Feature Primary Care

More health professionals for rural India

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8339 (Published 07 December 2012) Cite this as: BMJ 2012;345:e8339

Re: More health professionals for rural India

The Indian Medical Association (IMA) represents mainly allopathic private practitioners as members who have an obvious conflict of commercial interest by this new cadre of health care providers and hence are opposing it as expected.

I would strongly support the initiative of the Government for establishing a non-physician health provider cadre to meet the shortage of medical doctors for the rural areas which is highly commendable, pragmatic, timely and a much needed paradigm shift.

However, I differ on two aspects of the recommendation. First, that they should be confined to the rural areas only. It seems that the experts are ignoring the plight of millions of low-income urban slum dwellers living in both authorized and unauthorized slums of all metropolitan cities of India including capital of New Delhi who can neither afford nor access the services of allopathic doctors. MBBS doctors are not available in urban slum areas. Therefore, they should be allowed to provide their services, both in urban and rural areas based on need and acceptability.

Second, is the eligibility for the course to i.e. standard XII or 12 years of education. Again, the experts are ignoring to who caters to the health care needs of these rural and low income urban residents currently. They are treated either by the pharmacists and nurses of the government rural primary health centres (PHCs) where and when the medical officers are absent. Or they are treated by non-allopathic private practitioners who have interned or assisted allopathic doctors and learnt the tricks of the trade. Their qualifications range from graduates with BAMS (Ayurveda), BHMS (Homeopathic ), BUMS (Unani ) qualifications to no qualifications at all, but all of them practise as allopathic physicians and call themselves as RMP (Registered Medical Practitioners).

They already have acceptability in the community both rural areas as well as urban slum areas. Therefore, it would be more appropriate to supplement their existing knowledge levels with this course to provide better health care services maintaining essential standards. They are already in the community where they are needed, have acceptability and are affordable as well. Therefore, this course should be a post graduate degree open to those who already have a either a para-medical degree e.g pharmacy, nursing, pathology, radiology or are non-allopathic medical graduates as a first step.

Bidyut K Sarkar MBBS, M.D
Department of Epidemiology and Public health
University College London
E mail: bidyutk.sarkar@gmail.com

Competing interests: No competing interests

10 December 2012
Public health research
University College London (UCL)
208, HBRC, Deptt of Epidemiology and Public Health,University College london,1-19 Torrington Place, London WC1E 6BT,