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Union cabinet’s decision to approve BSc (Community Health) programme gets mixed response

New Delhi: The union cabinet’s recent decision to approve the health ministry’s proposal to institute a three-year BSc (community health) programme has received a mixed response from the medical community.

The undergraduate community health programme was proposed with an aim to address the deficiency of doctors in the rural areas. According to the proposal, those that successfully complete this course can seek employment as Community Health Officers (CHOs) in rural India.

Health Minister Ghulam Nabi Azad had informed the Parliament that the proposed course was likely to be introduced in the states willing to adopt it from the academic year 2013-14.

The responsibility of framing the syllabus for the course was given to the National Board of Examinations (NBE) after the Medical Council of India (MCI) refused to take up the work.

The programme drew flak from many doctors who have been vehemently opposing its introduction because of their apprehension that it would create a cadre of half baked doctors and would also possibly dilute the functions of a healthcare professional and the medical care system as a whole.

Notwithstanding the protest, the controversial programme, pending for a few years, was passed by the union cabinet on Nov 13 overruling the recommendations of the Parliamentary Standing Committee on Health, which opposed the programme and instead suggested that compulsory one-year rural posting for fresh medical graduates should be implemented to meet the shortage of doctors in rural areas.

Not surprisingly, the medical community is again vehemently opposing the scheme and its “hasty implementation”.

Dr S K Joshi, hospital administrator and assessor for NABH Accreditation, said, “In general, I don’t think this is a good programme. This will only produce half-baked doctors with no good training and expertise. I also didn’t understand the reason behind roping in NBE. So far NBE had no locus standi except awarding DNB degrees and other similar functions. The idea behind introducing the programme is not sound and it will only give rise to more number of quacks to rule Indian rural health scenario.”

Dr M C Gupta, a medico-legal expert, told India Medical Times, “The programme is introduced with the sole aim of fooling the general public and ditching the law. Government has just tricked people by changing the nomenclature of this programme time and again. Any BSc programme is always a non-medical programme, then how can a person trained under this programme prescribe treatment and consult rural populace?”

“Four years back, Mr Azad proposed a programme with the name — Bachelor of Rural Medicine and Surgery (BRMS), which was met with heavy opposition from all quarters with the common concern that how can this programme make a doctor in three and a half years. Then they changed it to Bachelor of Rural Health Care (BRHC), which was again snubbed. Then finally they have introduced it as BSc (Community Health) programme. The MCI totally refused to prepare the syllabus and other things for the programme as the MCI has the onus of preparing programme only for medical courses,” said Dr Gupta.

“Then the (health) ministry took the Director of National Board of Examinations (NBE) into its influence and convinced him to handle the responsibility of making the syllabus. As the NBE conducts postgraduate examinations in the field of medical sciences, awards Diplomate National Board (DNB) degrees, which are now considered equivalent to MD degree, it amended its rules specifically to make an exception to prepare the BSc (Community Health) programme syllabus. How can a body like NBE agree to this and dilute the functions?” he wondered.

Dr Gupta continued, “There are two things which are most concerning about the new programme. One, according to the provisions of the syllabus the personnel trained by the said programme can perform those things, which even an MBBS is not allowed. Second, they have even superseded the role of Ayush doctors, by including provisions for the prescription of ayush medicines.”

“The pretext given by the ministry that the programme is introduced with an aim to address the dearth of doctors in rural areas is false as doctors are willing to go to rural areas but the government really never comes up with opportunities by way of expansion of infrastructure and notification for vacant posts if any. The programme is nothing but an eyewash,” added Dr Gupta.

Dr Narendra Saini, honorary secretary general, Indian Medical Association (IMA), told India Medical Times, “We have already come out with a release to oppose the move. Even if they had to come out with such a concept they should have limited the role of the person to be trained under this programme. How can a person who is not a full-fledged doctor and hasn’t gone through the extensive training like MBBS, give prescription to the patients? Their role should have been limited to the collection of data as it is one of the most pressing need of the hour to know which all diseases are prevailing in the country and to what extent. Why have they been allowed to prescribe medicines even for diseases like TB? This is totally uncalled for.”

“Also, why have they been called community health workers? Is the anatomy of a person living in rural areas different from the one living in urban areas? How can the government restrict the health workers to a particular geographical area as the course is meant to serve only rural community? In fact, I feel sorry for those who will opt for the programme, as they will end up becoming a slave. They will have no option to move out from a certain geographical area,” he said.

“This is totally a political stunt by the present government as we know they want to have more things in their kitty. Earlier, we asked them to upgrade the existing facilities in the rural areas instead of announcing such an idea but the suggestions only fell on deaf ears,” he said.

Dr Saini said, “I was part of the series of meetings in which the ministry asked the MCI to prepare syllabus for the new course. But we refused, as our job is to make doctors and not half trained army of workforce.”

He said, “What we need is to make rural people aware of the prevention of diseases, about hygiene and this is the role that should be played by the people to be trained under this programme. Health cannot be taken so for granted. We don’t want an army of quacks everywhere. This will be another menace otherwise.”

“We have already written to the ministry and the parliamentary standing committee. We are also generating widespread consensus by spreading awareness about the discrepancies of the programme and the last option would be to explore legal route,” added Dr Saini.

However Dr M C Mishra, director, All India Institute of Medical Sciences (AIIMS), New Delhi, keeps a positive opinion about the initiative.

He told India Medical Times, “In India it’s very easy to criticize things but very difficult to do something and take steps. The programme is extremely good and is a step forward in strengthening the rural medical scenario. We do need non-doctor based cadre in India as we have a large population and we lack in providing proper medical care to the masses.”

“Additionally, it is not easy to produce doctors. Producing physician for every single citizen is not possible keeping in mind the dearth of adequate faculty and infrastructure at present. Physicians are a scarce resource; their expertise and knowledge should be utilized in more important jobs than mere counselling and prevention of diseases. The job of identifying symptoms, advising, counselling and prevention of diseases can be handled by para-medical staff effectively. A doctor should be called for any possible chances of disease developing in the patient. Rest the role of prevention and care can be handled by rural health cadre; this will reduce the burden of doctors and they can use their time and energy to more attention requiring cases. The trained staff under this programme will be hundred times better than the quacks which are prevalent in rural India,” Dr Mishra said.

He further said, “In US, the same task is performed by non-doctor cadre like nursing assistants, physician assistants etc. They help in identifying symptoms and make referrals and reduce the load of doctors. Nurses and midwives can be guided by the personnel trained under this. The whole system could be strengthened under this.”

“We must welcome the move. As I said, it’s easy to criticize. If there is no system in place, there would be no criticism either. I am strongly confident about the success of the programme,” concluded Dr Mishra.

With the union cabinet’s approval of the BSc (community health) programme it’s implementation is almost on the horizon. However, since the programme has generated widespread outrage, its proper implementation and success in the developing environment of opposition and hostility remains to be seen.

by Vidhi Rathee

17 Comments

  1. kr,Chandanjyoti kr,Chandanjyoti Saturday, January 24, 2015

    Good thought Oliur Rahman.

  2. kr,Chandanjyoti kr,Chandanjyoti Saturday, January 24, 2015

    Thougha all above comments were from a reputed medical people,but all are in practical,I am a rural health practitioner of assam continuing my servces since 2010,our model of 3years course is completely successful in assam.U are mainly afraid of to rural practioners in the sense of your private practice.Because 80% people to your private chamber from rural community,if the people get treatment in their own village,why people will rush to your chamber?and how will u get black money?is not it?

  3. Dr.Mukesh Dr.Mukesh Friday, November 22, 2013

    I m serving in rural area since last 4 years in difficult area. It was designated as desert development area .. many doctors like me serving . I m waiting for benefit of of pg diploma & degree course. But centre govt. Never put column in exam & counselling form. I m so much surprised when our dear cabinet minister azad sir announced that no any doctors come to take benefit of Inservice. & doctors r not ready to serve at rural.. very limited stat where doctors r not available as like asam , chhattisgadh…. so if needed provide degree bsc of community health only 4 this stat … pls strengthen infrastructure at other stat . Privide quater & paramedical staff….

  4. Oliur Rahman Oliur Rahman Thursday, November 21, 2013

    According to me,the initiative of cntral govt.is one of the most remarkble one.I greatly overwelmed the decision taken by cabinet ministers.From my observation in chattisgar’s RMA and Assam’s RHP doing vital job in very remote areas of that particular villages of those state.They are working in such inaccessible areas where medical officers(MBBS/BHMS/BAMS…) not willing to go or even not dare to go for serving the rural community.Again we know that more than 70% of the Indian population existing in the village areas.Afterwords no any medical officer willing to serve that huge number of rural community…why??
    Though medical officer AYUSH will appoint in such type of remote areas instead of medical officer MBBS. But the thing is that the course duration of both the M O are same only the line of treatment is different.Now the thing is that at present time if one medical officer (MBBS)has capeble to became a district joint director than why ayush doctor wil deprive of that.after all course duration is same & both of M.O having same gazzeted rank. Now according to the refference of Indian medical association AYUSH doctors should go and serve in inaccessible areas instead of MBBS doctor.Now whether IMA is insulting AYUSH doctor or IMA is going to clearify that AYUSH doctors treatment is only fit for rural people and they are not capable for urban people.we all should not to forget that if today MBBS doctors were sitting in district/state high rank post,than a day will come they(AYUSH dr.)will definetly claim for the same.And in future they may knock the door of the court(high/supreme).In that contrast its not possible to retain AYUSH doctor in those inaccessible areas.we all should mind it!! Atlast what will be the condition of the remote areas people??According to me,they will be more suferer than present senerio.Because of the reason no one will be at sub-centre level,whereas in our observation we noticed that at sub centre level Assam’s RHP and Chattisgar’s RMA doing vital job like a medicl officer. For creation of rural cadre I think this is highly selusited example for us. So I think decision taken by central govt is really remarkble and prestigious one.
    So its my kind request to central govt to initiate the Bsc Community health course as soon as possible by ignoreing and others criticism and send community health officer(CHO) to that remote areas where the villagers will find them as man indeed forever.

  5. Dr.B.Ravi Kumar Dr.B.Ravi Kumar Thursday, November 21, 2013

    The new breed should work in general hospitals for a year to gain meaningful experience. The so called M.B.B.S. doctor coming out of the private medical colleges(without any clinical material) are dangerous since it is akin to having a driving license and do not know how to drive. In any case the new entrants will not do negligence like giving Injection Diazepam for the allergic reaction of Injection Ampicillin.

  6. Dr S S Sodhi Dr S S Sodhi Wednesday, November 20, 2013

    As pointed out by Dr Saini, if the BSc (CH) start prescribing medicines (even if only in rural areas), it would not be good for the health of the country. In particular, when we are facing drug resistant TB, how can the Govt justify the right of these people to prescribe anti TB medicines? Replacing a quack by this cadre is not a remedy, but a medicine which would have more detrimental effects.
    Dr Sodhi.

  7. khalid islam khalid islam Wednesday, November 20, 2013

    Those people who are opposing this Bsc CH course from begeing to till date,always remember MBBS or others medical officer will never go to serve thats very very dificult area where sub centre is situated.so,its my heartest request to central govt.,go ahead without listening of IMA or others objection and start this important,needfull Bsc CH course as early as possible…
    Realy rural people are to much hungar for such type of rural cadre and we have no need to go US or outside for example,just you people observe Chattisgar’s RMA and also Assam’s RHP.

  8. Dr Joy Augustine Dr Joy Augustine Wednesday, November 20, 2013

    While there is genuine need for doctors in the rural areas . the remedy would be to post more doctors rather than make 2nd rate Docs or Glorified QUACKS. I would suggest that an additional (extra- without changing the entrance seats) the number of seats be reserved for MBBS
    (from the real rural areas and ensure that they work from where the came from for 5 years The degree may be made valid only after this).They may be given separate training after their CRRI- for a month and then send to the rural areas as resident doctors.

    This decision to start BSc appears to be, for an alternate intend rather than saving the rural folk.
    One thing : are the rural folk second rate? to get this type of pseudo Docs.

    Well, If we were willing to work in the rural areas , this contingency would not have come up anyway.

  9. Dr Pradeep Arora Dr Pradeep Arora Tuesday, November 19, 2013

    It is easy to criticize does not mean the outrageous ideas shall not be criticized. Respectable Dr M.C Mishra has compared the perspective BSc (Community health) graduates with the paramedical staff in US. And there lies the fallacy in his viewpoint. It is abundantly clear that the said course is intended to create a medical staff that shall dispense, discharge and deliver the services of a qualified doctor, There is not a shred of ambiguity about the fact that such trained personnel would make up for the non availability of qualified MBBS doctors at rural healthcare center. Such genre of personnel shall be not be merely ancillary to bonafide doctors , but act as legitimated substitutes. So the whole premise of support to this course by DR M C Mishra is untenable and flawed.

    To compromise with quality of training and erudition of custodians of healthcare of innocent people is preposterous, to say the least. There is surfeit of qualified medical professionals , but there is abject lack of political /executive will to deploy and employ the available resources and personnel.

  10. sanjay sanjay Tuesday, November 19, 2013

    It is my personal opinion that after MBBS and MD in PSM(community medicine).the doctor is not in direct care of the patient ie he is not doing direct clinical practice. the community medicine expert need not go through 5 year MBBS.and 3 year MD . It can be don even in 3 year course as BSc( community medicines ). why wast MBBS and MD seat for community medicine

  11. Dr Neeraj Nagpal Dr Neeraj Nagpal Tuesday, November 19, 2013

    Government is covering its own failure by shifting the blame on to MBBS doctors;

    Issue is not difficult to solve. Problem is that Govt does not want to pay salary commensurate with work to MBBS doctors in rural areas. They do not have jobs (Total 31000 jobs in PHCs only 2800 vacancies, whereas 45000 MBBS are being produced annually). 5000 MBBS doctors applied for 200 job as Medical officer in rural dispensaries in Punjab.

    We are currently conducting a survey kindly go through interim results

    https://www.surveymonkey.com/sr.aspx?sm=MphqNvk9F0Avtg8fejW6mjxzWN_2ftufIZ90B4R1Qgl94_3d

    To participate in the survey

    https://www.surveymonkey.com/s/6B5FXTB

    I am sure if we have a good sample size our results will throw new light on to the problem

  12. Dr Murli Janardan Sabath Dr Murli Janardan Sabath Tuesday, November 19, 2013

    I agree with your views, Prof John. Very well said. Regards.

  13. Dr Murli Janardan Sabath Dr Murli Janardan Sabath Tuesday, November 19, 2013

    The decision to start BSc (Community Health) could have defeated the protest by IMA and other professionals, but as Prof Mishra from AIIMS quotes, it is easy to criticise than to start something afresh and make it successful. While serving in rural areas during my early days after becoming a doctor, I have my personal experience of a rural area posting where I found that the Pharmacist or so called compounders have become full fledged doctors and they ‘practice’ their skills (quackery) without any fear since there are no doctors to contest. A pharmacist posted to a dispensary or a PHC is still aware of drugs and their side effects. But it was frightening to find that the healthworkers and Multi-purpose workers (MPWs) with a very basic knowledge of some medicines; were also indulged in treating people for common ailments. (Some of them even managed complicated case by hit & trial methods) Such things were noticed widely; but health authorities just watched helplessly as they didn’t have any clue how to address the deficiency of doctors. Doctors, on the other hand, never preferred such places since infrastructure was poor and salary too was not encouraging. Hence, may be Govt have found this as a shortcut measure to address the issue. There is a need to address the infrastructure issue first to motivate qualified doctors to serve in such areas. Nevertheless, a B Sc person cannot be equated with professionals who have undergone organised professional degrees & postgraduate qualifications.

  14. Prof.Dr.Alexander John Prof.Dr.Alexander John Tuesday, November 19, 2013

    This matter has been discussed in this forum in detail earlier and it is obvious that sound technical advice is not acceptable to the decision makers. The standing committee recommendations have apparently been overlooked.
    The B.Sc Community Health degree is going to result in the formation of a group of educated unemployed with may be a few luckier ones finding jobs which give poor returns (like many of the physician assistants in our country) ! At best they can serve as Multi Purpose Health Workers engaged in preventive and promotive work.
    70 % of Indians are not going to accept these as guardians of their health .And definitely the doctors aren’t going to permit them to do any curative work. This is going to only add to the frustration of the new graduates.The Education sector would perhaps be happy to have one more programme to sell – atleast for some time.

  15. Dr Vikash R Keshri Dr Vikash R Keshri Tuesday, November 19, 2013

    I can’t understand why the esteemed group of highly qualified doctors are so worried about B Sc. (Community Health).

  16. Dr. S. K. Sharma Dr. S. K. Sharma Tuesday, November 19, 2013

    This is not a good decision of government, It is merely discriminating the rural people and creating another confusion….they will not more then existing healthcare workers….It would have been better to police the existing Community Health Nursing workers with additional training..to accomplish this task…which has been very successful in western world in form of Nurse Practitioners.

  17. Dr S.K.Behera Dr S.K.Behera Tuesday, November 19, 2013

    So long their role is limited to what Dr Mishra of AIIMS says is fine. Once they start prescribing medicine,
    they are no less compared to Quaks. How can they diagnose a disease ? Unless they know what is the problem, how can they write some medicine. If the purpose is to bridge the gap as Doctors are not available, then you are telling they are village Doctors. The very fact is you are going to have an army of legalised quacks now. I should not ever entertain this.

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