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Push to create cadre of family doctors for rural India

5 Comments
Date:Apr 24, 2013

Government's National Health Systems Resource Centre is finalising recommendations which are likely to seek inclusion of family medicine in MBBS curriculum

In an effort to address the need for middle-level doctors in rural areas, the National Health Systems Resource Centre (NHSRC) will soon submit the recommendations of its task force on promoting the discipline of family medicine. NHRSC is the  technical support institution for government's flagship rural health programme, the National Rural Health Mission.

The recommendations that have been drafted were discussed at the first national conference on family medicine and primary care, organised on April 20 and 21 by the Academy of Family Physicians of India (AFPI), in association with the National Rural Health Mission (NRHM). The conference, titled “Preparing multi-skilled and competent primary care physicians: consensus on family medicine in India”, emphasised on the need for  general doctors, in times when everyone is focusing on specialities and super-specialities. A practitioner of family medicine, also called general physician or family doctor, does not have any specialisation but is equipped to address basic health issues related to any discipline.

"Details are being worked out, but the three main recommendations include the introduction of the concept in the MBBS curriculum; recognition of the course on family medicine by Medical Council of India; and creation of a post of family medicine practitioner at all community health centres," said Raman Kumar, president of AFPI.

Vishwas Mehta, joint secretary of health ministry, said that he and other officials were surprised to know that the course in family medicine is not recognised by the Medical Council of India. He said that the ministry will push for it as having middle-rung medical officers is crucial to make healthcare accessible in rural India.

"It is important to create posts for these doctors which will act as incentive. There is low enrolment in the course where it is taught, and the seats are not fully occupied," said Prasanth K S, senior consultant for public health administration with NHSRC. Among the prominent medical colleges which offer the course are Christian Medical College, Vellore, and AIIMS-Bhopal.

Skewed priority

Pavitra Mohan of Ajeevika Bureau, a non-profit based in Udaipur working among seasonal migrant workers, is sceptical. "We did not set up a task force to ensure that doctors earn degrees in specialisations and super-specialisations. The courses became part of the system as the demand increased. Then why a task force for family medicine? The government should create posts, and automatically there will be people training in the discipline," he says.

Other participants at the conference asked for innovative models of training."There should be different levels of training for people with different qualifications and needs. An established doctor can be trained for six months, while a fresh graduate will need two years. Modules should be formulated accordingly," said a participant.

 

AddThis

This only means the National Rural Health Mission is going to gulp down a few more hundred millions of money from government. Because NRHM is behind this idea of creating a new special task force of family doctors for rural villages, it is going to be another massive scam. Once we look at what this money-gulping organization has been doing through the past years, we can understand the motive behind their new scheme, which is to be implemented through their subordinate organization. The state organizers of National Rural Health Mission live like kings with the money allotted from central government funds. It is widely believed that Accountant General’s branches in the states are not allowed to look into their accounts. We shall take the particular example of Kerala which has the highest rates of literacy and health standards. When this scheme was introduced, the initial amounts allotted were utilized not for creating infrastructures in villages but for purchasing scores of costly cars for the officers to travel. They were all air-conditioned cars. Why were non-a/c Maruti 800 cars not purchased? The first directive to have come from central government ought to have been limiting only one car to each district and limiting the purchasing price of one car to 3 lakhs rupees. Costly cars purchased should immediately be sold in auction and replaced with Maruti 800s. This would bring millions back for being diverted to the rural areas. Then the spree was for purchasing buildings. The health services departments in all Indian states have enough buildings and space in the districts and in the headquarters to house NRHM offices. It is also transparent to operate this scheme from health services premises. Why did government allow this spend thrift scheme to operate outside the main stream? Was it not to allow a new generation of officers to have enough freedom for corruption? The organizing and operating of the scheme should have been from the government secretariats. Every building taken by NRHM pays exorbitant rents and every building purchased cost far higher than market rates. Crores of rupees were pocketed by state organizers on this account. Does the government of India have this much money to spare? Is it not people’s money? Every building purchase and rental by NRHM officers should be investigated and illegally made money brought back to public exchequer. Now it has become something lucrative to be posted as an NRHM officer, just like postings to key check posts of the sales tax department. If the salaries the officers draw are looked into, we will not believe that they are serving the poor government of India. Each decides his own salary which is unbelievably higher than what are paid in equivalent posts in the state health services. Some argue that unless paid salaries commensurate with corporate standards, bright officers would not be available to lead NRHM. Why should we pay corporate salaries to a bunch corrupt to the core? There are brighter candidates to replace them at the state health department level salaries, at least in Kerala. Purchase of luxury cars, purchase and rental of buildings at exorbitant prices and rates and self-fixation and drawal of inconceivably high salaries in all states must be immediately investigated by the government of India and the state branches of the Accountant General assigned the charge of conducting their audits.

26 April 2013

Following people’s resistance to horrible corruption in the National Rural Health Mission in almost all states in India, and also considering the demand for subjecting the accounts NRHM to auditing, the Government of India recently ordered that all NRHM in the states and in the centre will be from here onwards audited by the Comptroller and Auditor General of India. But this organization has never acquiesced to this auditing. Is it they who are to decide whether their accounts should be audited or not? Which cheating book-keeper will happily ever consent to auditing by competent agencies? Government also directed that all state branches should host websites in which every expense should be posted daily for people’s auditing, along with every detail of staff engaged and their daily activities. Not one state branch has done this. They all now have websites but they show only the photographs of a few pompous officers, attending seminars, holding discussions or inaugurating buildings. The most recent activity of NRHM in many states is constructing buildings which we all know, is a very lucrative business indeed. There are Public Works Departments of government in all states who are proficient at doing such things. NRHM is not a construction company. We have the history of Kerala Health Research Welfare Society which was constituted in Kerala decades earlier, with the promise that very advanced research and development was going to happen in Kerala. The only thing they ever did was taking hold of health services’ land, constructing pay ward building in hospital campuses and fattening themselves by collecting cut-throat rent. The agreement was to return the government land and the buildings back to the health department after 20 years and this private-like enterprise, following the same economical and administrative freedom and agility like the NRHM never handed back the land and buildings even after 31 years. Will anyone believe that it is headed not by a medical director but by a regional engineer-like some kind of thing? This NRHM is modelled after this KHRWS as this milking cow of Kerala is known to all Indian politicians, Kerala for a long time having been far advanced in health standards, now though pushed back. NRHM is run with people’s money and if it is meant to serve rural India, let them be forced to leave the cities and go to the villages. There will soon be another National Urban Health Mission, which can be sure of. If we go inside and learn the operation of NRHM, we will wonder how hard the state organizers strive to expend the money allotted to them. Because they are unable to do so, they come up with the strangest of ideas to expend it. Is this what Central Government planning is? Spending money because there is money to spend!

26 April 2013

Thanks Jyotsna for wonderful article about Push to create cadre of family doctors for rural India.
I am personally feels there should be Private or some NGO contribution for making good Doctors , Engineers & scientist. We have made some bold infrastructural change like in Uttarakhand state. Now there are many colleges that are built through public private cooperation.
Thanks
Joyti Singh

1 July 2013
Posted by
Joyti Singh

India needs more of GPs than Specialists. If you see rural areas theres no service in medicine there. Doctors need to be rural areas who specilaisez and handles common problems in rural areas.

28 October 2013
Posted by
Dr Kusuma Kumari G

This is the most sensible decision taken by Goverment of India. India needs these grassroot Doctors to take care of rural people in India. Rural Healthcare in India is pathetic and poor. I lived in a village in India called Kuttikole in Kerala There was no good goverment doctor there and we used to depend on one private practioner, He was so burdend with work that he was hard to consult. Now Goverment must promote this move so that rural peopel get good healthcare. I am sure this is a right move. May this turn true.

23 February 2014
Posted by
Dr Kusuma Kumari G

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