The rural service conundrum
RAMYA KANNAN
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The Medical Council of India needs to meet student expectations on pay and certification for the compulsory rural medical service plan to work.
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Photo: M. Moorthy
Not convinced: Some students are ready to go to villages if their remuneration demand is accepted.
About the same time last year, much of the medical fraternity in the country was up in arms. Some of them vehemently protested the move by the Union Health Ministry to impose a year’s compulsory rural service as the criteria for MBBS graduation, others brushed aside the idea as unfeasible.
With protests breaking out in many parts of the country, the Ministry decided to appoint a committee to go into the grievances of medical students. A committee was constituted under the chairmanship of R. Sambasiva Rao, former vice-chancellor, NTR University of Health Sciences, Vijayawada.
Union Health Minister Anbumani Ramadoss said the move was a way to tide over the crisis of the vast rural population being underserved by health services.
The bulk of the protests came from medicos, who protested “wanton” extension of an already lengthy period of study. Groups among them opposed the move to “use” medicos as replacements for medical officers at a fraction of the cost that regular staff would be paid. “Students cannot substitute medical officers. The government was trying to set aside its responsibility towards appointing medical officers and tried to make do with students, for whom they can pay a measly stipend,” said G.R. Ravindranath, general secretary, Doctors Association for Social Equality (DASE).
DASE was fundamentally opposed to the concept of a “compulsory service.” Other student groups in the country, however, had a more moderate position on this. A response articulated on www.rural-doctors.blogspot.com, reads thus: “None of the junior doctors is averse to one year of rural service if it is treated as service and they are given full pay of Rs. 18,000 per month for Medical Officers, which is likely to go up to Rs. 22,000 soon.” Medicos also wanted this one year to be counted as part of their service.
Sceptics, some of them from non-medical fields, joined the debate, wondering aloud if posting yet-to-be qualified persons would compromise the lives and health of patients in rural areas. Dr. Anbumani retorted saying the students would be sent for rural service only after finishing House Surgency, which makes them qualified. Further, they would be supervised by other senior medical doctors.
In January this year, the Committee submitted its recommendations to the Union Health Ministry. Prof. Sambasiva Rao, speaking to The Hindu, said he was constrained not to reveal the details of the recommendations until they were released officially, but that the suggestions were made based on discussions with all stakeholders in 20 towns and cities.
Speaking to The Hindu in April this year, Union Ministry sources said the Committee had recommended that anyone who wanted to apply for a postgraduate degree in medicine (or any specialities) in any institution — private or public — within the country would have to put in a year’s service in a rural area. Without a certificate attesting the one-year rural service, students’ applications for any postgraduate course would not be considered.
The committee has also recommended that the students be paid a stipend of not less than Rs.10,000 a month for the one-year period. Further, it suggested that any medico wanting to join the government medical service would also have to put in one-year service in a rural centre — primary health centre, taluk level hospital and a non-taluk level hospital. They would be paid the same stipend, and additionally, this one year would be counted as part of their service.
The Ministry has forwarded the recommendations to the Medical Council of India for its perusal. The MCI has, so far, made no announcement on the same.
As far as Tamil Nadu goes, it continues to be a model state for implementation for providing health services, says Health Secretary V.K. Subburaj. Therefore the problem of lack of doctors in rural areas is not a big issue. “We keep filling the vacancies as and when they arise, though we do not have a policy of recruiting a specific number of medical graduates every year. Also, the first posting for doctors who sign up with the government medical service is in rural areas,” he explains.
He says that at the MBBS level, there are sufficient numbers to serve in rural and non-rural areas, but the problem that exists in rural areas is frequent absenteeism and irregular attendance. The state government is trying to address this issue, he adds.
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