Indian plan for rural healthcare providers encounters more resistance

Dear Editor,

Rural healthcare in India, as well as in some other developing countries of the world, does need a fillip. It is a indeed congratulatory that the government has accepted the views of the Indian Medical Association (IMA) and has shelved the idea of starting rural medical colleges that would have churned out qualified graduate doctors for the rural areas in just three years, as against the five and a half years for all other graduate doctors all across India. The government of the day seemingly intends to help the rural population with better healthcare provisioning, and that could be one reason for jumping and going after any idea that is given to them. Starting off more medical colleges would perhaps be another idea that possibly would have been taken in haste.

It is time that the emphasis of medical education to be shifted from super-specialty on to Primary Care or Family Medicine, which is the need of the hour, in which the doctors are not restricted in their knowledge or for provision services only to a particular age, sex, or systems involved, and would also be capable to deliver curative, preventive and rehabilitative services as well to most of the common ailments. Ministry of Health and the Medical Council of India must do all that they can to promote the specialty of “Family Medicine” in India. They can start off forthwith by opening a separate department for Family Medicine in each teaching hospital, so as to promote this specialty, which will be able to manage most of the healthcare needs without the need of patients being shuffled around to different type of specialists. In this context, with requisite help from the Health Ministry, the IMA possibly would also like to start providing post graduation in Family Medicine under its own umbrella, or in collaboration with friendly countries as was being done earlier.

Possibly the government would do well to dig into the existing pool of tapped and untapped resources and start afresh by possibly allocating 10 to 15 percent of health budget, and creating:
(a) “Mobile eHealth Centres”, and
(b) “Health District Centres”

Each “Mobule eHealth Centre”, or MEC, can easily look after around 3000 families in areas that are well connected. In far flung, sparsely populated, difficult and remote areas, possibly such a unit would be able to meet the healthcare needs of around just 500 families. Six such “MEC” could be linked up with one “Health District Centre” that would have facilities of secondary or tertiary care and a pool of specialists available to provide needful assistance through tele-medicine and videoconferencing, etc, 24 X 7. Each geopolitical district may have more than one “Health District”, based on population and its needs.

Presently there is a multiplicity of efforts on the part of the government, which needs to be undone and facilitate utilization of existing potentials and resources to the maximum. To offset the deficit, some additional trained manpower and doctors may be hired, and their services can be supplemented by availing honorary services from retired doctors from government services, like the railways or military, etc. If needed, volunteer help may be sought from well qualified and leading doctors who are engaged in private practices, for specified hours and time of the day at the “Health District Centres”.

‘Mobile eHealth Centres’ could be based on a platform of self-contained mobile vans/ boats/ etc. They can be tasked with visiting each locality under their charge once a week, check and treat common ailments, provide health counseling, run routine tests and collect samples to be dispatched to reference labs, do X-rays if needed, promote video-conferencing with senior specialists who are readily available at “Health District Centres” (HDCs) and also at tertiary care and teaching hospitals for this help, and finally provide a refill of medicines for seven days until their next visit. This can be achieved by a complement of a well trained team comprising of:
(a) A doctor who is an expert or specialist in Primary Care or Family Medicine
(b) Health Counselor
(c) Male and female nurses
(d) Lab Technician
(e) Physiotherapist
(f) Dentist
(g) One expert in health informatics, who can help in tele-medicine and can handle collection and dissemination of medical data
(h) Pharmacist
(i) A physically fit and well trained driver who also knows is also trained in CPR and provisioning of first aid.

If this model is followed, besides cost reductions and prevention of unnecessary wastage of resources and efforts, many unwanted hospital and clinic visits can be prevented, while home based and self-care can be promoted within reasonable limits. By extending screening and preventive services, health status can be improved markedly. Generation of clinical alerts & reminders would be an added feature as would be a paperless atmosphere. All this can help in better planning, budget allocation and utilization, easy monitoring and audits of various types, prevention of wastage and of unwarranted or futile interventions, better continuity and follow up, and ushering in of some degree of accountability as well. That said, it shall always be prudent to take small steps initially, and build from there based on whatever has been actualized and also from the experiences generated.

India definitely has the requisite potentials and resources, but then under the government’s direction and supervision, they need to be harnessed and channelized in the right direction. It needs to look for long term needs, equitable healthcare provisioning, that would not require frequent alterations and big changes. Policy makers need to look more deeply into the available resources and match them successfully with the healthcare needs that would also sustain the ‘millennium development goals’. This model was discussed at length during the ‘Commonwealth Medical Conference’ during October 2012 at Chennai, India, and it was also believed that this model could be easily replicated in all developing countries within the Commonwealth for provisioning of better rural healthcare services.

Best regards.

Dr. Rajesh Chauhan
Dr. Ajay Kumar Singh Parihar
Dr. Shruti Chauhan