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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.
