BRHC: Towards Healthy Rural India

I am a guy from a small village. Having firsthand experience of the healthcare situation in rural areas, I think a three and half year BRHC(bachelor of rural health care)/B.Sc(community health) course as proposed by govt is a right move towards improving the rural healthcare delivery system. It is unfortunate that this course has faced strong opposition from IMA, MCI and parliamentary committee on health. 


According to rural health statistics 2011, rural India has a shortage of 76%doctors, 53%nurses, 88%specialist doctors, 85%radiographers and 80% laboratory technicians. In order to address this huge gap in human resources in health,BRHC was originally proposed by NRHM,based on the recommendations of its Task Force.
 
IMA in its opposition for the course states “Introducing separate set of professionals exclusively for rural india, Govt is resorting to discrimination against rural citizens, treating them as second class citizens, which violates the right to equality (art.14) of Indian constitution”. This clearly is an irrational argument,as providing some care is always better than no care.Contrary to the argument it is not ‘little less competent physician’ in place of ‘physician’ its ‘little less competent physician’ in place of ‘no physician’ which offcourse is major positive change. It can be compared to a situation where,when it is planned to build a road to a remote village,somebody commenting it violates right to equality as village is served by normal road,while cities by highways.One reason behind opposition appears to be out of fear that medical graduates both allopathic and AYUSH will face competition from these new course graduates.This is wrong as these professionals are not allowed to practice in urban areas.Moreover in rural areas,the gap in demand and supply is so huge that it is virtually free of any competition.
 

The traditional method of compulsory rural postings for MBBS graduates has already been proved inefficient.As most of the MBBS graduates  have higher aspirations of pursuing PG course and research, they are less willing to serve in rural areas. Moreover those who wish to go also find the working conditions there unadjustable due to poor infrastructure. Forcing them to go to rural areas makes them work halfheartedly resulting in more than 50% of doctors enrolled for rural postings being absent from their positions.

In such a situation BRHC course, wherein 10+2 passed students are recruited locally,trained at district level college or institution appears meaningful. After graduation they are required to serve in their home regions for a specified period. By their ability to adjust better to local conditions and by overcoming cultural and communication barriers they are able to provide better care.

Going by the curriculum of MBBS degree, it has a significant portion orienting the students to their future PG courses and research, which is of little practical importance in treating the common diseases and illnesses contributing for major disease burden. By omitting such portions, it makes possible creation of a course which can create professionals who can competently handle the common diseases. Success of this approach has been already proved beyond doubt in Chattisgarh and Assam where RMAs(rural medical assistants) have been introduced on similar lines.Contrary to IMA observation that this course creates incompetent quacks, it is this course which can curb the growing number of quacks in rural areas, who are mushrooming by taking advantage of this huge scarcity in rural healthcare. Recently Dr.Devi Shetty (Narayana Hridayalaya) has proposed setting up of a govt medical college in every district of India. This though a nice idea, is beyond the scope of available resources. BRHC can prove practically possible alternative to this idea. In conclusion, I believe this course if implemented will surely shift the centre of gravity of healthcare systems from urban areas to rural areas.