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Doctors for the villages

The Union Government's decision to make it mandatory from 2008-09 for all new MBBS graduates to serve in a rural area for one year as a precondition for being granted permanent registration, is commendable. Health Minister Anbumani Ramadoss' initiative is in sync with India's public health needs and health-for-all commitments. Radical surgery is needed to correct distortions in health delivery, particularly of basic health services in the rural areas. The rural postings, while aiding this, will underpin the National Rural Health Mission — a programme meant to improve health care access, in keeping with the promise made in the Common Minimum Programme of the United Progressive Alliance. The government seems to have convinced the Medical Council of India and other professional bodies to support the proposal, overcoming their initial reluctance. Today, up to 40 per cent of the doctors posted in primary and community health centres fail to turn up. About 29,000 graduates pass out of medical colleges each year. The rural postings will provide the young doctors the right orientation and perspective with regard to the tasks at hand — which involve additional challenges stemming from large-scale poverty and malnutrition. The deployment of more practitioners of modern medicine in the rural areas will also check quackery. The absence of enough doctors encourages quacks to flourish and leads to dependence on unproven alternative systems. In contrast to the predominantly urban presence of the allopaths, 60 per cent of the 5.5 lakh practitioners of traditional medical systems are in the rural areas.

The initiative, however, will go only part of the way in meeting the larger challenges. Many primary and community health centres lack infrastructure — patient care amenities, diagnostic tools, drugs, staff accommodation, and so on. Doctors posted in rural areas will face some hardships, to offset which they should be given adequate incentives. There should be systems in place for the graduates who are thus posted, not only to widen but also sharpen their knowledge and skillset through programmes for professional enhancement and continuing medical education. A simultaneous move to make it mandatory for doctors to attend periodic CME sessions is welcome. Complementary changes in the system of medical education itself, in terms of content and orientation, are needed. Some 70 per cent of India's 4.5 lakh-plus doctors and 80 per cent of the six lakh hospital beds are in the urban areas. Health expenditure figures reflect the urban bias. Correcting this skewed pattern should be the long-term goal.

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