Paving pathways for the evolving cadre of primary health care providers

13 December 2012

The three year, rural based medical qualification is much welcome in a country which is currently driven by a parsimonious public health expenditure and unavailability of healthcare providers. It is time that this predicament be dealt with an added effort to redesign medical education in India.

In Chhattisgarh, where the concept of Rural medical Assistants (RMA) was initially mooted and brought to fruition against immense political and medical fraternity odds was an ostensible success. More so, because around it is a predominantly tribal State and of the approximate 856 public health facilities, 44% are in the most difficult areas with very poor access.

The impact evaluation of the healthcare service provided by RMAs carried out in 2009 by the Public Health Foundation of India (New Delhi), the National Health Systems Resource Centre (New Delhi) and the State Health Resource Center (Raipur) supported by WHO, concluded that the efficacy of RMAs have been equivalent to that of conventional physicians in primary health centre (PHCs). This finding further established the role of RMAs in improving the health services at the PHCs.

But the predicament which emanates from the Chhattisgarh experience is that the course could not go beyond three batches, creating around 1300 such professionals registered under the “Chhattisgarh Chikitsha Manadal”, a regulatory body shaped by the State. The professionals trained, are working in contracted jobs under the National Rural Health Mission (NRHM) and none of them are employed in a regular capacity of the Government. There is currently inadequate professional pathway that has been devised for these rural practitioners.

Looming concerns around varied recruitment practices into these courses across States, ethical confinement of a trained professional to rural area as well as public only serving the public health system exist. As they will not be allowed to practice in a dissimilitude of settings saturation of their services are expected sooner. Thus, the new cadre created by this modified system of medical education comes with crucial questions for healthcare governance among health regulatory stakeholders in India.

Competing interests: None declared

Raghavendra Madhu, Public Health Practitioner

Kamlesh Jain

Public Health Foundation of India, Public Health Foundation of India PHFI PHD House

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