vast majority of our country's population resides in rural areas where they do not have access to primary healthcare. Providing quality pastoral health care is the state responsibility, which successive governments have failed to meet. The rural-urban divide is rising by the day. The poor living conditions in villages are responsible for the continuing large-scale movement to the urban areas. The resultant persistent rural to urban exodus has strained the urban fabric and the healthcare system. Our commitment to the WHO to provide ‘Healthcare to All' by 2020 seems unachievable.
No serious effort has been made to retard the uncontrolled population growth. The villages are significant contributors to this bludgeoning population. The population policies of governments have been without critical thought or research. Policy paralysis is mainly due to a scare that it may upset certain castes/religions and erode vote banks. The ruling government has instead launched a ‘Make in India’ campaign to capitalize on the population bubble and has not attempted to tackle the population issue.
Life expectancy of villagers is lower because of lack of essential amenities, poor hygiene, and absence of a credible healthcare system. Plans to improve healthcare in villages rolled out by successive governments have either been cosmetic or ill-planned/conceived. Despite significant progress in the country's economic status, no serious effort is in sight to upgrade medical facilities in the country.
Successive governments have pursued a harebrained scheme of sending young medical graduates to villages by coercion, enforcing a rural service bond. Young medical graduates are not permitted to take post-graduation courses if they haven’t done rural service. Different modalities have been tried to force these fresh graduates into villages, but all have failed miserably. The philosophy of only new graduates treating the rural population is ethically and morally wrong.
A fresh graduate should not be expected to manage patients in a relatively challenging environment with hardly any support facility and necessary experience. Subjecting them to such trying conditions, without appropriate training/experience, is retrogressive. Secondly, even if they join duties in rural areas, they spend their entire tenure preparing for postgraduate entrance examinations rather than treating patients. Many of them are newly married. There is no social life or any recreational facility for these doctors and their families in the villages. Proper schooling too is not available for children. Governments have been apathetic to improving living conditions of doctors and other officials posted there.
Doctors are expected to treat patients with just a stethoscope as their diagnostic tool and move around handling patients holding a medicine bag in their hands, as seen in old time movies. The Primary Health Centers are ill-equipped and without adequately trained paramedics. Possibly, the planners feel that doctors can wield a magic wand to treat patients. Some rural setups have modern gadgetry, such as laparoscopy equipment, but there is no specialist/surgeon or anesthesiologist posted nor is ancillary support available. This disjointed situation is a result of ignorance of healthcare administrators, who are administrative service officers with no healthcare background.
How does one ensure that doctors go to backward areas where they are desperately needed? The only plausible way, under the present circumstances, is to beef up the strength of doctors in public hospitals of the district headquarters and by making service conditions more attractive. Doctors permanently posted in these district hospitals should be asked to compulsorily do a 2-3 months’ tenure, every year, in a village of their district. With a reasonable travel time from home, this may be more acceptable to them. The staff must be assured quality boarding and lodging arrangements during such stints.
* Writer is Dr Mukul Kapoor, Director, Department of Anesthesia, Max Smart Super Specialty Hospital, New Delhi. Can be contacted at firstname.lastname@example.org