Sub: Shortage of qualified doctors in rural areas and proposal to start BRMS course. Respected Sir/Madam,
We know about the shortage of qualified doctors in rural health services and Govt. of India�s proposal of starting BRMS course as a solution to this problem.
Why Govt. should not first investigate the reasons behind this situation?
Govt. should have discussed with the appropriate people from doctors association, medical institution, medical organizations, various medical bodies etc. when with less numbers of graduates available in the past. Qualified doctors were joining the rural health services then what happened to them now as almost 35,000 qualified medical graduates being produced every year in India. This clearly proves that fault lies with Govt. (either central of state) appointment policies.
1.There is no formal categorization of PHCs and CHCs (e.g. most difficult, difficult and not difficult).
2.No fair posting and transfer policy of the department, with lot of political interference.
3. The Proposal to start BRMS is a retrograde step: Health and Family welfare Department, Government of India and Medical Council Of India had over a period of time abolished Medical Diplomas like LMP, LIAM , LCPS , MCPS etc to ensure that every citizen is provided with uniform quality of Health care.
4.Adhoc posting policy (usually posting orders for 3 or 6 months or 11 months, and on completion of this period, doctors have to follow a process of further continuation). There are so many doctors who are working with this adhoc arrangements for more than 10 years. During this period, they do not get their annual increments and other privileges admissible to a regular government employee.
5. CIn majority of the states, initial adhoc postings need to be confirmed or regularized by respective state�s public service commission. And PSC does not advertise these posts annually.
6. In majority of the difficult primary health centers in rural areas, where, government wants to post doctors, basic living facilities (quarter, safe water supply, electricity back up support, communication facilities, transport facilities, etc) are not available. The rural primary health centre where he will be serving will not get regular support in the form of regular drug supply, necessary equipments, nurses and paramedical staff,.
7. Transfer policy is purely dominated by political system and also in majority of instances; monitory transactions are involved in transfers. The system never assures a medical officer that if he has completed his first tenure of 2-3 years at a difficult PHC, he/she will never be posted in his life time to these PHCs again.
These are the some of the reasons that qualified doctors are not present in current rural scenario. There is no greatness in blaming the doctors. If somebody has to blame, one must blame the apathetic Govt. policies. Govt. has only given slogans like Health is Wealth, India Lives in Villages but not acted accordingly. The Govt. has never increased the budget for health, and when budget is not there and rampant corruption is there, nobody should expect better results.
Health system totally depends on a qualified doctor at the helm of affairs but today he is ruled by the beaurocrates and these IAS fellows decide the various health programme and policies. These are the root causes of this disaster named, �Shortage of qualified medical doctors in rural area�
Create a conducive working atmosphere at PHCs for a medical officer to stay and efficiently discharge his job functions. Its not that the doctors are not willing to join PHCs, it�s the government who is creating a situation there by even the willing doctors are refrained from providing services to the needy rural population.
Nobody should blame doctors! IMA is the largest NGO of qualified medical graduates. In its Central Council Meeting held at Hyderabad has unanimously rejected the idea of staring BRMS course creating a artificial differentiation between urban and rural population which is totally inhuman and against the spirit of Indian constitution and Alma Ata declaration as well.
1.Categorize PHCs and CHCs in to most difficult, difficult and not-difficult health institutions (GOI has already developed criteria for such categorization for EAG states).
2.Strict policy of posting of fresh graduates only to most difficult and difficult PHCs only (this will automatically reduce political interference).
3.Categorize all health institutions in the district as sub taluka level, taluka level, sub divisional level and district level institutions.
4.Decide on the tenure for each place of posting (e.g. first two years at most difficult PHC, followed by next two years at difficult PHC and then posting at a good functioning PHC /CHC). Assure that once a medical officer completes his/her tenure, he/she will never be posted back to same category of institutions. If this policy is strictly followed, a medical officer who has put on 7-10 years of service, will be posted at taluka level and after 15 years, essentially at district HQ (for education of his/her children) (Government of Himachal Pradesh is strictly implementing its posting, transfer policy, and in spite of laser number of medical colleges, most difficult and hilly terrain, there are less than 20% vacancies at PHCs in Himachal Pradesh. If one state can enforce such policies stringently, why GOI should not enforce other states to follow such policies)
5.Special monitory incentives for difficult posting (e.g. government of Madhya Pradesh has agreed to sanction an incentive of Rs. 25000 to a doctors for posting at difficult PHCs. This is over and above his salary. Thus a newly recruited doctor will get around Rs. 50000 per month).
6.Other incentives could be in the form of special reservations for post graduations for doctors who have completed at least four years of service at most difficult and difficult PHCs.
7.Most important � Get away with adhoc posting policy. Issue regular posting orders, so that they get all privileges admissible to a regular government employee.
8.Accommodation: Construct PHC building with at least two quarters for doctors, two quarters for nurses, a quarter for pharmacist and two quarters for CL IV staff. Considering total construction, this can be completed in six months. Get away with construction through PWD. Hire a private agency for this construction. Thus within one year all most difficult/difficult PHCs will have their building and quarters.
9.Other incentives to doctors: Communication incentives, hiring of a vehicle for transport and field visits, incentives for recreation (e.g. audio-visual aids, books, etc), additional leave for 15 days in a year, etc.
The government is not in a position to have sufficient faculty in its medical colleges, and always play jugglery by just showing faculty on papers or temporary transfers at the time of MCI inspection. This has totally jeopardized quality of present medical education. And, the government gives a blind eye to this serious situation.
Over and above, now, if these new colleges cum up, from where we shall get minimum required faculty? Proposal of allowing retired teachers of medical colleges (after 65 years) to go to the districts (where these new colleges would come up) for teaching up to 70 years is just theoretical. A teacher, who is well settled by 65 years in a big city, will never like to go to district at the fag end of his carrier. This will be again posting just on papers and a visiting professor once in a week.
Why, the government is shying away with its responsibility of improving governance (posting, transfer policy, additional incentives, regular posting, accommodation to doctors and paramedical staff, removing political interference and monitory transactions in posting and transfers, etc)
A huge financial cost would be involved for creating physical infrastructure at district level where it is proposed to start such colleges. If the government purposefully utilize these funds for creating infrastructure in rural areas (PHC building, quarters, other basic infrastructural facilities), declares substantial incentives for doctors and even for nurses, improves governance and create a conducive working atmosphere, there is almost 100% probability to get MBBS doctors for all PHCs.
Government does not have any monitoring mechanism and will to ensure that BRMS doctors will essentially practice in rural areas only. Experiences show that majority of BAMS/BHMS doctors are not practicing their own pathy and government is just a silent observer and is not in a position to take any actions. This would also hold true for BRMS doctors.
A PHC medical officer is expected to attend medico legal cases, write medico legal reports and attend court cases. A BRMS doctor will have no competency for this and also legal sanctions.
A PHC medical officer is expected to perform regular vasectomy and tubectomy operations (family planning program is the most important component of a PHC). As per Supreme Court�s verdict, only MBBS doctor is qualified to perform these skills. This also hold true of MTP and also for provision of basic obstetric and neonatal medical emergencies. If the government is seriously concerned about reduction of infant mortality, maternal mortality (important MDGs) and total fertility rate, BRMS doctors just can not provide these critical services.
Dear friends IMA�s highest decision making body has already passed a resolution against the need of starting such irrelevant ill conceived BRMS course. No individually is above Central Council decision. All the available evidences shows that qualified medical graduates are willing to join but Govt. own policies are not favorable. Govt. was to blame doctors for neglecting rural population which is absolute lie.
Every one of us care for the health of rural populace, however the medicine �proposed by Govt. is dangerous itself�! So, dear friends we must remain united and fight against this �Govt. endorsed� quackery. (BRMS) Thanking you, in anticipation.
With Warm Regards,
IPP National IMA HQ