Can a shorter medical course solve rural doctor shortages?

Source- The post is based on the article “Can a shorter medical course solve rural doctor shortages?” published in “The Hindu” on 23rd June 2023.

Syllabus: GS2- Issues related to development and management of health

Relevance- Issues related to rural health

News-  Last month, West Bengal Chief Minister Mamata Banerjee asked the Health Department to consider starting a three-year diploma course for medical practitioners, who would then serve in primary health centres.

Why is the idea proposed by the West Bengal CM not a right solution?

The diploma course may not provide trained doctors to adequately deal with the conditions in rural areas.

Rural areas may not have adequate facilities, infrastructure, or transport. In case of emergency or a critical care situation, trainees will face difficulties in dealing with the situation

There are concerns regarding the future status of these trainees.

India has paramedical staff like physician assistants. They can be trained better to deal with emergencies. That would be a better idea than this three-year diploma.

Why the idea proposed by the West Bengal CM sound good?

There exists a general aversion among professional doctors to practise in rural areas. In West Bengal, the number of doctors per 10,000 population is below the national average.

So, it makes sense to drive a cadre of doctors who are capable of providing first-level care to the rural countryside.

PHCs are the most essential rung of the healthcare infrastructure and should possess doctors who are fully trained. But, we can consider mid-level healthcare providers who function in sub centres, a rung below PHCs.

Is this a discriminatory move to provide less qualified practitioners for rural populations?

Arguments in favour– Health awareness among the rural population is not very good. Many do not have the resources to get the medicines they need. In such situations, if less qualified doctors are appointed in rural areas, it is not fair.

Arguments against– There is a need to differentiate between fiscal realities and fiscal ideals. The State has a prime responsibility in ensuring the highest attainable quality of care. But the realities on the ground makes it difficult to ensure highest care.

if there is no perfect solution on the horizon, and no action is taken, then it leads to even bigger discrimination.

Some kind of an interim arrangement is needed when there are not enough fully qualified doctors.

How can rural postings of doctors be encouraged?

There is a need for hard incentives. More doctors need to be recruited into rural areas rather than retaining them, because recruiting practitioners and retaining them are two different things.

To retain them in rural areas is not going to be possible for at least 30-40 years because ultimately, rural doctor shortage is a development problem.

Medical graduates do not want rural service as they are scared that they will get stuck there for ages. So, we must create a system where there is a continuous chain of doctors in rural areas.

Developed and developing countries are providing short-term courses. They provide care of a quality that is largely equivalent to doctors. So, mid-level practitioners at the sub centre level is a very important requirement today.

There is a need for a system where full-fledged medical graduates realise their social obligations. There is a need to take steps to motivate medical graduates to go to rural areas.

How wide disparity in the spread of our medical colleges can be tackled to address rural shortages?

Most medical colleges are concentrated in the southern States and some in forward States like Maharashtra and Gujarat.

About 85% of the seats are reserved for candidates from within those States.

Purely private investments are not sufficient to deal with this inequality. Government investments are also needed. Over the last decade, government medical colleges have shown a remarkable increase in numbers.

There are good examples from other countries. For example, Myanmar redistributed nursing colleges to decentralise nursing education from Yangon. It has shown great improvement not just in terms of redistributing medical colleges, but also in terms of rural retention.