The rural health cadre will not create two classes of doctors, it will help fill two different needs.
The cabinet is pondering the idea of a cadre of mid-level health practitioners, a plan that has been fiercely resisted by medical associations because they worry it will dilute the worth of MBBS graduates. It has also been recently rejected by the parliamentary standing committee on health, for allegedly creating two kinds of doctors, and consigning rural areas to the care of under-educated practitioners. On the other hand, the Union health ministry is backing the plan, as is the Planning Commission and a range of public health experts who recognise the urgent need to train medical professionals to serve in rural areas. The three-and-a-half year degree, originally called a Bachelor of Rural Medicine and Surgery, has now been amended to BSc (community health) to placate the Medical Council of India. It will include a basic grounding in primary level management of diarrhoea, pneumonia, malaria, TB, diabetes etc, and these health officers would be able to refer complicated cases to specialists.
In other words, it would begin to systematically serve the needs of rural India, so far shamefully let down by the healthcare system. In 2006, 72 per cent of India’s population lived in rural areas, but barely 26 per cent of its doctors did. But any attempt to address this shortfall through brief, intense and dedicated training programmes in community health has been shot down by medical associations. In 2009, the Delhi High Court provided a legal mandate for such a course, saying it was “better to be treated by a trained doctor than a quack”. Chhattisgarh and Assam have already experimented with the three-year model through their own legislations, with heartening results. If the Centre manages to get this plan through, it can then let states decide if they want to opt out of it, without holding back others.
What’s more, this would encourage students from rural areas to join the programme and learn to deal with common medical problems, and to serve close to their homes, if possible. This aligns their incentives to professionalise and serve their communities, unlike other unworkable recommendations like forcing MBBS graduates to spend time in compulsory rural postings. These community health officers could also choose to study further, specialise and join the mainstream if they want, through specially designed “bridge courses”. Both rural India and the urban