Lesser Doctors for Lesser Indians!!?

The Times of India on 30 th December 2009 reported an absurd proposal by the health ministry. Dr Meenakshi Gautham, a concerned health activist, filed a PIL in the Delhi High Court seeking to ameliorate the pathetic health condition in rural areas. I agree that it was something that should have been filed decades ago and then not just for the rural, but also for the urban poor. The Health Ministry and the MCI, on the direction of the High Court went into a huddle, in fact many high power huddles and then naively concluded that the magical solution for the rural folk will be to mobilize a new set of ‘doctors’ who are less trained (3 ½ years) as against the standard training of 5 ½ years for a medical graduate. This is not only discriminatory against the rural poor but a retrograde step that will create two tiers of doctors with two practice jurisdictions. The new set of BRMS graduates ( Bachelor of Rural Medicine and Surgery) will of course be expected to practice within the jurisdiction of villages while the others will stride the polished corridors of swanky city hospitals. This is an insult to the already deprived villagers who will now have the official classification of lesser Indians who deserve lesser trained physicians.

I must first pre-empt the usual argument of ‘something is better than nothing’ for these poor rural people and the repeated plaint about doctors refusing to serve in rural areas. The answer to this serious problem is not the creation of a lesser cadre for the lesser privileged but in addressing the fundamental problems in health management and manpower distribution. Most of us think that more doctors is a prescription for better health. Health, particularly at the grass root levels are achieved by education, awareness, prevention and health surveillance. It is no secret that the average doctor (rural or urban) would not be excited about pursuing these less glamorous aspects of health care.

I randomly chose a country in Southeast Asia and compared it with India based on available WHO statistics. Thailand is a much smaller country than India but has an economy that is somewhat similar. Thailand has a lesser physician density (3 per 10,000 pop) when compared to India which has (6 per 10,000) population. However every one of Thailand’s health indices is better. The life expectancy at birth is 62 years for an Indian whereas it is more than 70 for a Thai. About 79 out of 1000 live births are expected to die in India whereas the death rate in the same category is only 8 per thousand live births. Obviously, more doctors did not help the cause of public health in India. The key is commitment to health. This can be seen by the fact that the per capita expenditure on health is about three times higher in Thailand than it is India (Intl $ 109 in India and Intl $346 in Thailand). The density of nursing personnel in Thailand is twice as much as the nursing personnel density in India (28 and 13 for every 10,000 population respectively). Public spending on health in India at 0.9% of GDP is way below the public health spending in Thailand. In short, the health of a nation is not defined by the number of doctors but by the commitment of its Government. Nurses, Para -medics, health workers and maternity care givers are a greater need than poorly trained doctors. Doctors, even if they are called ‘Rural’ Doctors, are bound to chase the more glamorous aspects of health care. Nothing can stop these ‘rural physicians’ from slowly encroaching into the more financially rewarding urban and semi urban regions of the country. No regulatory body can practically restrict their activities to the ill defined concept of ‘rural’. Even legally, the courts will strike down as unreasonable restriction if a ‘qualified doctor’ is told to treat only people in a certain region (rural). It will be an infringement of the fundamental right to freedom of profession, occupation, trade or business under Art 19 (g) of the constitution. If a person can treat a rural person (as a bachelor of rural medicine and surgery) there is no way that he can be prevented from treating an urban person who has the same human features in anatomy and physiology. What is sauce for the goose is sauce for the gander !!!

The Government should focus its welfare intentions on creating incentives for doctors who are willing to serve the rural population. Creating another category of doctors and imposing unreasonable restrictions on their right to work can only be seen as an immature and poorly thought out strategy that has no respect for the sensitivities of the rural poor in addition to being hare brained and impractical.

George Paul