Rural service: Clear SC ruling welcome

The Supreme Court’s directive to the states to frame a uniform policy on the terms of compulsory rural service for doctors for admission to postgraduate and speciality medical courses will put an end to the confusion and inconsistency over the matter. The court has ruled that rural service can be made mandatory, fixed its duration as two years and the bond release amount at Rs 20 lakh. The term of compulsory service has varied from two to five years and the bond amount from Rs 20 lakh to Rs 50 lakh in different states. Some states do not even have a provision for compulsory rural service. Along with the state governments, the Centre and the successor body to the Medical Council of India should take note of the orders and observations of the court and implement them at the earliest as they have an important bearing on public healthcare.  

The court has made it clear that there should be no escape from rural service. It is not an arbitrary demand or forced altruism, but an obligation because the government spends a large amount on training doctors. It varies from Rs 50 lakh to Rs 1.5 crore per student, depending on the state and the college. Only a fraction of this is borne by students by way of fees, so they have a responsibility to repay the society. Healthcare in rural areas is very bad. While the World Health Organisation recommends one doctor for every 1,000 persons, in India, there is only one doctor for over 11,000 persons. The ratio is much worse in villages. Doctors are reluctant to work in rural areas. Governments should improve the facilities not only to attract doctors but also to provide better healthcare and living conditions in rural areas. There should be little scope to worry about living conditions these days when transport and communications have improved even in the villages. In any case, there should be no escape from the obligations of service. 

While compulsory rural service should be enforced, it is no complete and permanent solution to the problem of inadequate healthcare service. Increasing the number of doctors is the remedy, as better demand-supply equations will reduce the shortages. It is estimated that the country needs at least five lakh doctors more as of now. Controversial solutions like training ayurveds, homeopaths, etc., to provide basic allopathic healthcare to the people can at best be temporary. More medical colleges should be set up, which will produce more doctors. Proposals like converting district hospitals or even private hospitals into medical training centres should receive better consideration in this context.

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