BRMS: Barefoot- Cattle class doctors for Rural India

The problem is an immense one: Lack of trined doctors in Rural India.

Some borrowed data:
  • India is short of 6 lakh doctors
  • 8% primary health centres don’t have a doctor
  • Doctor : Patient ratio is 1.62 per 10,000
  • India contributes to 20% of the world’s maternal deaths, 30% of TB cases, 68% of leprosy cases, 23% of child deaths and 26% of vaccine preventable deaths.
The problem is not that India is producing a low number of Doctors- but that the trained doctors don’t want to work in rural areas.  In 2006, only 26% of doctors in India resided in rural areas, serving 72% of India’s population.
The question here is why so? Why doesn’t a trained doctor want to go and work in a rural area? The answer is simple- Lack of infrastructure & lack of incentive.
The Government tried taking Bonds of upto 75,000Rs from students entering into the medical colleges to assure that they will work in rural postings on completion of the term- most usually just pay up the sum and choose to not work in rural areas or in many cases don’t even bother paying the sum as no one is asking.
If the government concentrated rather on improving the quality of infrastructure at the rural hospitals, provided adequate services in these centres so the doctors that work there can actually put their training to some use and not feel helpless. Also, it takes a lot of commitment and sacrifice on a young person just starting a career and in most cases also a family to start setting up a life in a rural area, and some added financial perks are in order as incentive for them to make that decision. If these areas are addressed, most trained doctors I think will not mind working in rural areas for a varying amount of times- and its only proven right by the amount of Indian doctors working in rural areas in Australia, USA and other developed countries. They don’t mind working in rural areas in these places because they get good infrastructure in hospital and a fatter paycheck than that you’d get by working in a city in Australia.
Shortage of doctors over all and specifically in rural areas has been a problem of developed countries like Australia, New Zealand, USA etc untill the very recent past, and they didn’t fill in these gaps by lowering the requisite standards of doctors to fill up these places, but by attracting appropriate talent by providing good working conditions and financial incentives to doctors from across the world.
If you see the rural hospitals in Gujarat, most of the medical officer positions are filled up by young doctors from Bihar/ Orissa. At least this was the case when I worked in the area in 2005. The reasons they were attracted to these jobs in Gujarat was that they were sure that they will be paid in time, have a peaceful life and actually be able to work as a doctor in a hospital because the required material- infrastructure was in place at a better level than in their home- states.
The Government of India sadly doesn’t take this into account though- and decides that the way to get some doctors in the rural areas is to have some quasi-trained BRMS doctors and then find ways to incarcerate them in the rural areas by strict laws. Well, we all know- laws don’t work.
Let’s see what’s all wrong with the BRMS model:
  1. Quality of training:
    • Only the doctors will understand how ill-trained and inadequate one feels just at the beginning of the career after finishing MBBS from even the best medical colleges of India. The medical acumen and management skills are only mastered years after on-going practise and training to be safe and adequate- and this is even more important factor in the rural areas where you don’t have hi-fi investigation and management facilities and peers to discuss cases. I can’t even begin to imagine how helpless and inadequate an BRMS doctor will be when he is left in the community to perform as a ‘Doctor’ in a rural area after a 3.5 years academics and 6 months of practical training/ internship.
  2. The initiation of the concept:
    • Apparently the concept of these ‘Half-Trained’ Doctors was brewed in the times of Ketan Desai as the chief of MCI. Now that Desai has been dishonorably discharged from the post and is being investigated  by CBI etc regarding his vested interests in licencing and approval of various medical and paramedical training institutes, one only can question his motives behind this decision.
    • This BRMS thing would mean there will be a lot more new quasi-medical colleges, in every district of the country. Naturally private sector will have its own share of BRMS colleges set up as well, and then the Inspection-Bribe-Approval drama will start. BRMS colleges will end up being another sourse of income for the Desai type authorities that approve whether these private BRMS colleges are up to the standards. Also the Private education industry will make a lot of money from the potential candidates. BRMS will end up becoming the IIPM of Medicine.
  3. The Candidates:
    • The conditions that these BRMS candidates will be imposed according to Dr. Bhalodia (a known Desai aide) were that
      • These candidates will be given a district specific license and they won’t be able to work anywhere else- ever
      • These candidates will not be eligible for any advanced medical training in the future- ever.
    • So what grade of candidates will these institutes attract then- if getting in this degree means that you’re practically being bonded to live the rest of your life in that particular district and never advance in your career or be further trained in the field of medicine? I am sure the lowest grade of eligible candidates will only opt for these courses- but is this the level of ‘Doctors’ the rural population has to put up with?
  4. The Clients:
    • So 76% of Indian population lives in rural area- and you want them to make do with a clearly inferior quality of medical care?
    • What about the improvement of the basic healthcare model and infrastructure in these regions? When will that become a serious priority?
    • What/ Who will protect this population from mal-practise? Will the BRMS doctors be covered by the medical indemnity from the Indian Medical Association or any other private insurers? I don’t think so.
    • What/Who will encertain that these BRMS doctors won’t charge illegal fees for services etc which has been a rampant practise of the qualified medical officers in rural areas?
    • What/Who will encertain that these BRMS doctors won’t open up small private illegal GP practises like their BAMS/ BEMS/ DHMS/ BHMS/LRCPs…….. etc etc illegal/ semilegal parallel medical degree holders and just compound the existing problems of private-clinic malpractise in rural areas?
Over all, this BRMS doctors solution is like appointing a ‘Jan-Lokpal’. As they said, Janlokpal is not the solution, the existing system needs to work properly- Janlokpal will only add another Babu to the system; I think adding BRMS is not a solution to the dearth of proper medical care to the rural masses of india- improvement of the infrastructure and adding financial incentives to attract proper talent to the area is. BRMS is just another quack in the quack-ridden rural health set-up.
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