Monday, 30th October 2017

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Centre firm on ‘barefoot doctors’

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By G.S. MUDUR
  • Published 30.05.13
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New Delhi, May 29: The Union health ministry has signalled its intentions to go ahead with plans to introduce a cadre of rural health care providers through a new BSc course, ignoring objections from a parliamentary panel.

The ministry told Delhi High Court this week that it had sent a draft cabinet note on the three-and-a-half-year course in community health to the Prime Minister’s Office for comments. This is standard procedure before the matter is sent to the cabinet.

The so-called “barefoot doctors” who pass the new BSc course will primarily support public and preventive health activities but also possess skills to deal with simple injuries, infections, and other conditions that do not necessarily require MBBS-qualified doctors.

A medical lobby has opposed the government’s proposal to introduce the course, whose supporters have accused these doctors of trying to protect their turf.

After listening to both sides, the parliamentary panel on health this year asked the government to drop the proposal without elaboration, while acknowledging the need to improve rural health services.

“It’s been a long wait. We’re hoping the cabinet will clear this quickly and we’ll see the course start,” said Meenakshi Gautham, a public health specialist in Delhi who had filed a petition in Delhi High Court in 2009 seeking early implementation of the proposal.

The National Board of Examinations had earlier this month approved the curriculum for the course, drafted by a panel of experts appointed by the Medical Council of India.

Several panels of medical experts have since 1999 called for the introduction of an educational programme to create rural health care workers with skill levels higher than those of auxiliary nurse-midwives but below those of MBBS doctors.

The proposal for an alternative health education programme emerged amid concerns that the existing MBBS education was not preparing doctors to serve in rural areas. Mandatory rural service has been debated in the past but remains largely unimplemented.

The Indian Medical Association, a body of mainly private doctors, has run a campaign against the proposed course, claiming that its graduates would be “half-baked doctors”. It says implementation of the proposal would mean rural inhabitants would receive substandard care. But supporters of the course have accused it of trying to protect the interests of town and city-based doctors.

“The IMA has consistently ignored the reality of the rural health needs of India and concentrated on turf protection,” said Kunchala M. Shyamprasad, a former cardio-thoracic surgeon and member of a government task force on health education.

Some public health experts say that Assam and Chhattisgarh have already demonstrated successful models of such a course.

A study by the Delhi-based Public Health Foundation of India has found that rural healthcare providers in Chhattisgarh, trained under a short course, were at times as competent as MBBS doctors in dealing with infections, injuries and maternal health.