To be eligible for postgraduate programmes, doctors must undertake one-year rural posting
Incentives will work better
The decision of the Union government to make it mandatory for all MBBS doctors aspiring for postgraduate specialisation to undertake a one-year rural posting is unfair and impractical. Stipulating that the candidates complete their rural stint even before they sit for their postgraduation entrance examination will open the door to all kinds of manipulation to meet the eligibility criterion. For the fact remains that rural healthcare in India is in a shambles. Devoid of basic infrastructure, there is very little that doctors can do in these parts of the country. Hence, forcing doctors to move to the villages will not solve anything.
It is true that rural healthcare suffers from an acute shortage of medical professionals — around 60% of general doctors and 80% of specialists are missing. But things have come to this pass precisely because of long-running government apathy towards healthcare. At only 0.32% of the country`s estimated GDP, the Union budgetary allocation for healthcare is woefully inadequate. Even these funds are not utilised properly as exemplified by the deplorable condition of primary and secondary healthcare centres. With poor pay and little incentives, doctors cannot be expected to work with such decrepit infrastructure. In such a scenario, it is only natural that they seek greener pastures in the cities.
The only way to rectify the situation is to boost spending on healthcare and incentivise rural postings. Medical professionals should be offered enhanced compensation, housing benefits, and paid refresher courses and seminars to get them to work in the villages. Besides, rural health centres should be well equipped and made operational so that doctors are motivated to work there. This requires a thorough revamp of our approach towards healthcare, backed by strong political will. Short cuts like forcing doctors to undertake rural postings will only incentivise innovation in circumventing the rules.
Make doctors serve the poor
At a time when state governments have lost the capacity to provide quality healthcare, the Centre`s decision that all MBBS graduates must serve a compulsory one-year stint in rural areas before being eligible for MD or MS programmes will reverse the situation. This is a sound strategy that will benefit India`s villages where people hardly get to see doctors. Public health centres across thousands of backward villages remain unmanned not because there is a dearth of doctors or even paramedics. Soon after graduating from government medical colleges, young doctors refuse to serve in the countryside because these postings prevent them from lucrative private practice.
Fresh MBBS graduates are often poached by better pay and working conditions offered by the private sector, offering medical facilities which only the middle class and the affluent can afford. The private sector is loathe to setting up hospitals in rural areas, leaving village folks at the mercy of quacks. It is not that government medical colleges do not produce adequate number of MBBS graduates. There is an overall shortage of 60% general and 80% specialist doctors in the rural areas, a testimony to MBBS graduates` apathy to serve the country where infant and maternal mortality rates are still quite high.
Last year, the Karnataka government imposed compulsory rural service (CRS) for all MBBS students, irrespective of whether they were enrolled in government or private medical schools. Failure to abide by the mandatory undertaking, including signing a CRS bond, invited paying a Rs 6 lakh fine. But the Kerala government capitulated to protests by doctors and abolished the CRS for MBBS students. In India, where the healthcare system is starved of resources and in dire need for reforms, the government`s initiative, if seriously implemented, will be a fitting response to villagers` desperate cries for help that often go unheard.