Rural posting, 2600 PHC’s Against 50,000 Doctors

Dr Narender Saini
General Secretary
of Indian Medical

Dr Narender Saini, General Secretary of Indian Medical Association, who earlier served as the President of Delhi Medical Association, with his focus on “health for all” at affordable cost, in an interaction with Ekta Srivastava, ENN, speaks about the role of IMA in forwarding the healthcare issues to the Government

‘Healthcare for all’ was your mission while you joined as General Secretary. How has been you journey so far?
Indian Medical Association (IMA) is a body which creates awareness into the system to self regulate ourselves and creates awareness among people. We don’t have the power, which the government has. So, we can apprise the government, where the lacuna is in the government system. Now, on these two facts we have been quite successful but we still lag in creating dent in the government system. First and foremost for making affordable and accessible healthcare, the government has to increase the GDP, which unfortunately we have not been able to get it raised, which is still around .9 percent to 1 percent and very low in comparison to other countries. Even the neighboring countries like Sri Lanka and Bangladesh are spending more than 2 percent of their GDP. In our many efforts we met the Parliament, Planning Commission and Standing Committee on health, with a hope that one day we might see our targets achieved and make the health as the primary agenda in the forthcoming election.

Recently, in the interim budget there is no any mention of health, not even the leading newspapers have given it any preference?
That is very unfortunate because the whole world and especially in the developed world, elections are based on health politics but in India it has never been given the same importance. We are making efforts to create awareness among the public that they should consider health as a primary agenda. We have said that ‘Right to Health’ should be the agenda of every political party. For the same, we come up with the white paper and forwarded it to every political party.

In your opinion,where do you think the government has failed in providing better healthcare?
The foremost is not giving importance to healthcare. Since your focus is not health, you will not spend on health. Secondly, we have this tendency of spending more on treatment than on prevention. We create diseases first and then we spend the whole of the budget in treating those patients. Hygiene is such an important thing. If you create awareness about hygiene then most of the communicable diseases can be prevented but unfortunately the focus is not there in prevention. The other important thing is accountability. How much the money has been allocated, where it is used, there is no any proper record. Then is the data collection, for whom we are making policies, what are the diseases, how many have been infected, there is no statistics and without proper data one cannot have proper policy. So, I think these are four or five things where the government has failed.
While doctors and medical students are opposing to have rural posting, How then healthcare facilities will reach them?
We are not against doctors going to rural areas. We are for it that doctors should go to rural areas. But how they should do it? That is a question. Government says that they should do one year rural posting. The two of us are saying the same thing but at a different time. The government says that they should do their rural posting besides doing their internships, before doing their PG exam they have to go for a rural posting, which means one year extra. If you see any professional courses, this is the longest duration course that too at undergrad level. Rather we should try to think that if we make it shorter than it would be better, more practical. So what we are saying is that make the rural internship for six months and during the three year post graduation in any of this year’s you can post the students in rural areas for six months. This is more practical.
Now, to make rural posting of these 50,000 doctors, which are passing out every year you need the same amount of vacancies. For this we file an RTI and got to know that there are just 2600 seats vacant in rural areas in various primary healthcare sectors’ (PHC’s). How you will accommodate that many people, when you don’t have that kind of infrastructure. For putting up this infrastructure, I am not talking about money, but you need at least a nurse and a compounder for that you need a minimum of Rs 10,000 crore every year and your budget is 30,000 crore only. Well, what we have said is that make this posting during the course or make compulsory six months during the internship of one year. Simultaneously, it will become the responsibility of the respective college to provide the rural posting.
Then we can have add-on increment for the medical officers who are deployed for rural areas, can have mobile van dispensaries. Another thing which I want to say on rural posting is that there are so many Ayush, Ayurveda and Homeopathic people, where they had spend their time and government has invested their infrastructure. So they can also be used in rural areas provided the basic facilities.

We are more of paper tiger, make policies, speak beautifully on those policies but when we make execution I don’t know  where our vision goes!

There are 50,000 students every year who clear MBBS but there are only 20,000 seats in PG. How is the Government planning to accommodate these left 30,000 students, is IMA raising voice against this?
We have already raised that. What we are saying is that India lacks 5 lakhs doctors, that is a presumption but it might be more as our data is very weak. If you accumulate this for a 5-year term then 1.5 lakh is getting wasted every year into just sitting in the room and reading. We have written to the ministries several times to increase the seats. In USA they have just 18,000 seats for medical graduate but they have 30,000 seats for post graduate. Rather we have given a proposal to MCI to give them a 6-years course out of this six years, 3-years should be basic sciences and in the next three years he will choose his specialization so that he does not come out as a plain MBBS like in the USA and other countries he comes as a specialist and out of this 3-years, one year will stand in a rural posting. Plus his clinical can start from the first year only.

What do you think about the quackery happening in medical education?
Quackery is of two kinds in this country, first quackery is when they do not have any educational background in medicine but they behave like medical professional. The other kinds of quacks are those who are qualified in one specialty but start prescribing for other. This is something which needs a greater attention because many people are losing their lives in their hands. The third of quacks are chemist they dispose all kinds of medicine and fourth kind of quacks I would say are some people in our community who do not prescribe any medicine or call themselves a doctor, but advise all sorts of medicines without any knowledge.

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