Health is not something that can be associated with life in rural India. The prime minister has expressed a desire for a new system that would offer healthcare to people ?with no access to proper hospitals?. The standard of healthcare in the villages is truly appalling, and has been so for the past many years. The primary healthcare centres are hideously neglected, and the block centres are not much better. Recent inspections have exposed the staggering level of absenteeism of doctors, and the fact that many of them do not live in the quarters assigned to them near the centres. Therefore the Centre is planning a three-year course to run side by side with the five-year MBBS course to produce doctors who will man the primary health centres. Such a licensed training system was abolished in 1952, and the Centre wants to reinstate something similar.

Times have changed rather dramatically since then. The decline in the rural healthcare system has many causes. Only one of them is the increasing investment in and competition for seats in medical colleges and, recently, the growth of expensive private medical colleges. The social stakes in the study of medicine have increased proportionately. Idealism does not flourish under such circumstances and a spell in a village is unattractive. Another tier of training in medicine may not produce greater willingness on the part of new doctors to practise in primary health centres. There is an implicit selectivity in the idea ? in terms of ability and paying capacity ? that is disturbing. Besides, absent doctors are not the sole problem. The whole system is rotten. Sub-systems that siphon off either funds or material, including equipment, essential drugs and blood, are far stronger. No quick-fix solution is possible. The West Bengal government?s brainwave about peopling primary health centres with homeopaths and ayurvedic doctors and block primary health centres with allopathic doctors had all the marks of desperation, haste and a total loss of the ability to think. Desperate measures will do no good where healthcare must begin from the beginning ? from information about nutrition and the need for clean water, to awareness about immunization, reproductive health, or occupational and infectious sicknesses. A programme for a special three-year training could help, only if the other deep-rooted problems are dealt with too.