New Delhi, March 20: A parliamentary committee on health has opposed a Union government proposal to create health care providers exclusively for rural areas, acknowledging yet ignoring successful models from two eastern states and echoing sections of doctors.

The parliamentary standing committee on health, chaired by Rajya Sabha member Brajesh Pathak, has asked the government to drop its proposal to introduce a new educational course, BSc (Community Health), designed to create rural community health officers.

The health ministry, in line with recommendations from multiple groups of experts, wants to post these officers in subcentres, the first point of contact with the health system in rural areas where doctors are never available.

The officers — trained through the 3.5-year BSc course — would primarily support public and preventive health activities, but would also be trained to provide care to manage simple injuries, infections or other conditions that do not require MBBS-qualified doctors.

The standing committee said a few of its members were in favour of the government’s proposal, taking into account successful model programmes in Assam and Chhattisgarh and the promise of patient care in rural areas, but the majority of its members was against the idea.

The Indian Medical Association, a body of mainly private sector doctors that is opposing the plan, had told the standing committee the rural community health officers would be nothing more than “half-baked” doctors.

The standing committee, in its report just tabled in Parliament, has asked the government to increase the number of medical colleges in rural areas and make a year’s service in rural areas compulsory for MBBS graduates, echoing suggestions by members of the IMA who met the committee.

“This standing committee has become a mouthpiece of the IMA,” said Meenakshi Gautham, a former post-doctoral fellow with the Institute of Health Policy at Erasmus University in the Netherlands. She is now in India and urged the government to quickly implement the proposal.

Health ministry sources revealed that the standing committee had taken up the issue on its own. The government is not obliged to follow its recommendations.They said while the government will seek to increase the number of medical colleges and MBBS seats, the community health officers are intended to be posted in subcentres where no doctors are available.

“They will neither be called doctors nor will they ever replace doctors,” a senior health official said. “They’re primarily public health officers with the expertise to offer emergency services which they can and refer patients to doctors in primary care centres.”

“The committee does not seem to care about our silent, suffering rural populations who just don’t have MBBS doctors to treat them,” Gautham, among several doctors and public health experts who deposed before the committee, told The Telegraph.

Since 1999, several panels of medical experts in India have repeatedly argued for the need to introduce an alternative health education course to deliver health care to residents in rural areas. Since 1999, several panels of medical experts in India have repeatedly argued for the need to introduce an alternative health education course to deliver health care to residents in rural areas. (See chart)

Public health experts have cited successful programmes launched by Chhattisgarh in 2001 and Assam in 2005 to call for emulation in other states where rural areas have no doctors.

“The rural health care providers posted in Assam’s subcentres have made a huge difference,” said Dittakavi Chakrapani, a former administrator, now the director of the Centre for Innovations in Public Systems, a think tank in Hyderabad tasked with replicating best practices.

Between 80 and 90 students have graduated through this course in Assam between 2005 and 2012, he said. The number of institutional deliveries each year in Assam’s subcentres have jumped from a few hundred before the rural health care providers were posted there to a few thousand each year over the past three years after they took up their positions, Chakrapani said.

Several doctors and public health experts, including K. Srinath Reddy, president of the Public Health Foundation of India, and Vinod Paul, the head of paediatrics at the All India Institute of Medical Sciences, New Delhi, had told the standing committee they support the plan.

Medical experts rooting for the proposal suspect the IMA is trying to protect the interests of doctors who fear they will lose clients from rural areas who now have to travel long distances to seek treatment.

Gautham points out that a new study from Chhattisgarh “demolishes the claim by the IMA” that rural health providers are half-baked doctors.

The study by the Public Health Foundation of India examined the performance of MBBS-qualified doctors and rural health care providers trained by the state under the 3.5-year course and found that both were equally competent in handling common infections, injuries and maternal health conditions.