|Year : 2010 | Volume
| Issue : 1 | Page : 1-2
Rural doctors course: Need and challenges
Vice President IPHA (North Zone) & Professor, Department of Community Medicine, Maulana Azad Medical College, New Delhi-110002, India
|Date of Web Publication||29-Sep-2010|
D K Taneja
Vice President IPHA (North Zone) & Professor, Department of Community Medicine, Maulana Azad Medical College, New Delhi-110002
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Taneja D K. Rural doctors course: Need and challenges. Indian J Public Health 2010;54:1-2
Government of India has decided to initiate a four year course in Bachelor of Rural Health Care, also nicknamed 'Rural MBBS' and later renamed as Bachelor of Rural Health Care, against the current five and a half year MBBS course to overcome the shortage of doctors in the rural areas  .
As per the latest figures available about 10% PHCs in the country are without doctors and 19.47% PHCs in the Empowered Action Group (EAG) states are without doctors  . Situation is likely to be worse if we look at the statistics in 300 most backward districts of the country. The shortage will accentuate as we try to meet the Indian Public Health Standards which require three doctors for each PHC. The shortage of doctors in rural areas remains in spite of almost doubling of number of medical colleges and medical graduates over last two decades. The chances of MBBS doctors being available for services in the rural areas are remote as majority of them prefer to go in for post graduate courses and settle in urban areas  . Earlier moves by the government and decision by Central Council for Health and Family Welfare in 1996 to make rural health service compulsory for new doctors could not be implemented due to various reasons including poor infrastructure in the rural areas. Not only there is shortage of doctors in the rural areas but those who are posted there do not have the aptitude to work there as their training and aspirations are inclined towards urban areas. Therefore, there is definitely a need for alternative to current model of MBBS doctors who are trained to provide basic health care in the rural areas.
Before, implementation of the said course it is imperative to look at a few of the challenges and find possible solutions for them to ensure successful implementation of the course and outcome as desired.
As per Medical Council of India the students with biology in +2 will be enrolled from rural schools on the basis of 12 th class marks. They will be allowed to practice in areas with a population of less than 50,000 and for five years they will not be eligible for post graduation courses  . It has been presumed that these measures will result in favorable attitudes to serve and settle in rural areas. Although, rural schooling up to 12 th standard is likely to result in a larger proportion of them being inclined to serve in the rural areas, but it is not sure that they will not be lured by urban economy and the facilities. The deterrents such as allowing them to practice only in areas with a population of less than 50,000 can be challenged in the court. Any possibility of pursuing postgraduate courses will keep their interests and efforts towards that rather than serve in the rural areas, for which the course is envisaged. Thus defeating that very purpose for which it is meant. It is worth mentioning here that in the recent years training in MBBS course, particularly internship, has been a casuality of postgraduate entrance examination as students have been preparing for this examination during the undergraduate years with little attention to training aspects, required for an MBBS doctor. In order to overcome these anticipated problems, the new course should be semiprofessional, 'non doctor' on the lines of nurse practitioners and medical assistants in UK and Canada. A separate council should also be created for recognition and regulation of this course. Such a course should not have eligibility for post graduation in various medical disciplines.
Second challenge will be posed by non availability of candidates who have passed 12 th in biology along with physics and chemistry from the schools located in rural areas. It has been observed that there is dearth of Senior Secondary Schools, particularly with science stream in the rural areas of the backward districts. This calls for out of the box thinking so that suitable alternatives can be worked out. Capacity building at the school level will be a long term measure and will have to be addressed through education department. However, in the short term, meritorious students who have passed 10 th class from the rural schools may be supported with boarding and lodging facilities for studies at sub- district or district schools.
It will also be worth trying, may be on a pilot basis, to admit in this course a proportion of paramedical workers who have the plus 2 level schooling with biology and have been serving and residing in the rural areas for at least five years and have been doing good work in their areas. In all probability they will stay in the rural areas after completion of this course as they have used to working in that environment. Second advantage with them is that they are familiar with the local social organization and hence involving the community in planning and health care delivery will be less difficult for them. It is a common observation that at the PHCs where doctors could not be posted or have not been coming for duties being on long leave, the paramedicals provide treatment for common ailments and referrals in emergencies and serious cases. Equipping them with more skills through such a course will not only benefit the rural population but also provide opportunities for carrier progression to them and motivate them for good work.
Next important question is about the training. It has been proposed that they will be trained for first two years at PHC, CHC and district hospitals, followed by training at a tertiary care hospital.  It is not clear as to who will be their teachers and trainers during this period. Do we expect service doctors at these facilities to provide them the required training when they have not been trained as teachers and trainers? In addition, these facilities in 300 backward districts where the new course is proposed are short of doctors and deficient in infrastructure. So, how can these be effective training institutions? Besides these issues it will be pertinent to address the issues of creating classrooms, hostels and other teaching requirements in these institutions. It is not clear as to when they will learn the pre and para-clinical disciplines without which it will not possible to scientifically learn clinical and community health care aspects at the PHC, CHC and district hospital postings.
It has been stated that curriculum for this course will be modular.  It is a good proposal for stepwise learning. However, if these modules are to be available only in English, it will be difficult for students from rural schools to comprehend these modules and internalize the presenting complaints of the patients. Therefore, it is suggested that these modules may be in local/ mixed language to ensure better comprehension. The symptoms be described in prevalent local terms as well. This will also ensure better communication with the local population.
Thus, there is definitely a need for the new course. However, it has to be safeguarded that it does not become another channel to lucrative urban medical practice and race to postgraduate medical courses, failing the very objective of a basic doctor. Efforts will have to be coordinated with education department for availability of students with + 2 level education in biology from the rural schools of selected backward districts of the country, suitable training materials developed in local language and concerns on trainers and training facilities addressed to make a successful beginning of the course.
| References|| |
|1.||The Hindu, Feb 6, 2010, New Delhi. |
|2.||Ministry of Health and Family Welfare. Table 23, Number of PHCs with Doctors and without Doctor/Lab Technician/Pharmacist. RHS Bulletin 2008,36. Available from: http://www.mohfw.nic.in/rhs bulletin/march [last cited on 2008]. |
|3.||Raha S, Berman P, Bhatnagar A. Career preferences of medical and nursing students in Uttar Pradesh. India Health Beat 2009;1:In Press. |
|4.||What is Bachelor of Rural medicine and surgery? Readers Zone 2 nd Jan 2010. Available from: http://readerszone.com/India/what-is-bachelor-of-rural-medicine-and-surgery.html . |