Odisha HRD

Approaches to deal with medical vacancies in rural areas

January 5th, 2010

Following are excerpts from a report in http://www.hindu.com/2010/01/03/stories/2010010360571100.htm that points out some schemes taken up by some of the states in India.

• Chhattisgarh has adopted the three-year-doctor scheme – now the post is called rural medical assistant — to almost completely eliminate vacancies among medical officers.
• Sikkim looked at measures addressing professional and social isolation by building a positive workforce environment – continuing medical education (CME) programmes and turning primary health centres into social hubs.
• Locale-based selection and a special short-term expansion of nursing school capacity under private-public partnership have led to a strategy of filling 10,000 auxiliary nurse midwife (ANM) vacancies within four years in West Bengal. West Bengal has focussed on an innovative increase of ANM education. It needed 10,000 more ANMs to close gaps and put a second ANM in place. In the last one year 2,761 new ANMs passed out of 41 schools. In addition, locality-based selection by panchayats has ensured that the candidates are residents of the areas of work.

On the same theme, recently there were reports about a new program proposed by the health ministry and the medical council of India called `Bachelor of Rural Medicine and Surgery’ (BRMS). Following is an excerpt from a report in Times of India about this.

Under the scheme, the undergraduate `Bachelor of Rural Medicine and Surgery’ (BRMS) degree would be acquired in two phases and at two different levels — Community Health Facility (one-and-a-half year duration) and sub-divisional hospitals (secondary level hospitals) for a further duration of two years.

The BRMS degree would be offered by institutes in rural areas with an annual sanctioned strength of 50 students. "Selection of students would be based on merit in the 10+2 examination with physics, chemistry and biology as subjects. A student who has had his entire schooling in a rural area with a population not more than 10,000 would be eligible for selection, which would be done by professional bodies set up by the Directorate of Medical Education of the state governments," the scheme noted.

This was further discussed in an opinion piece in TOI. Following is an excerpt.

The current proposal seeks to churn out general practitioners for rural India. Hence the move to reduce the duration of the degree course from five and a half to three and a half years. This, in a way, seems to be a revival of the Licentiate Medical Practitioners (LMP) scheme that prevailed before independence whereby students were trained as medical doctors for around three years, awarded a diploma and then fulfilled the needs of rural healthcare as a way to bridge the gap between demand and supply of licensed medical practitioners outside metropolitan India. LMPs, in fact, outnumbered MBBS graduates and they were largely serving in the rural areas.

In the US they have Nurse Practitioners who can substitute doctors for many tasks. See this Boston Globe article about Nurse Practitioners (NP) and also this site about where nurse practitioner programs are offered.

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I like the idea to have medical positions in rural areas which requires a  lower or different qualification than MBBS. However, the name `Bachelor of Rural Medicine and Surgery’ (BRMS) is not good as it suggests that rural medicine is something different from regular medicine.  Similarly the restriction on who can pursue this degree, although well meaning, is discriminatory. So my suggestion would be the following:

• Call it something like LMP or NP instead of BRMS.
• Don’t make it completely for a restricted class of people as mentioned with respect to BRMS above. Have a good percentage reserved for those people; but not exclusively for them.
• However, positions requiring those qualification should only be available  in rural areas so that when someone takes those programs they know that they can only get jobs in rural areas. So they are mentally prepared for it.
• But there should be a new program  that someone with LPM/NP/BRMS can take after say 10 years of job experience so as to get an MBBS equivalent degree. This will allow for an upward career path; but after 10 years of job experience.
• Offer these programs and other associated nursing and health assistant programs widely in all sub-division hospitals. Part of the program may be required to be done in a regular medical college to give wider exposure.
• These programs should have strong public health components.

Entry Filed under: Learning from others,Medical, nursing and pharmacy colleges