Compulsory Rural Postings after MBBS

rural-healthcare-11The Hindustan Times reported on Friday that the Union Health Minister Dr. Anbumani Ramdoss has announced that young medical graduates, fresh out of medical schools will now have to mandatorily serve one year in rural and semi-urban centres in India.

Dr. Ramdoss believes that this will help in augmenting healthcare services in these parts of the country. It is well known that in the Indian hinterlands the availabilty of healthcare services is pathetic.  In villages, where more than 66% of India lives, it is rare to find a qualified doctor. In semi-urban centres too modern, good quality and reliable healthcare is largely unavailable.    

The government has set up a network of Primary Healthcare Centres in the rural areas. However, these centres are mostly crumbling buildings with poor or non existant medical infrastructure. The doctors posted in these back of the beyond places are mostly conspicuous by their absence. District Hospitals established in all district head quarters are also in a bad shape. The medical infrastructure is poor, doctors are poorly paid and are mostly buried under an avalanche of patients. 

While good quality healthcare remains out of the reach of most Indians living in rural and semi-urban India, their does seem to be a crying need for qualified doctors. However, I am not sure if a compulsory posting of young doctors is the solution.

The minister must recognise that young doctors passing out of India’s medical colleges aspire to a career in medicine, which can afford them a modern and comfortable life. They see their peers passing out of fancy business schools choosing high profile careers in business . A doctor toils much harder-many years at the medical school to earn a grduate degree, followed by a gruelling post graduate course and than the struggle for a job in an intensely competitive medical world. Now to send them for one more year to the inhospitable Primary Healthcare Centres and District Hospitals appear to be cruel.

Moreover, one is not sure how competent fresh medical school graduates are and what quality of care will they be able to deliver in ill equipped and distant rural and semi urban medical centres, where they might have to work unsupervised. While, they may be much better than what we have today (assorted quacks), they will hardly be able to do justice to the demands of their profession.

While the minister might argue that since medical education in India is largely subsidised by the government and therefore it has a right to ask these young graduates to spend one year of their professional life working for the government in far flung inaccessible areas, this would hardly cut any ice. By the same logic shouldn’t engineers, business and science graduates passing out of government owned colleges and Universities be also required to serve in remote areas. This can never work.

I do believe that there are no easy answers here. It will take many years for good quality healthcare services to ‘trickle down’ to these remote rural areas. For the moment, the government must provide roads and communication infrastructure, which allows patients to be quickly transported to urban centres, where relatively better healthcare is available. The government must offer incentives such as an option for subsidised post graduate education, health insurance and guaranteed employment for doctors, who choose to serve a year or more in rural hospitals. 

Last but not the least the government must improve its healthcare infrastructure. It must invest in better equipped facilities, ensure better hygiene and provide a better professional work environment. It can even experiment by involving private players in a model which guarantees minimum returns on private capital and the franchisee will guarantee far better and more efficient care.

At the end of the day, the government must try and attract young doctors rather than force them into rural postings.





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