Can a Shorter Medical Course Solve Rural Doctor Shortages?

June 23, 2023

Context:

Last month, the West Bengal Chief Minister asked the Health Department to consider starting a three-year diploma course for medical practitioners, who would then serve in primary health centers (PHCs).

Issues with Such Diploma Course for Medical Practitioners:

Inadequate Training: The diploma course may not train trainees adequately to deal with the conditions in rural areas, which may not have adequate facilities, infrastructure, or transport.
- PHCs are the most essential rung of the healthcare infrastructure and should possess doctors who are fully trained.
Unclarity about Future: There is no clarity about their future status.
Discrimination: This would be a kind of discriminatory move as it seems to provide less qualified practitioners for rural populations and more qualified practitioners for urban settings.
- Also, full time practitioners are going to feel this as discrimination against them.
Problem Intensifier Step: Create an alternative cadre of doctors just because regular doctors don’t want to go to rural areas would acknowledge that full-fledged doctors need not go to rural areas, which would increase the problem and create a larger divide.

What Alternatives are There?

Mid-Level Healthcare Providers: A mid-level healthcare professional can deal with the immediate situation and try to transport either the patient or the appropriate medical facility/equipment.
Motivate Full-Fledged Medical Graduates towards Social Obligations: Need to bring in a system where we make our full-fledged medical graduates realize their social obligations.
- We do have adequate medical graduates, but we have to take steps to motivate them to go to rural areas.
More Recruitment: We should be looking at ways to recruit more doctors into rural areas rather than retaining them, because to retain them in rural areas is not going to be possible for at least 30-40 years because ultimately as rural doctor shortage is a development problem.

Challenges with the India Health Sector:

Accessibility: Accessibility to healthcare services remains a significant challenge in India, particularly in rural areas.
Affordability: Healthcare costs can be a major burden for a large portion of the population, especially those from low-income backgrounds.
Quality of Care: Ensuring consistent and high-quality healthcare services across the country is a significant challenge.
Infrastructure and Technology: Healthcare infrastructure, particularly in rural areas, often lacks proper facilities, medical equipment, and technologies.
Public Health System: The public health system in India faces various challenges, including weak healthcare governance, inadequate healthcare funding, and fragmented implementation of healthcare programs.

Recommendations to make Indian Healthcare Better:

Implementation: Faster Implementation of the National Digital Health Mission would prove to be the most important infrastructure initiative
Use of Technology: Tele-radiology, AI based software for reporting would help bridge the Doctor to Patient Ratio.
Low Cost Devices: Make in India for High end products like MRI, CT Scanner, Ultrasound machines at reasonable prices would help to increase the Installed Base in tier 2 and 3 cities.
Innovation: Innovation, supported by a culture of scientific research specific to the Indian subcontinent, will not only help us treat patients better but also keep us abreast with physiology specific to our country.

Key Government Initiatives in Health Sector:

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)
Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
National Health Mission

Conclusion:

To provide equal medical services in each corner of India is not just a need, but a democratic value, which India has to achieve.
For achievement, we can learn from Myanmar’s step of redistributed nursing colleges to decentralize nursing education, which has shown great improvement not just in terms of redistributing medical colleges and having representation across provinces, but also in terms of rural retention, because much more than incentives, pecuniary or intangible, recruiting doctors from rural areas and placing them there is one of the evidence-based solutions to improve rural retention.

Additional Information:

Fundamental Right related to Health
- Article 21 of the Indian Constitution guarantees a fundamental right to life and personal liberty. The right to health is inherent to a life with dignity.
Directive Principles of State Policy related to Health
- Articles 38, 39, 42, 43 and 47 of the Indian Constitution mandates states to ensure the effective realization of the right to health.
Sustainable Development Goal (SDG) related to Health:
- SDG 3 deals to ensure healthy lives and promote well-being for all at all stages.
International Convention related to Health
- India is a signatory of Article 25 of the Universal Declaration of Human Rights.
- It is an international document adopted by the United Nations which grants the right to a standard of living adequate for the health and well-being of humans including food, clothing, housing and medical care and necessary social services.