Acknowledging the difference the National Rural Health Mission (NRHM) has made to the health care system; the third Common Review Mission (CRM) says many States have come up with innovations for attracting and retaining professionals in public service in rural and remote areas.

While most States focus on financial incentives, Chhattisgarh and Rajasthan have created a special cadre for whom financial and non-financial incentives are offered.

Regulatory mechanisms of rural service bonds for medical students and pre-postgraduate mandatory qualification have helped in a big way. For the first time, vacancy among professionals in rural India has been addressed, says the latest CRM report.

Locale-based selection and a special short-term expansion of nursing school capacity under private-public partnership have led to a strategy of filling 10,000 auxiliary nurse midwife (ANM) vacancies within four years in West Bengal.

Haryana has eliminated its vacancies with a mix of incentives and simplification of recruitment processes. Chhattisgarh has adopted the three-year-doctor scheme – now the post is called rural medical assistant — to almost completely eliminate vacancies among medical officers.

Sikkim looked at measures addressing professional and social isolation by building a positive workforce environment – continuing medical education (CME) programmes and turning primary health centres into social hubs.

“Unfortunately these examples, well known for some time, have not been picked up by the States with high deficiencies.” In Rajasthan, ANM admissions are made only every 18 months for the 18-month course. The admissions can be made every year or every six months so that two or three batches of students do the course at any given time and trained ANMs are available every six months or every year. Now, little urgency is shown and expansion is weak, says the report.

West Bengal has focussed on an innovative increase of ANM education. It needed 10,000 more ANMs to close gaps and put a second ANM in place. In the last one year 2,761 new ANMs passed out of 41 schools. In addition, locality-based selection by panchayats has ensured that the candidates are residents of the areas of work.

In Haryana, the recruitment of medical officers and specialists is a success story. Of the 437 PHCs, only 10 have reported vacancies and just transient. The State has solved the problem by issuing monthly advertisements and holding district level walk-in interviews.

Chhattisgarh and Rajasthan have initiated a cadre of rural medical service corps with financial and non-financial incentives and an optional entry into the system. This scheme is popular and it may make a substantial difference to the vacancy situation in these hard- pressed States.

Sikkim has focussed on providing support to families of those posted in remote areas, besides an effort at “improving the social network and good facilities as an incentive to work in fairly remote areas.”

In Meghalaya, a combination of rural service bonds for sponsored candidates and contractual appointments have reduced PHC vacancies to zero. Given the difficult terrain, this is a significant achievement. However, dearth of specialists continues to be a problem, the report points out.

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