Please accept my apologies for making it sound in my last blog that I had a solution for the rural health problem. I don’t. But I have done a lot of thinking on the subject, while being ably guided by many wise friends that I was blessed with. So what unfolds now, is a collective thought process, and not mine alone:
- Training of RMPs is a must. The government itself has come to this conclusion some time ago and is making some effort in this direction. But the effort has been half-hearted and the results have been half-baked. The process is a difficult one, as the RMPs have low and variable academic credentials.
- Identifying 100 most common diseases, 50 most common symptoms, 25 most dangerous signs is very important and the teaching of the RMPs should be based on these. The education has to be a completely practical one, with minimizing the theoretical aspects as much as possible. Practical manuals and videos have to be given to them and case based learning should be encouraged. Education, evaluation and certification should be made mandatory, and should be taken very seriously.
- Ultimately, to rectify the present lacunae, a separate medical course has to be designed and introduced. The present resistance from the MBBS doctors for this idea is based on their unfounded fears. There should be a short course, probably for two years, involving the practical rural health problems. They should be specifically instructed on how to work in an area with fewer resources and to refer the patient to a higher centre when required.
- The new course should be reserved for people in the local area. The graduates should be given license only to practice in the designated area.
- Both the education for the RMPs as well as the education for the village doctors MUST be given in the local language. This is a radical concept, but a thoroughly necessary one, because the rural medical practitioners must not be forced to spend too much time to pick up a new language. This will not only keep the local languages alive, but will also help the general public in understanding the diseases and the treatment. Care should be taken in avoiding the archaic words in the languages, however.
- Telemedicine should widely be made use of. The decreasing emphasis on clinical skills (unfortunate perhaps, but it is true), coupled with increasing technological sophistication will ultimately lead to the ability to provide treatment to most diseases from a distance with the help of village doctors.
- The greatest role that the enormous number of RMPs and the would-be village doctors (of course with a more glamorous title) is to focus on the prevention. They should be taught the fundamentals of prevention as they are in a unique position to actually supervise the execution of preventive programs.
- There is a hugely increased rural health budget this year – the scam infested NRHM is receiving Rs 20822cr this year- but what actually is percolating down is not even tangible. The performance indices are still the IMR, MMR and such, which were designed in 2005. Newer indices should be chosen and worked on.
- Ultimately, it will all boil down to all round village development, better irrigation and agrarian facilities, better power management, better schools, better transport facilities and the whole nine yards of non-corrupt governance. Whenever we are talking anything about our country, why the heavens we always reach here?