The right prescription? Rural stint for PG students good, but don’t burden private colleges

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September 23, 2020 6:00 AM

While many experts have called for a series of measures—conversion of district hospitals into teaching hospitals, creating a cadre of nurse practitioners, etc—to bridge the healthcare personnel gap, the government has had marginal success in bolstering numbers.

Ayushmaan Bharat and the National Health Mission will play a vital role in ensuring that no one is left behind when it comes to accessibility and affordability of quality of healthcare.

India has long needed a remedy for its chronic shortage of doctors. If the pandemic exposed how bad this was in the cities—recall Mumbai and Delhi seeking doctors & nurses from other states, and Kerala creating a temporary cadre of fresh MBBS graduates to serve as Covid-19 doctors—the situation is much worse in the rural parts of the country. Indeed, as per the health ministry’s Rural Health Statistics 2019, at the end of March last year, there was a shortfall of nearly 18,000 specialists at community health centres in rural areas in the country. Overall, against the WHO ideal of one doctor per 1,000 population, India has just 0.68.

While many prominent experts, including Dr Devi Shetty of Narayana Hrudayalaya and Dr K Srinath Reddy of PHFI, have called for a series of measures—conversion of district hospitals into teaching hospitals, creating a cadre of nurse practitioners, etc—to bridge the healthcare personnel gap, the government has had marginal success in bolstering numbers.

Indeed, as FE has pointed out before, even the compulsory rural practice rule for medical graduates, with large indemnity liabilities to be free of this, hasn’t really worked, with graduates neither fulfilling rural practice obligations nor paying the bond amount, and the state governments being reluctant to take punitive action. Indeed, at many prominent medical colleges, more than 90% of the graduates have defaulted on bond release payments.

Against such a backdrop, the move to make a district residentship programme (DRP) mandatory for PG students—they will have to spend three months during their third, fourth or fifth semester of PG at facilities that come under the district health system (DHS) including primary health centres, community health centres, district hospitals, etc—must be cheered, with a few caveats.

As per the DRP norms notified by the Board of Governors in supersession of the Medical Council of India, all PG students at any medical college, public-funded or private, will have to serve at facilities under the DHS on a rotation-basis. Satisfactory completion of the DRP will be a must for a PG student being allowed to sit for the final degree examination. While the college will have to coordinate this with state governments, they will also be required to keep paying their PG students the stipend they receive in a normal course even when they have been deputed to the DHS.

On their part, state governments may consider paying an honorarium in recognition of their services. This, if implemented properly (without the laxity that has characterised the indemnity bond initiative) should bolster rural healthcare personnel strength. With hands-on experience of the diverse healthcare needs noticed in settings that involve the wider community, the students are sure to gain while rural India’s needs for allopathic specialists will be somewhat met.

However, the government needs to factor in the burden it places on private medical colleges who will be forced to pay for the government’s need to bolster healthcare personnel; the least the government can do is to ensure that it takes on the stipend burden for the period PG students are deputed to the DHS. Similarly, for the students who have paid hefty sums to get into PG courses in these colleges, the government will need to ensure states pay competitive honoraria. Else, it should just limit the scheme to government colleges.

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