According to statistics, India constitutes 17 per cent of the world's population, but accounts for 20% of its ailments, most of which most exist in rural India.
India is currently short of 6 lakh doctors and 12 lakh nurses, despite the fact that we have 300 medical colleges, which comprise a total of 34,000 seats. However, 17,000 of these seats fall under constitutional reservations, 6,000 under other quotas, leaving only 11,000 seats for merit students. Every year, there are 11 lakh students vying for these 11,000 seats. Of these students, a negligible percentage opt to practice in rural areas.
As per the latest data available, there are 1,45,000 sub centres in India lacking medical doctors, and therefore being run by nurses. In addition, 50-60% of our community health centres are being run in the absence of doctors.
The MCI (Medical Council of India) realised this disparity and decided to do something about it by taking the National Rural Health Mission's plan for more medical colleges a step further- by proposing to set up medical schools in rural districts, where there are no medical colleges. Dr Ketan Desai, president of the MCI during a press conference held on 5 February 2010 in New Delhi said, "We have come up with a plan to set up medical schools in rural India, to absorb the surplus of candidates that don't get admission in the cities. This will address the need for doctors in villages, since students who study in cities do everything in their power to stay and practice in cities. They don't want to go back to their villages. The idea is to produce doctors trained to cater to the rural population without compromising on the quality of training. This model is not meant to replace the current one, but to strengthen and supplement it."
This new course will be called Bachelor of Rural Healthcare, and will be an undergraduate course. The only difference between this course and an MBBS will be the fact that rural schools will not impart specialised training, but will include instruction on family medicine, which is the cornerstone of rural healthcare. "These students will not be given specialised training because the sub centers are like dispensaries- there is a table, a chair and stethoscope to work with. Maybe a BP machine that may or may not work. These doctors will be trained in addressing the day to day problems of people. There is no point training them for procedures like bypass surgery, MRI, transfusions etc, because they will not be performing them. If the illness is severe, then the patient will be referred to the closest hospital that is able to handle his illness. Thus, the rural doctor's competencies will be clearly outlined," continues Dr Desai.
The proposed course will comprise of three and half years of study and 6 months of internship, making it a 4-year course. The students who get their medical degrees from these rural schools will only be authorised to practice in that notified district of the state. Their licenses will be renewed annually for a period of five years, after which they will be granted permanent registration. It is proposed that 300 medical schools be set up right away, admitting 25-50 students in each batch to address India's huge deficiency of doctors as soon as possible. Any student who has passed his 12+2 examinations with Physics, Chemistry, Biology and English from a notified rural area will be eligible to apply.
Dr Desai also addresses the monetary motivation of rural students heading to big cities, "These doctors will receive the same salary as a government doctor. There will be no difference in how much they earn." This model will be implemented on a pilot basis in a few government hospitals which have a minimum bed capacity of 150, and then extended to the private sector. Though the MCI is still waiting for the government's final decision, they have high hopes for their brainchild.
If this project is carried through in the way it has been proposed, we can hope to see a breakthrough in the way rural healthcare is administered in India today.
