Desperate step

The Union health ministry’s move to make one year of rural service compulsory for all MBBS graduates for eligibility to join postgraduate courses is a desperate measure. A number of incentives and disincentives have failed in the past to persuade fresh graduates from medical colleges to serve a stint in villages.

The system of giving grace marks for post-graduate admission on the basis of the rural stint of candidates and reservation of seats for postgraduate courses has not worked. At the state level some states have tried to enforce the norm of rural service by mandating a signing of bonds which carry an underlying pledge to serve in rural areas for a specific period. But in many cases doctors have chosen to opt out of their commitment and pay the fine. 

While the idea of compulsory rural service is frowned upon by many, there are not many other options left. Those who disfavour the proposal have claimed that more and better incentives would work. But it is difficult to frame more incentives than are offered now. The moral and substantial case for rural service is strong because medical education is subsidised by the government and therefore the  doctors have a responsibility to serve the society which bears a part of the cost of their education.

Medical facilities in villages are extremely poor and there is a 60 per cent shortage of doctors. Services in cities are better and doctors prefer to serve there for social and financial reasons. But a short stint for them in villages would make a big difference to public health services in areas where they are most needed. The government had cleared a proposal to create a cadre of rural health practitioners through a basic  three-year medical course. This should also be pursued.

Shortage of doctors is not the only problem with public health service in villages.  There is also a shortage of nurses and paramedical staff.  Backward and rural areas do not have adequate number of hospitals and health centres. Even where they exist, facilities like equipment and laboratories are poor. Rural health  progammes are not administered well. It may even be the lack of facilities and attractive service conditions that may be discouraging some doctors from serving in rural areas. The spending on public health, which is very low now, should improve for this. Compulsory dispatch of doctors to villages will have a positive impact only when other problems are also addressed.

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