The proposal of an Indian health ministry panel to create a parallel stream of medical practitioners to improve the delivery of health care in rural areas has triggered a debate across the nation's medical community.
The panel, which includes senior doctors and health administrators, has proposed a three year training course to produce community health practitioners who would be deployed in rural areas that have an acute shortage of graduate doctors.
However, officials of the Indian Medical Association said that any such move would be “dangerous” and urged the government to develop alternative solutions to address the shortage of rural doctors.
The ministry's panel has described the shortage of doctors in rural India as alarming. Several thousands of posts for doctors and surgeons remain unfilled. About 13% of all medical posts and 38% of the posts of specialists lie vacant in primary health centres in rural areas.
“We have to be realistic and accept that doctors who have completed the MBBS (Bachelor of Medicine and Bachelor of Surgery) programme or have acquired even higher medical degrees are unlikely to want to go to villages,” said Kunchala Shyamprasad, vice president of the National Board of Examinations and a member of the panel.
Under the existing medical training system the medical degree course takes five and a half years, and higher degrees require a further two years or more.
As an additional solution the health ministry has been considering imposing a mandatory term of rural service of one year for doctors. “But we won't achieve much by pushing doctors into areas where they don't want to go,” Dr Shyamprasad said.
The panel said that the existing pattern of medical education in India does not prepare doctors to serve in areas that are poor in resources. Medical graduates do not have the confidence to function in a setting that lacks multidisciplinary support or advanced diagnostic hardware, it said.
The three year course for community health practitioners is expected to involve lessons in basic medicine—including anatomy, pharmacology, pathology, obstetric care, trauma and clinical assessment—and internships.
But Indian Medical Association officials have condemned the proposal, warning that it would put rural patients in the hands of untrained people.
“This would be a dangerous and retrograde move,” said Sanjiv Malik, the association's president. “In an age of specialisation this proposal seeks to create half baked doctors.
“There could be many situations that community health practitioners would be unable to handle. How would a community health practitioner respond when a woman in labour abruptly needs a caesarean section?”
However, some senior members of the medical community have said it would be worth while for India to test the idea. Martanda Valiathan, a professor at the Manipal Academy of Higher Education in Mangalore, in the southern state of Karnataka, said, “There are several issues to be resolved: the faculty, the syllabus, the procedures they will be allowed to do and will not be allowed to do.
“But after decades of failing to get qualified doctors to serve in rural areas, I think this is something that could be tried out.”
