https://epaper.thehansindia.com/Home/MShareArticle?OrgId=2372535729a
In India, there is increasing specialised healthcare for those who can afford it. The gap between medical delivery for the rich and the poor is increasing. The Bhore Commission Report (1952), to reformat the medical and health systems, sought to fill the vacuum of trained doctors in rural areas. There was previously a licentiate system of medical practitioners (LMP) that provided valuable services to rural India. They underwent training in medical colleges and had an official degree to practise medicine, though in a limited manner. Unfortunately, the committee rejected this system in its entirety. Its core recommendation became a properly trained ‘basic doctor’ as the best person who, given adequate ancillary staff, can impact health delivery. Some solid recommendations, however, remained utopian, as we are still struggling with the health parameters. The load is now on tertiary-level hospitals, which are not able to cope. The Primary Health centres, visualised as the backbone, crumpled to their present degenerate state.
Rural India stays detached from the main hospitals in most instances. Ironically, the majority of Indian doctors stay in urban areas, catering to an urban population that may form only 20% of the Indian population. With a weakened primary health care system and poor transport facilities, health delivery in the villages has gone into the hands of quacks. Barely educated, they are smart people in the villages who have exploited fluid medical systems to make money.
There has been a recent move to introduce a system that allows untrained people, outside of the medical college curriculum (like in the past), to become trained as ‘community health providers’ who can practise preventive and primary medical care. This can be a dangerous and ill-conceived move to increase the doctor-patient ratio. A proper debate is essential to devising a method of training a group of ‘middle-level practitioners’ who would be useful and at the same time non-dangerous, addressing the biggest fear of concerned Indian doctors. It would be a far better idea to look for well-trained nurses to fill this need for primary health care. Their numbers are better than doctors, they are part of a structured curriculum, and they are an inherent part of the medical delivery system without any ambiguity.
Health does not depend only on the availability of doctors, drugs, and equipment. It depends greatly on the provision of clean water, good roads, the elimination of garbage, closed drainage systems, improved food and educational opportunities, and sterling transport services. The very act of covering our drainage systems would eliminate many of our health problems. But successive governments across the country have not done too well on these counts. The reasons are mainly faulty planning at the political-bureaucratic level, even as doctors take the blame for many of the ills plaguing the medical delivery systems.
RANDOM MUSINGS 