Angered that only 24% doctors out of the 6930 who graduated from MBBS and PG courses last year served a mandatory stint in a rural hospital, the Bombay High Court asked the Maharashtra state government to 'enforce discipline'. The bench asked the government to ensure that no rural health post should remain vacant this year. Justice Chandrachud said, 'Instead of giving back to society by spending one year in a rural health centre, here the idea is to find a way out (of serving the bond period).' He added, 'The younger generation should place an emphasis on public service.'
The court was informed that most doctors opted to pay the bond money (Rs 10 lakh for MBBS and Rs 50 lakh) to opt out of rural service. The court was hearing a PIL filed by Purnima Upadhyay on the large number of cases of malnourishment and infant mortality in tribal regions of Maharashtra. 'The state spends large sums of money towards the medical education of students who pursue undergraduate, post graduate and super specialty courses. It is no excuse that the candidates did not present themselves (for allotment to a rural health centre),' said the judges. 'Were the bonds executed? On the one hand, the state faces lack of adequate medical services and, on the other hand, posts are lying vacant.'
The compulsory rural service rule for Maharashtra medical students has been around since 1970 when aghast at the near-absence of healthcare services had introduced a bond in which an MBBS student had to give an undertaking to the government that after completing his/her course, he/she would've to work for the public health or medical education department for a minimum of a year, failing which he/she would have to pay Rs 5000 to the state government (an extremely high amount in 1970). Since then the bond amount has gone up to a whopping Rs 10 lakh in 2008. In December 2011, the Maha government had decided to scrap the bond citing the inefficacy of the system and inability to execute it properly. Since then no formal announcement has been made about the issue and the court's statement suggests that the bond hasn't been scrapped yet.
The Centre is also looking to put in place a compulsory one-year rural stint for all MBBS students. We talked to Dr Madhav Deo (Padmashree Awardee and member of Academic Council of the Medical Council of India), whose piece entitled 'Doctor population ratio for India The reality' in the April issue of the Indian Journal of Medical Research argued that the problems faced by rural India in accessing healthcare services couldn't simply be solved by making scapegoats of young medical students but by confronting the real issues like lack of specialists, facilities and deep-rooted corruption. We talked to him to get a deeper insight into the problem and how we could solve the woeful rural healthcare scenario.
Q: In your opinion, is the compulsory rural posting a bad idea?
Dr Deo: No one says it's a bad idea, but past experience suggests that it will be badly managed. Improved management can address the current issues and there's no need for coercive techniques. Also let's not forget that all these UG students will only act as generalists without any insight into specialties. The real problem facing rural India is the lack of specialists. The government's decision to send inexperienced junior doctors to rural India is flawed to the core. Read on to find out more
