Mismatch between need, availability of medical personnel: Can decentralisation help?

By Bharat Dogra*
As thousands of medical students from India have recently faced extreme difficulties and risks in Ukraine, a lot of attention has been drawn to the anomaly of a very large number of Indian medical students going to study in difficult conditions in many countries, Ukraine being only to them, when there is such a big need for more doctors in their home country. Hence it has been argued that adequate opportunities for medical education should be available within India.
In the ensuing debate, it has been pointed out that some 16 lakh students take NEET, some 8 lakh qualify, and actually there are only about 90,000 seats. In addition an important recent finding of a study group, led by Anup Karan of the Indian Institute of Public Health, has been cited.
It says, “Active health workers’ density of doctors and nurses/midwives ( in India) is estimated at 6.1 and 10.6 respectively. The numbers drop to 5.0 and 6.0, respectively, after accounting for adequate qualification. These estimates are well-below the WHO threshold of 44.5 doctors, nurses and midwives per 10,000 population.”
Clearly there is a huge gap in aligning important needs of people with the aspirations of those who are eager to provide these needs.
It is the job of government policy and planning to fill this gap. Much can be done at several levels. This is impotant not just in the context of medical personnel but in the context of several other important services as well. My suggestion here is for a highly decentralized approach.
There is clearly need for strengthening government health system at decentralized level and more specifically at district level as well as village level. Big improvements are needed in primary health centers, community health centers and district hospitals.
This system should be made capable of meeting about 90 per cent of health needs of people living in a district at a very low cost to them, with the provision of entirely free care for the poorest, with only very limited need for referring highly complicated and specialized cases to higher levels of government or private care.
For securing such a capable health care system, the budget at this level needs to be increased several times, backed by improved management, strict curbs on corrupt practices, adequate supply of low-cost generic medicines and people’s supportive activities for the success of decentralized health system, including emphasis on preventive aspects.
The need for doctors and all other medical personnel within the government health system will increase in all districts with such improvement and expansion. Within such a health system, at district level itself, the planning for adequate medical personnel including doctors should take place, with local exams being held for various categories of medical personnel.
In the case of closely integrated districts, as in urban areas, two or more neighboring districts can be grouped together for this effort, if it is more practical to do so.

Some 16 lakh students take NEET, some 8 lakh qualify, and actually there are only about 90,000 medical seats

All those selected should get low cost, good quality medical education (entirely free for the poorest among the qualifying), linked not just to district hospitals but even to primary health centers and community health centers. This is important also for learning the basics of rural medicare.
The students who opt to receive this very low cost education will be asked to commit themselves to serving at least for a decade within the district, where they will be assured (after qualifying) well paid jobs as doctors and other health personnel for which they have been trained, as also provided housing and other essential facilities, by the government health system.
At the same time, within this same system, high fee education can be accessed by others who refuse to make such a commitment, and they will be free to practice privately or exercise other options.
A system of rewards and honours for those who serve well in rural areas and slum communities can be established. Medical journals not just in English but even in local languages can be started even at district level to document such efforts and their learnings. Research and efforts can be an important part of this district level decentralized system, with linkages.
Hence there will be a clear match between what is needed and the aspirations of the young in meeting these needs in terms of dignified and well-paid, assured, longer-term livelihoods close to home. Similar decentralized planning can lead to a match between meeting the needs of other sectors in a much better way by linking needs to aspirations.
---
*The writer is Honorary Convener, Campaign to Save Earth Now. His recent books include ‘Planet in Peril' and ‘India’s Quest for Sustainable Farming and Healthy Food'

Comments

Anonymous said…

Mr. Dogra in his article stated medical professional and para-professional crisis. He also suggested for making doctors matching with need and demand of vast population in India. It is very much true.for this purpose governments should increase medical intake capacity in medical colleges. But this doctors will not serve the down trodden. Their purpose of this medical degree is to earn money and their family's or parental want is taking this profession as a lucrative money making profession. Attitudes towards obtaining a medical degree is more concentrated on the philosophy of making wealth.
He also suggested some steps for encouragement of medical professional and para professional. Are these really possible to be implemented by government or other and how much?

April 09, 2022

Tracing roots of Hindutva Zionism: cannon fodder for 'warped' nationalist pretensions

By Shamsul Islam* Those who believe in a world free of hegemonic ethno-nationalism, racism, religious bigotry and hatred have rightly taken note of Zionism and its ally Christian Zionism, major perpetrators of ethnic cleansing of ‘Others’. However, the civilized world with its core belief in multi-culturalism and peaceful co-existence is oblivious to a no less dangerous threat to the present human civilization: the Hindutva Zionism. As the term reads it is part of the Hindutva world-view which stands for an exclusive Hindu India minus Muslims and Christians. The other religions like Sikhism, Buddhism, and Jainism will have no independent status but treated as part of Hinduism. The Rashtriya Swayamsevak Sangh (RSS; National Volunteer Organization) is the most prominent flag-bearer of the Hindutva politics whose cadres presently rule India, the largest democracy in the world. RSS was founded by Keshav Baliram Hedgewar (1889-1940) in 1925 who was disillusioned with the Indian freedom st

'Blatant violation' of law by Central government in making NREGA payments

By Our Representative In September third week, NREGA workers across the country were mobilised for two day so raise their issues and submit a memorandum to the Prime Minister. Organised the NREGA Sangharsh Morcha (NSM), a collective of groups that work with NREGA labourers across the country, workers from 13 states -- Andhra Pradesh, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand, Karnataka, Madhya Pradesh, Odisha, Rajasthan, Telangana, Uttar Pradesh and West Bengal -- carried out Kaam Do Abhiyaan, staging demonstrations and rallies against what they called blatant violation of law by the Central government in making NREGA payments. While NREGA has had very positive impacts, it has lately become fruitless, exploiting labour, even though workers who have put in honest hard work have to wait for their wages endlessly, it was suggested. In such a situation, there is a need to firm up NREGA implementation and end systematic corruption to ensure that workers get their basic NREGA entit

Shocking? No Covid vaccine trials conducted on pregnant, lactating women: RTI reply

By Rosamma Thomas* A Right to Information applicant who sought details of safety trials conducted in India on pregnant and lactating women for three Covid vaccines in use in India – Covishield, Covaxin and ZyCov-D -- was shocked to learn from the Central Drugs Standard Control Organization (CDSCO) that Serum Institute, manufacturer of Covishield, and Cadila Healthcare, manufacturer of the ZyCov-D vaccine, had not sought permission for such trials. Bharat Biotech, manufacturer of Covaxin, had sought permission for trial on pregnant women and later withdrawn its application. This response , provided after the applicant was initially unsatisfied with the response and went in appeal, is from the joint drugs controller, CDSCO. It was dated September 13, 2022. One researcher closely following the vaccine rollout, however, is of the opinion that the lack of a trial on pregnant and lactating women is a blessing; potential trial participants and their unborn babies thus escaped harm. Aruna Ro

Fascism on prowl? Religious meet 'deeply pained' at silence of Church, bishops, priests

Counterview Desk The ‘Forum of Religious for Justice and Peace’which held its 17th National Convention at the Montfort Social Institute, Hyderabad, Telangana from 22 to 24 September 2022 on the theme “Deepening our Identity as Religious: Responding to the Signs of the Times”, has expressed concern “at the deteriorating situation of our nation on every front”, especially stating, “Fascism seems to have come to stay” in India. At the same time, the convention, which took place with the participation of 60 persons from 16 states representing 20 religious congregations, in its unanimously-adopted statement added, “We have reached abysmal depths on every parameter: be it social, economic and political”, underlining, “The poor in India become poorer every day; the rich and powerful continue to profiteer at their expense and amass scandalous amounts of wealth.” Text: We, members (63 women and men Religious, from 16 states representing 20 Congregations) of the Forum of Religious for Justice

Rajasthan cops 'halt' Gujarat Dalit women's rally: homage to untouchability victim boy

By Our Representative In a surprise move, the Rajasthan police stopped a Dalit women's rally from Gujarat on the borders after it crossed Gujarat alleging that it would "disturb peace" in village Surana, Jalore district, where the gruesome incident of death of a Dalit boy took place on August 13 after he was brutally beaten up by his teacher on touching the drinking water pot. Sources said, while the Gujarat government had "no objection" in allowing the rally, which originated from the Dalit Shakti Kendra (DSK), an empowerment-cut-technical institute for teens founded by human rights leader Martin Macwan, on September 24 morning, the Rajasthan police stopped it for two and a half hours before allowing it to proceed to Surana. The decision to take out a women's rally was taken at a DSK meeting on September 5 following a condolence meeting of the NGO Navsarjan Trust, also founded by Macwan, activists committed to work against caste-based discrimination, orga

Introducing non-native cheetahs is 'not equivalent' to restoring pride in the nation

By Bappaditya Mukhopadhyay* The Cheetahs from the African continent has finally been introduced to India by the Indian Prime Minister on his 72nd birthday. The process had started with the previous Government in 2009. However, the Supreme Court clearance was pending owing to the objection by the National Tiger Conservation Authority (NTCA) plea to reintroduce cheetahs. Finally the clearance was obtained in January 2020 and thereafter Kuno National Park (KNP) was chosen for the reintroduction of first set of Southeast African Cheetahs. In the near future, depending upon the success story of the current reintroduction, more cheetahs from South Africa may also be introduced. This exercise has generated a lot of interest among various stakeholders with opinions on both sides galore. It is important to pose some questions that surround the whole exercise. Let us evaluate some of these arguments. The first set of arguments are quite detached from the issues of conservation as they most

Buddhist shrines were 'massively destroyed' by Brahmanical rulers: Historian DN Jha

Nalanda mahavihara By Our Representative Prominent historian DN Jha, an expert in India's ancient and medieval past, in his new book , "Against the Grain: Notes on Identity, Intolerance and History", in a sharp critique of "Hindutva ideologues", who look at the ancient period of Indian history as "a golden age marked by social harmony, devoid of any religious violence", has said, "Demolition and desecration of rival religious establishments, and the appropriation of their idols, was not uncommon in India before the advent of Islam".

'Military diplomacy': US praises Bangladesh Army for leadership role in UN operations

By Kamal Uddin Mazumder* As the Indo-Pacific region represents the world’s economic and strategic center of gravity, the Indian Ocean today is becoming the centerpiece of all geo-strategic play. Cooperation in the region is crucial to implementing the international community’s global agenda, including achieving the UN’s Sustainable Development Goals. Major powers like the US have enhanced and deepened their strategic engagement and leadership roles with countries in the region. The Indo-Pacific Army Management Seminar, or IPAMS, is a U.S. Army Pacific (USARPAC) initiated conference that is aimed at facilitating and enhancing interactions among the armies of the Indo-Pacific region. This year's 46th Indo-Pacific Armies Management Seminar (IPAMS)-2022, co-hosted by the Bangladesh Army and US Army Pacific (USARPAC), concluded in Dhaka. The objective of IPAMS is to promote peace and stability in the region through mutual understanding, dialogue, and friendship. It is the largest confer

Grave error? Scholar blames ex-Gujarat babu for anti-Christian riots 'citing fake report'

By Rajiv Shah A few days back, I received a message from one of the finest former Gujarat government bureaucrats, PG Ramrakhiani, a 1964 batch IAS official, who retired in November 2000. I would often interact with him in 1997-99, even later, after I was sent to Gandhinagar as a Times of India man to cover Sachivalaya. Those were turbulent times. Shankarsinh Vaghela was the Gujarat chief minister, under attack from two sides – from the BJP, which he had left to form a separate breakaway party, Rashtriya Janata Party (RJP), one one hand, and the Congress, which was supporting him from outside, on the other. Ramrakhiani, in his message, referred to the book authored by Ghanshyam Shah and Jan Breman, both top-notch scholars who have known Gujarat in and out. Called “Gujarat, Cradle and Harbinger of Identity Politics: India’s Injurious Frame of Communalism”, I reviewed the book in January 2022. It claims that Muslims in Gujarat have been turned into “new untouchables”, thanks to the Hin

Swami Vivekananda's views on caste and sexuality were 'painfully' regressive

By Bhaskar Sur* Swami Vivekananda now belongs more to the modern Hindu mythology than reality. It makes a daunting job to discover the real human being who knew unemployment, humiliation of losing a teaching job for 'incompetence', longed in vain for the bliss of a happy conjugal life only to suffer the consequent frustration.

Counterview

Search This Blog