0 Bewertungen0% fanden dieses Dokument nützlich (0 Abstimmungen)
20 Ansichten1 Seite
The government hopes a new Community Health course will help fill medical posts in rural areas. In 2011, primary health-care centres in villages faced a 12% shortfall in physicians. The IMA con tends that the course would be a compressed version of the MBBS.
The government hopes a new Community Health course will help fill medical posts in rural areas. In 2011, primary health-care centres in villages faced a 12% shortfall in physicians. The IMA con tends that the course would be a compressed version of the MBBS.
The government hopes a new Community Health course will help fill medical posts in rural areas. In 2011, primary health-care centres in villages faced a 12% shortfall in physicians. The IMA con tends that the course would be a compressed version of the MBBS.
India looks to a new course to x rural doctor shortage Indias Government hopes a new community health course will help ll medical posts in rural areas. But the Indian Medical Association is against the idea. Dinsa Sachan reports. The Indian health ministry is just one hurdlea Cabinet approvalaway from implementing a community health programme that could remedy the huge shortfall of primary health- care providers in the countrys hinterlands. Rural India is largely deprived of a medical workforce because allopathic doctorswho have at least a 55 year Bachelor of Medicine and Bachelor of Surgery (MBBS) degreeprefer urban settings. In 2011, primary health-care centres in villages faced a 12% shortfall in physicians. The countrys 148 124 sub-centres, which are the closest stops for primary care for people living in villages, are currently only manned by midwives. During the past decade, many expert committees have advocated deploying mid-level health-care workers primarily at sub-centres. Bearing these recommendations in mind, as well as a writ petition led by public health activist Meenakshi Gautham, the government first mooted the proposal for a community health coursenow called Bachelor of Science (Community Health)in 2009. The schemes main critic has been the Indian Medical Association (IMA), a national trade union of doctors. The IMA con tends that the course would be a compressed version of the MBBS and would dispatch unprepared doctors to villages, putting the health of their inhabitants at risk. A parliamentary committee took note of the matter in 2011 and presented a report in the parliament in March this year, criticising the course on grounds similar to those given by the IMA. However, the government informed the Delhi High Court on April 18, during the hearing of a contempt petition, that the health minister was going to go ahead and seek Cabinet approval for the course. If the Cabinet gives a green light to the course, it would clear the path for implementation. Although the IMA argues that the programme would create a rural-urban divide, some evidence suggests the opposite. A study published in Social Science and Medicine earlier this year suggests that mid-level health workers are a viable solution for Indias health- care problem. In 2001, the state of Chhattisgarh started its own version of a 3-year community health programme to address the shortage of medical practitioners in its villages. The products of this coursecalled Rural Medical Assistants (RMAs) have been in service since 2008. The study showed RMAs perform as well as MBBS doctors when it comes to diagnosing ailments such as pneumonia and diarrhoea. Lead author Krishna D Rao, of Public Health Foundation of India, a non-profit organisation, says the results prove RMAs are adequately trained to handle rural health care. The study clearly shows that clinicians with a shorter duration of training, such as RMAs, are the answer to rural Indias problem of shortage of doctors, Rao says. Although the study could not persuade the parliamentary com- mittee, it has elicited positive response from the Chhattisgarh gov- ernment. T Sundararaman, exec utive director of National Health Resource Centre, and a coauthor, says, The study made it clear to the state government that the RMA model is a workable model. Encouraged by the studys results, the Chhattisgarh government is now investing in nurturing its existent RMA cadre by sending them for refresher trainings at the Christian Medical College, Vellore, one of Indias top medical schools. The IMA, however, remains un- impressed. D R Rai, senior vice president of the IMA, says, If doctors arent going to villages, nd out why and x it. Community health workers cant replace medical practitioners. Public health activist Gautham disagrees. There is evi dence that doctors will not go to villages. The IMAs doctors or nothing approach for primary care has succeeded in keeping millions of people in persistent deprivation for years, she argues. Vishwas Mehta, a joint secretary in the health ministry, says the ministry is committed to the implementation of the course as well as other rural health- care reforms. Were also looking at upgrading the status of Ayush (alternative medicine) practitioners to public health o cers by providing them with a bridge course. A proposal for mandatory internships in rural areas for fresh MBBS graduates was also mooted recently, he tells The Lancet. In a hearing on Aug 29, the Delhi High Court asked the government to le an a davit on the progress on the Cabinet front. Despite the long wait, Gautham is condent that the Cabinet will eventually approve the course. The current Union Cabinet has experienced and well informed minds. If the ministry presents its case well, there is no reason why they shouldnt get a yes, she says. Dinsa Sachan The study clearly shows that clinicians with a shorter duration of training...are the answer to rural Indias problem of shortage of doctors... U S A r m y / S c i e n c e P h o t o L i b r a r y For the Chhattisgarh study see Social Science & Medicine 2013; 84: 3034. http://dx.doi. org/10.1016/j.socscimed. 2013.02.018