Healthcare sector faces enormous challenges in the country. These include high poverty, low levels of literacy, poor infrastructure, lack of doctors and other healthcare providers and poor access to health and sanitation services in rural areas. Several efforts have been made in the last few years to overcome these challenges. These efforts have met with varying degrees of success. One such effort was a three-year medical course in Chhattisgarh.
The course was started in April 2001, soon after the new State was carved out of Madhya Pradesh. There has been lot of discussions about this initiative at national and international forums. The initiative has been praised by policy makers and public health experts and damned by doctor’s organisations, including Medical Council of India and IMA. It has been reviewed in scholarly articles. These reviews have however omitted to look at it from the point of view of the most important stakeholders in this scheme – the 1,400 odd Rural Medical Assistants (RMAs).
The course ran into a controversy even before it started. The course was named ‘Diploma in Modern Medicine and Surgery’ when it was conceived in April 2001. However, the very concept was challenged before the High Court in May 2001 itself on the ground that no course in modern medicine could be started without the approval of the Medical Council of India (MCI).
The State Government reacted to this by changing the name of the course to “Diploma in Alternative Medicine”. This change in name was done with a view to avoid litigation. However, the modern medicine and surgery continued to be the content of the course. This is the root cause of all the problems faced by the RMAs today.
Another problem with the course was the manner in which it was implemented in the State. The course was not started in Government run institutions, but was given to profit private organisations, who charged huge fees from the students. The fee paid by the students for the three year course was in the range of `1 to `1.5 lakh – much more than the fees paid by the MBBS students in Government Medical Colleges in the State.
Three colleges were inaugurated on October 2, 2001 and three more were opened soon after. Around 2,200 students were admitted in these six colleges from 2001 to 2003. When the students realised in 2003 that they had been taken for a ride because they would not be legally entitled to practice modern medicine after they passed out, they went on a strike.
The State Government again reacted by changing the name of the course. This time the course was named ‘Diploma in Modern and Holistic Medicine’. However, the students were not satisfied and went on another strike in Juy 2004 and the name of the course was once again changed. The course was later named ‘Practitioner in Modern and Holistic Medicine’.
There were elections in the State and a new Government came to power in 2004. The new Government stopped fresh admissions to the course immediately, though the course was officially declared closed only on September 1, 2008.
By December 2006, most students passed out. They were still not able to practice and therefore they went on another strike. This time the State gave a more reasonable response by increasing the duration of internship from six months to one year and by giving state level recognition to the course through the Chhattisgarh Chikitsa Mandal.
By October 2008, when the course was officially closed, all students except 809 who dropped out, completed internship.
The real problem of the students started then. They had a diploma which did not allow them to practice. They had spent a lot of money, time and effort in getting the diploma. They faced litigation in the High Court from powerful adversaries like the MCI and IMA and had little chance of success. They had no income and faced severe challenges in their own families as well.
It should be recalled that these are youngsters who joined the course under the impression created by none other than the State that they will serve their community by being a healthcare provider. They were still willing to do this and work in remote areas of the State where no other doctors are willing to go. However, they face hurdles all along their path.
The State finally came to their rescue in 2009, when posts of Rural Medical Assistant were created in the State Health Cadre and recruitment rules allowed pass-outs of this course to be recruited to these posts.
The number of posts created was much less than the number of the pass out students. Still it was a big relief to them. A few RMAs were recruited in 2009 itself. More posts have been created under National Rural Health Mission since then. Most of the pass-outs have now been absorbed in the government sector.
It is an interesting fact that today almost all Primary Health Centers in the State of Chhattisgarh are manned by RMAs. For several years now they have provided much needed healthcare in remote areas. Most of them were found to be knowledgeable and competent. They have good medical skills. The biggest thing was that they were willing to learn and acquire new skills, which is a lot more than what can be said about many MBBS doctors. It is also interesting that those who have not found a job within the government sector have been employed by private nursing homes run by MBBS doctors and yet the IMA as a body has been opposing them.
In my view, it is substantially due to the hardwork of the RMAs that led to improvement in health indicators in the State in the past few years. As a matter of fact, Government of India has been impressed with the work of RMAs and has announced a three-year
course at the national level. The course is likely to be called ‘Bachelor of Rural Medicine and Surgery (BRMS)’
Government of Chhatti-
sgarh must support RMAs. It was a good thing that they were recruited in the government sector. As they cannot go for private practice, some more posts need to be created so that the remaining passouts can also get a Government job.
Though 17 long years have passed, the case against the course is still pending before the High Court. This creates a feeling of insecurity among the RMAs. They are all the time busy consulting lawyers. The State must initiate a dialogue among all the stakeholders including the IMA and MCI to find an amicable solution.
Government of India must also use its good offices to bring all the parties to the discussion table. The problem is not insurmountable as the course has now been stopped and the number of affected persons is limited. MCI may be requested to design a bridge course for them so that they can
get an MBBS qualification in due course.
Meanwhile they should be allowed to treat patients under the supervision of MBBS doctors. The unnecessary litigation is taking a huge toll on them. With the hardwork which they have put in and the service which they have rendered to the people of the State, they deserve sympathy and help.
After all, not even a single case of malpractice or negligence were reported against them. They have fulfilled an important need and have served as skilled and effective healthcare providers in rural areas.
(The writer is a senior IAS officer in Chhattisgarh. He can be contacted at dr.alokshukla@gmail.com)