetence of fresh MBBS graduates appointed as bonded medical officers can be put to rest.
• LMPs could be allowed to take up a postgraduate course in primary care as an option to study further.
• Reviving LMPs can help address the dearth of trained primary care physicians in rural India.