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