The
tussle between Governments and Doctors over the delivery of medical care in
rural areas never ends! While each party has something to blame on the other,
doctors have at least shown some positive impetus in this direction, unlike the
successive Governments which have simply engaged in a dirty blame game. No
solution can be unilateral; it takes two to a tango. What can the Government do
for a lasting long-term solution in this regard? This article tries to find few
possible and practical solutions. This will be an open-ended article and every
reader is welcome to add their valuable suggestions or advice suitable
modifications.
To
squarely accept a fact, the present MBBS education has merely reduced itself to
a pre-PG qualification rather than aiming at producing a qualified doctor
equipped to take on the medical needs of the real world. Doctors with MBBS
qualification alone find themselves apprehensive to cater the needs of rural /
urban population. Added to the woes are the expenses currently involved with
medical education. While private practice may not ensure enough remuneration
for MBBS doctor, practicing in rural areas has the added disadvantage of
lacking facilities for investigations.
What can
be done to overcome all these issues? If the Government can take the lead, the
doctors of India are sure to support. What can the Government do in the present
scenario?
One
solution can be the introduction of MD in Rural Medicine.
- This 3-year course should be offered to any MBBS graduate who is interested to pursue it.
- There should not be any NEET qualification for this.
- Fees should not be levied for pursuing this course.
- These PGs should be paid regular stipends.
- There should be special curriculum designed with emphasis on clinical medicine (with minimal support of investigations, which can be performed at clinic level), treatment of special problems commonly seen in rural places (snakebite, scorpion bite, insecticide poisoning etc) in addition to strong principles of triage.
- The exit exam should be strict and of very high standards.
These MD
– Rural medicine doctors should work at Government designated rural centre for
a mandatory period of 5-years as extended service.
- During this period, they should be exempted from medical litigation, but can be tried with local medical councils.
- The Govt should pay them in accordance to doctors in government services, but they should be exempted from paying income tax for these 5-years.
- The local village governance should ensure a good accommodation for the doctor and provision of two trained male and female health attendants each, to ensure involvement of community as a whole.
- With the present status of technology, these doctors should be officially connected to multiple apex centres for tele-consultation and to enable easy referrals.
At the
end of 5-year term, these doctors can be given their original certificates and
endowed with MD-Rural medicine PG qualification too along with a certificate stating
their services to the healthcare of nation. As a mark of respect for their
service, Government can offer some subsidies to them (like, concession in
home-loan rate, easy loan system for establishing their private practice etc)
Even if
each medical college can offer 3 seats per year for MD-Rural medicine course,
in a matter of 10 years, there would be a substantial number of qualified
doctors serving the remotest of rural centres in the nation. Many of the
doctors who have competed their 5-year term might be inclined to practice at
rural places, thereby adding to the volume. Those who are interested and show
the service inclination can be officially absorbed into the rural healthcare of
Government.
On a
long-run, this seems to be one of the most useful and successful ways of
catering healthcare to rural places of country. This method ensures additional
qualification to the MBBS doctor, eliminates the need for unscientific
bridge-courses, improves the financial position of physician, guarantees
delivery of healthcare services to rural places, caters healthcare awareness in
village governance, gives scope for successive improvement in clinical medicine
and many more with time.
So far,
all the methods devised by the Governments have failed to ensure rural
healthcare. It is time for the system to devise such concrete, long-term
methods of healthcare delivery. Both state and central governments should
evaluate and implement such long-term solutions rather then destroying the
healthcare with myopic measures of bridge-courses or rural posting during
internship.
All
suggestions and improvisations as well as constructive criticisms are welcome.
