Missing response

Doctors staging a protest on February 4 against the proposed Bachelor of Rural Medicine and Surgery course outside India Habitat Centre in New Delhi, where a national workshop on an alternative model for undergraduate medical education was hosted by the Medical Council of India.-V.V. KRISHNAN

As was indicated in the story on the shortage of health care professionals in rural India (Missing Doctors, Frontline, February 26), the hearing in the joint public interest litigation (PIL) case filed by Meenakshi Gautham and the Garhwal Community and Development Society, Uttarakhand, against the Union of India and the Medical Council of India (MCI) came up on March 10 at the Delhi High Court.

The writ petition essentially argues that the Centre must implement the recommendations of the National Rural Health Mission (NRHM) task force and the November 2007 resolution of the 9th Conference of the Central Council of the Ministry of Health and Family Welfare (MoH&FW) on the creation of a separate cadre of health professionals to render basic primary health care to the unserved and underserved rural population.

The recommendation of the task force was not aimed at producing short-course health practitioners with an open licence to practise across the entire allopathic domain but towards establishing a short-course training wherein non-clinical principles would be meshed with clinical training. The graduates of this course would be licensed to provide medical services within a notified package of primary health care.

Specifically, the prayers of the petition were: (a) declare Section (12)(b) of the Indian Medical Council (IMC) Act unconstitutional as it denies the fundamental right to health to the majority of people of India, and (b) direct the Centre to introduce a short-term course to train professionals for primary health care in rural areas and then license and regulate its graduates.

During the hearing on January 27, the MCI in its affidavit proposed that a course called Bachelor of Rural Medicine and Surgery (BRMS) be run by medical schools and the degrees be awarded by the universities to which such medical schools are affiliated. Interestingly, the MoH&FW, too, in its affidavit mentioned BRMS as an important and significant step.

However, the petitioners pointed out in their counter-affidavit that BRMS was conceptually different from what they had argued for and what the task force had recommended that it was something that would be responsive to the primary health care needs and local conditions across different States. They further argued that what was needed was to take the task force recommendation forward rather than evolve new structures ab initio as the MCI was doing.

Adjourning the hearing to March 10, the court issued the following order: The Secretary/Joint Secretary (Health) is directed to file a further detailed affidavit dealing with the various contentions raised by the petitioner regarding the recommendations made by the task force and also the recommendations of the Central Council of Health. In response to this, the government/MoH&FW filed a counter-affidavit for the March 10 hearing, which, interestingly, made no reference to the task force or the Central Council as the court had directed.

This affidavit admitted that in spite of there being 300 medical colleges in the country, there was a serious imbalance in terms of medical professionals between rural and urban areas, which has been a serious concern for the Ministry. Further, it stated that there was a shortfall of around 8,000 doctors against the required number for the primary health centres (PHCs). The affidavit also referred to the new MCI scheme for the BRMS degree course but this time without calling it BRMS. It said the Ministry had received the MCI proposal on February 26, which incorporated the inputs that emerged from a workshop organised by the MCI on February 5-6, and this was being examined in consultation with all stakeholders and State governments.

The affidavit gave the salient features of the MCI proposal, including the following: (1) The course will be conducted by a medical school attached to a district hospital and will be affiliated to an examining university for conferring the degree, and the degree holders will be registered with the concerned State Medical Councils; (2) The duration of the course will be four years, including six months of rotational internship; (3) Candidates should have completed their entire schooling (10+2) from the notified rural area in the concerned district, and admission will be district-based as far as possible; and (4) The graduates will be employed only in sub-centres and PHCs for the first five years.

Interestingly, a recent news report (Indian Express, March 15) said surgery had been dropped from the course name, which had been changed to Bachelor of Rural Health Care.

The petitioners had argued that according to the recommendations of the task force and the Central Council, the MCI was to have no role to play in the course. They contended that the MCI was basically a union of MBBS doctors, and given that it had consistently opposed the idea, a different body was needed to administer the new short-term course. The district-based restrictions have also been criticised since anyone willing to serve a given rural area should be eligible to enter the course, irrespective of where the individuals schooling was done.

After the hearing on March 10, the court issued an order saying that it was for the present not concerned with the petitions first prayer but with the second. The court order, accordingly, said: [T]he members of the task force consisted of eminent persons and it had also invited experts to its meetings. The task force has made certain recommendations. We still do not have any categorical response from the Central government in respect of the issues raised despite the order dated 18th November 2009 requiring the Secretary, Ministry of Health, to file an affidavit in that regard. Almost four months have gone by but unfortunately the said Secretary has not yet filed any affidavit dealing with the issues raised. Accordingly, we grant one last opportunity to the Secretary to file his/her response and to categorically and unequivocally state whether the Central government accepts the recommendations made [by the task force]... [and the Central Councils] resolution [that accepted the task force report]. The affidavit should be filed within two weeks.

The next hearing is now scheduled for April 7.