Doctors shun rural responsibility

HEALTH

A new approach is needed to provided quality healthcare in the rural areas

Sangita Jha / New Delhi

Rural to Urban India is more often a one way street. Not only for thesake of employment but even for medical needs. Rural India appears tobe lagging behind when it comes to access to quality primaryhealth care.

A disturbing trend which is fast taking deep roots is in the approachof the governments – both Central and state - to give more attention tothe tertiary health sector. A number of super-speciality hospitals arecoming up in big cities. For the government the catch word is thePublic-Private-Partnership (PPP). There should be no complaint againstthe super-speciality hospitals but it becomes a matter of concern whenthe primary health finds itself completely off the radar.

To make the matter worse, doctors often develop cold feet when itcomes to serve in the rural areas. The matter gets further compoundedwhen the medical students make beeline to get into the MD course aftertheir MBBS. Everyone wants to be a specialist. This is not without anyreason as fat money is in the super speciality hospital.

Senior consultant with Sir Ganga Ram Hospital in New Delhi R. S. Tonkrues the fact that the medical students just want to do the MD. "Noone is just satisfied with the MBBS degree. I keep telling the juniordoctors if they all work in big cities for big hospitals what willhappen to the patients in the rural areas. But no one is ready tolisten to," Tonk says, regretting the medical system which is evolving.

Even the government data candidly admits the underlying problem in the rural areas which are getting neglected in health care. Government data reveal that rural India is short of over 16,000 doctors, including 12,000specialists. As many as 12,263 specialists are needed in communityhealth centres (CHCs) and 3,789 doctors in primary health centres(PHCs). These data belong to the Union health ministry.

The government data explains why the preventive aspect of health care is not being addressed in the manner it deserves. It alsoshows why top medical institutions like the All India Institute ofMedical Sciences (AIIMS) are crowded by patients from far-flung rural areas with their medical ailment in the advanced stages.

Tonk, who in his own capacity has brought together a team ofdoctors from Delhi to reach out medical services to the rural areas ofHaryana and Western UP, believes that timely medical intervention inthe villages could well take care of the problem of overcrowding inthe premier medical institutions in the metro cities.

The health ministry data show that the shortage of doctors isparticularly acute in villages of Uttar Pradesh and Madhya Pradesh.Health experts are of the opinion that the doctors are not being givenenough incentives to work in the rural areas. As per the officialfigure 1,087 specialists and 614 doctors are needed in Madhya Pradeshand 1,442 specialists and 1,689 doctors in Uttar Pradesh.

The other states that face an acute shortage of trained medicalpractitioners in PHCs are - Assam (500 doctors), Orissa (413), Bihar(211), Gujarat (65) and Punjab (45). Each PHC is targeted to cover apopulation of approximately 25,000. The PHCs act as referral centresfor Community Health Centres (CHCs), which are 30-bed hospitals at thedistrict level.

Though under the National Rural Health Mission (NRHM), the healthministry is trying to augment the human resource crunch, the doctorsare reluctant to serve in the rural hinterland due to a host ofreasons. The ministry is giving thrust on better accommodation formedical professionals in the rural areas after this having beenreported as one of the key reason for lack of interest on the part of medical professionals.

Health experts are of the opinion that mere remuneration is not enoughto attract doctors in the rural areas. Some even opine that there should be acompulsory five years stint for doctors to work in the rural areas. Itappears that the road leading to better health facilities in the ruralIndia has obstacles all the way.

The silver lining, however, is the huge corpus of funds at thedisposal of those who wish to take health care in the rural areas, asa number of corporate bodies are coming forward as part of thecorporate responsibility obligation. As has been the experience ofsome of the senior doctors who have been mobilising doctors to spendtime in the rural areas, the opportunity is aplenty, which cansupplement the government efforts.