Kerala has reacted coolly to a Central government scheme to conduct a short-term course to train doctors exclusively for service in the rural areas where regular medical graduates are reluctant to work.
About 3,000 doctors and medical students demonstrated outside the Raj Bhavan in Thiruvananthapuram last week to register their protest against the scheme.
The demonstration was called by the Indian Medical Association which claimed the proposed three-and-a-half-year Bachelor of Rural Medicine and Surgery (BRMS) course would create quacks.
The Centre drew up the BRMS scheme in consultation with the Medical Council of India as doctors are not coming forward to work in villages despite the National Rural Health Mission's offer of many incentives.
The scheme envisages setting up medical institutes in all states to run the BRMS course. They will be located in rural areas and have an annual intake of 50 students each. Admission will be restricted to those who have passed the Plus Two (Medical) examination from rural schools.
Several states, including Left-ruled West Bengal, have evinced interest in the scheme.
Kerala's Health Minister PK Sreemathi has said the state will take a decision in the matter after consultations with doctors. Her observation that the state has enough doctors to take care of its rural health care needs, however, betrays a lack of interest in the scheme.
The doctor-patient ratio (including practitioners of western medicine, homeopathy and the indigenous systems) in India is 1:870. If practitioners of non-western medicine are excluded, there is only one doctor for 1,634 people. Comparable figures for some other countries are: the USA 390, the UK 440, Qatar 450, and China 950.
Kerala, a leader in the matter of health care, had achieved the health and demographic goals set for the National Rural Health Mission (NRHM) several years before it was launched. The Mission, therefore, set separate targets for the state.
A NRHM review team pointed out two years ago that the state is facing some new problems. Its morbidity profile is fast changing with childhood diseases dropping and old-age health problems rising. Some infectious diseases have resurfaced and lifestyle-related non-infectious diseases are on the rise.
The team observed that the situation calls for location and community specific planning guided by an epidemiological approach. The state has not taken any concrete steps in this direction so far.
The minister's claim that the state has enough doctors to take care of the needs of the rural population deserves close scrutiny.
The number of medical officers under the state Directorate of Health Services in 2008 was only 3,862. This works out to one doctor for 8,244 people. The distribution of doctors across the state is highly skewed, varying from one doctor for 5,807 people in Thiruvananthapuram district to one doctor for 11,343 people in Malappuram.
Surprisingly the backward Wayanad district has one doctor for 6,448 people although Ernakulam has only one doctor for 9,194 people.
To get a correct picture regarding availability of doctors, we have to factor in the large number of medical practitioners in the private sector too. According to information gathered by the NRHM review team, there were 24,401 doctors in the private sector.
A complaint often heard in the past was that many primary health centres in the rural areas were not functioning for want of doctors. According to the Health Minister, there is now no PHC without a doctor.
This does not mean that the PHCs have their full complement of medical and paramedical personnel. Most of them are functioning with less than the sanctioned staff strength.
The Indian Medical Association's stir against BRMS is a repeat of its campaign in the 1950s which led to the closure of medical schools which were running licentiate courses. Products of those institutions were rendering yeomen service in the small towns, mostly as family doctors.
Today Kerala presents a queer picture with total absence of family physicians on the one hand and proliferation of specialists and super-specialists on the other. Mercifully, the services of highly qualified personnel are available at rates that are lower than what prevails in the metros.
With the big private sector institutions setting their sights on lucrative medical tourism, it remains to be seen whether the local population will continue to get the same service at the same cost for long. This is a factor the government must take into account while assessing the long-term requirements of the state, especially the needs of the poor people. -Gulf Today, Sharjah, February 1, 2010.