Will the BRCH course that is only rural-specific help to raise the standards in rural health care services? What about the need for specialists in rural areas?
Proposals to effect changes in the way medicine is being taught are always debated widely in the country. However, in the last few years, the clash has always been around the basic issue of how to ensure equitable access to quality health care in the rural areas.
As in the case of the proposed one-year extension of the normal MBBS course to facilitate posting of house surgeons in rural areas, the suggestion of a course-cruncher programme to train rural students in health care has also met with vehement protests.
Initially proposed as the Bachelor of Rural Medical Sciences degree, now altered to Bachelor of Rural Health Care (BRCH), the four-year course will be conducted in district hospitals which will double as medical schools. A maximum of 25 local students will be selected and taught by retired professors. After completion of the course, these rural doctors can serve only in district hospitals/taluk hospitals and primary health care centres. They will not be allowed to practise in any city/corporate hospital.
The doctors who graduate will be the Indian equivalent of the Chinese “Barefoot doctors” who serve in rural areas after basic medical and paramedical training. According to the Medical Council of India, the BRCH will help tide over the shortage of trained manpower for rural health care.
Replying to questions in Parliament last week, the Minister of State for Health, Dinesh Trivedi, said the course was a revolutionary step to ensure proper healthcare in villages. The objectives are to provide trained persons in rural areas to provide treatment for ailments, early diagnosis, stabilisation and referral and promoting public health activities. He added that it was planned to have 1.47 lakh such rural doctors who would work in healthcare sub-centres at the district and village levels.
“Superfluous for Tamil Nadu”
Tamil Nadu thinks differently. According to health authorities, there is no ‘felt need' for the BRCH programme in Tamil Nadu. Currently, there are 15 government medical colleges in the State and an average of 3,500 people pass out every year.
“In Tamil Nadu, the first posting for anyone who joins the Government Medical service is in a PHC. They have no option but to serve in the villages at least for a year,” says Principal Health Secretary V.K. Subburaj.
The government absorbs about 2,000 doctors for various posts in the rural areas across the State. “However, this may not be so every year. So we actually have a waiting list of doctors registered with the exchange, and we fall back on this list when we have to fill vacancies. Again, service PGs (postgraduate doctors who are in the government service) are given preference for higher education. Those posted in remote/hilly areas also get extra points,” Mr. Subburaj explains.
In this context, a BRCH course could be superfluous in Tamil Nadu, health educators claim. Doctors Association for Social Equality president G.R. Ravindranath says, “At present all PHCs in 11 States and 5 union territories are staffed with doctors. More than twenty thousand doctors across the country are waiting for government jobs. The problem is that governments are not utilising the existing man power properly.” BRCH will affect the job opportunities of young MBBS doctors and create a new class inequality with rural students being allowed to practise only in rural areas.
Besides, he points out that the need in rural areas is actually for specialists — gynaecologists, anaesthetists and general medicine.
The only way to staunch this demand would be to introduce more seats at the PG level. He also suggests that government should use existing infrastructure and increase the number of seats in the medical colleges instead of going about expanding facilities at district hospitals.
Former Union Health Minister Anbumani Ramadoss picks up another thread of dissent in his op-ed column in The Hindu, “The issue is the impact of this scheme on the status of the rural Indian. In what way are rural Indians different from their urban counterparts? Do they deserve health care from medical personnel who are less qualified than those who attend to the health needs of their urban brothers? Are their well-being and lives less important than those in urban areas?”