New Delhi, Feb. 3: Sections of India’s medical community are questioning a U-turn by India’s apex medical education regulator in signalling its support for a government plan to create rural healthcare providers to make up for the absence of doctors in villages.
The Union health ministry has proposed a three-and-a-half-year Bachelor of Rural Medicine and Surgery (BRMS) programme and asked the Medical Council of India (MCI) to design the course and syllabus. The MCI has called a meeting of medical faculty and directors of medical education from different states tomorrow in New Delhi to discuss strategies to implement the proposal.
The graduates of the proposed BRMS course would be expected to diagnose and treat common illnesses and injuries in rural health sub-centres. India’s estimated 145,000 sub-centres do not have a single doctor.
But the MCI’s support to the plan has triggered ripples of disquiet rather than delight even among sections of doctors and public health activists who have long campaigned for alternative health education to train rural healthcare providers.
A public health specialist and a non-government organisation in Chamba, Uttarakhand, who have petitioned Delhi High Court for the alternative health education model, are questioning the sincerity of what they describe as a 180-degree U-turn by the MCI.
“The MCI is trying to take over something it has repeatedly opposed in the past,” said Meenakshi Gautham, one of the petitioners.
“The MCI itself has never implemented any educational reforms to improve rural health.”
Senior MCI officials told The Telegraph the idea of an alternative health education course emerged about a decade ago from within the MCI, but there was no move from the government to implement it.
“We realised the present model of medical education is unable to produce doctors for rural areas — there was a need for an alternative education mechanism for rural areas,” said Ved Prakash Mishra, the chairman of the academic cell of the MCI.
“The BRMS course will accept candidates only from notified rural areas. Its graduates will be entitled to practice only a well-defined set of modern medicine skills in their own states,” Mishra said.
The MCI’s own documents suggest that in early 2000 it had armtwisted the Bengal government into dropping a course the Calcutta National Medical College had launched to create rural health workers. The MCI warned the college it would de-recognise its MBBS degree if the course was not stopped.
In July 2003, the MCI’s executive committee had observed that it would not encourage short or condensed health education courses.
Three years ago, a Union health ministry medical education task force proposal for a short-term course in medicine to create a cadre of health workers to deliver primary healthcare to rural areas also encountered objections from the MCI.
The task force had suggested that states should take the responsibility of training rural healthcare providers, designing their own curriculum based on their local needs.
A senior neurosurgeon who had participated in the 2003 MCI meeting told The Telegraph that the MCI was at that point not in favour of short-term courses for training healthcare providers.
“I am still opposed to this,” said Prakash Tandon, former head of neurosurgery at the All India Institute of Medical Sciences, New Delhi. “There is no guarantee graduates from the (BRMS) course would remain in villages. No one can tie them to rural areas.”
MCI officials said they had objected to proposals that sought to equate primary healthcare providers with MBBS doctors. “We could not include graduates from condensed courses into the register of MBBS doctors,” said MCI president Ketan Desai.
But a task force member said no proposal had ever asked for rural healthcare providers to be registered as doctors. “We want the design and the running of the courses to be left to the states,” said Kunchala Shyamprasad, the task force member.
Chhattisgarh is the only state that successfully ran an alternative health education system between 2001 and 2005, and produced nearly 1,300 “rural medical assistants”. Assam and Bengal have also since legislated for similar courses.
About 400 rural medical assistants have been absorbed in Chhattisgarh, said Vikas Sheel, the director of the National Rural Health Mission in Chhattisgarh. “A state is best equipped to identify local problems and design the health education programme.”
http://www.telegraphindia.com/1100204/jsp/nation/story_12064869.jsp
