Making doctors available for rural India

The National Medical Journal of India , 2012

While most states in India have the perennial problem of vacancies for the position of doctors in villages, it is not so in Tamil Nadu. Almost all posts of medical officers in 1529 primary health centres (PHCs), mobile medical units under the control of the Director of Public Health and Preventive Medicine, around 270 government hospitals (GHs) and 30-odd institutions under the control of the Director of Medical and Rural Health Services are always filled up. There is a long waiting list of doctors awaiting posting orders in such rural set-ups. Tamil Nadu has also had a variant of ‘compulsory rural service’ functioning successfully for the past 4 years. In most other states in India, the health department officials try to find various means of recruiting doctors to work in PHCs. A few states have even started posting AYUSH (Ayurveda, yoga and naturopathy, siddha, unani and homoeopathy) graduates instead of MBBS graduates. The Tamil Nadu Public Service Commission (TNPSC) has selected and posted 756 MBBS doctors and 333 specialists through the General TNPSC 2009 examination to various institutions. Another 2107 doctors, already working in PHCs and GHs on a temporary basis, have cleared the Special TNPSC 2009 examination and are awaiting their regularization orders. The transformation in Tamil Nadu was achieved neither by law, nor overnight. It is a series of rules and welfare measures by the state health department that have brought about this change.

Indian Journal of Community Medicine, 2013

Background: Attracting doctors to rural posts is an ongoing challenge for health departments across different states in India. One strategy adopted by several states to make rural service attractive for medical graduates is to reserve post-graduate (PG) seats in medical colleges for doctors serving in the public sector. Objective: This study examines the PG reservation scheme in Andhra Pradesh to understand its role in improving rural recruitment of doctors and specialists, the challenges faced by the scheme and how it can be strengthened. Materials and Methods: Qualitative case study methodology was adopted in which a variety of stakeholders such as government officials, health systems managers and serving Medical Officers were interviewed. This was supplemented with quantitative data on the scheme obtained from the Health, Medical and Family Welfare Department in Andhra Pradesh. Results: The PG reservation scheme appears to have been one of the factors responsible in attracting doctors to the public sector and to rural posts, with a reduction in vacancies at both the Primary Health Centre and Community Health Centre levels. Expectedly, in-service candidates have a better chance of getting a PG seat than general candidates. However, problems such as the mismatch of the demand and supply of certain types of specialist doctors, poor academic performance of in-service candidates as well as quality of services and enforcement of the post-PG bond need to be resolved. Conclusion: The PG reservation scheme is a powerful incentive to attract doctors to rural areas. However, better monitoring of service quality, strategically aligning PG training through the scheme with the demand for specialists as well as stricter enforcement of the financial bond are required to improve the scheme's effectiveness.

International Journal of Medicine and Public Health, 2012

Background: Shortage of medical graduates and post graduates in the government sector, especially in rural areas is a major problem in India. Rural and remote areas of Gujarat are facing shortages of MBBS graduates and post graduates. About 25 percent of posts in the health and family welfare department are vacant. The worst affected is the class I positions where over 40 per cent posts were vacant. This study is an attempt to identify the motivating and de-motivating factors, in joining government service, among the medical graduates and post graduates in Dahod district of Gujarat. Methods: Questionnaires were prepared for two groups of doctors: those who are in government services; those who left the government services. The questionnaire included both item wise response and likert scale questions. 36 in-service medical professional and 19 private doctors participated in the study. Results: 44% of in service professionals from urban areas are working in urban areas, while 56% of them are working in rural areas. On the contrary, only 15% of the in-service professionals from rural areas are working in an urban area, with majority of them (84%) are posted in a rural area. In services doctors believe that job security is more in government sector as compare to private sector. Variables like work environment, accountability, career development, social recognition and remuneration is less than satisfactory in government service. Conclusion: The decision to practice in rural areas is the result of complex interaction between a number of factors including individual background, service infrastructure, human resource practices including opportunity for career growth, remuneration, and autonomy. The study provide strong indication that promoting students from rural background to pursue medical education through reservation or scholarship may go a long way in addressing shortage of medical professional in rural areas. Following motivational factors can help in retention of skilled man power in government: positive work environment, adequate remuneration/compensation, career development and a supportive health system, adequate compensation and working conditions. Time bound promotion can be one of the important factors for retention of doctors in government sector.

THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 31, NO. 3, 2018, 2018

Background. Globally, India has the highest number of medical colleges followed by Brazil and China.

BMJ Global Health

This analysis challenges a tendency in public health and the social sciences to associate India's medical pluralism with a distinction between biomedicine, as a homogeneous entity, and its non-biomedical 'others'. We argue that this overdrawn dichotomy obscures the important part played by 'informal' biomedical practice, an issue with salience well beyond India. Based on a qualitative study in rural Andhra Pradesh, South India, we focus on a figure little discussed in the academic literature – the Registered Medical Practitioner (RMP) – who occupies a niche in the medical marketplace as an informal exponent of biomedical treatment. We explore the significance of these practitioners by tracking diagnosis and treatment of one increasingly prominent medical 'condition', namely diabetes. The RMP, who despite the title is rarely registered, sheds light on the supposed formal-informal sector divide in India's healthcare system, and its permeability in practice. We develop our analysis by contrasting two distinctive conceptualisations of 'informality' in relation to the state in India – one Sarah Pinto's, the other Ananya Roy's.

Canadian Medical Association Journal, 2009

International Health, 2012

2018

Background: Retaining doctors in rural areas is a challenge in Bangladesh. In this study, we analyzed three rural retention policies: career development programs, compulsory services, and schools outside major cities – in terms of context, contents, actors, and processes. Methods: Series of group discussions between policy-makers and researchers prompted the selection of policy areas, which were analyzed using the policy triangle framework. We conducted document and literature reviews (1971-2013), key informant interviews (KIIs) with relevant policy elites (n = 11), and stakeholder analysis/position-mapping. Results: In policy-1, we found, applicants with relevant expertise were not leveraged in recruitment, promotions were often late and contingent on post-graduation. Career tracks were porous and unplanned: people without necessary expertise or experience were deployed to high positions by lateral migration from unrelated career tracks or ministries, as opposed to vertical promotion. Promotions were often politically motivated. In policy-2, females were not ensured to stay with their spouse in rural areas, health bureaucrats working at district and sub-district levels relaxed their monitoring for personal gain or political pressure. Impractical rural posts were allegedly created to graft money from applicants in exchange for recruitment assurance. Compulsory service was often waived for political affiliates. In policy-3, we found an absence of clear policy documents obligating establishment of medical colleges in rural areas. These were established based on political consideration (public sector) or profit motives (private sector). Conclusion: Four cross-cutting themes were identified: lack of proper systems or policies, vested interest or corruption, undue political influence, and imbalanced power and position of some stakeholders. Based on findings, we recommend, in policy-1, applicants with relevant expertise to be recruited; recruitment should be quick, customized, and transparent; career tracks (General Health Service, Medical Teaching, Health Administration) must be clearly defined, distinct, and respected. In policy-2, facilities must be ensured prior to postings, female doctors should be prioritized to stay with the spouse, field bureaucrats should receive non-practising allowance in exchange of strict monitoring, and no political interference in compulsory service is assured. In policy-3, specific policy guidelines should be developed to establish rural medical colleges. Political commitment is a key to rural retention of doctors. Implications for policy makers • The recruitment policy of the health cadre of Bangladesh Civil Service should be changed in such a way that leverages applicants with training in public health, health systems, health management, etc., in addition to the existing qualifications. • Recruitment and promotion of doctors should be timely, customized (ie, according to the specific need of the health cadre of Bangladesh Civil Service), and transparent. • Career tracks (General Health Service, Medical Teaching, Health Administration) are found to be porous and unplanned; so, these need to be clearly defined, distinct from one another, and respected (ie, free from political motives or motives other than relevant expertise and experience). • Health bureaucrats working at district and sub-district level reportedly relax their monitoring for personal gain or political pressure; so, they should receive non-practising allowance, so that they are encouraged for stricter and better monitoring. • Since medical colleges are often established based on political consideration (public sector) or only profit motives (private sector), specific people-centered policy guidelines should be developed and implemented regarding establishing rural based medical colleges. Implications for the public This research unearths several loopholes contributing to the failures in retaining doctors in rural areas. These findings would empower the citizen to enhance their vigilance on the public-sector doctors and their managers, and hold them accountable for the services they are mandated to provide. Abstract In a recent article, Gorik Ooms has drawn attention to the normative underpinnings of the politics of global health. We claim that Ooms is indirectly submitting to a liberal conception of politics by framing the politics of global health as a question of individual morality. Drawing on the theoretical works of Chantal Mouffe, we introduce a conflictual concept of the political as an alternative to Ooms' conception. Using controversies surrounding medical treatment of AIDS patients in developing countries as a case we underline the opportunity for political changes, through political articulation of an issue, and collective mobilization based on such an articulation. Citation: Askheim C, Heggen K, Engebretsen E. Politics and power in global health: the constituting role of conflicts: Comment on " Navigating between stealth advocacy and unconscious dogmatism: the challenge of researching the norms, politics and power of global health.

Journal of Ayurveda and integrative medicine

This paper looks at the treatment seeking behaviour of rural households and presents factors that discourage them from using public health facilities. It also brings out how Allopathic medical graduates as well as institutionally qualified AYUSH doctors predominantly offer services in cities and townships which results in lakhs of village households having to depend on unqualified medical practitioners as the first line of medical treatment; also how this situation will continue unless the approach to providing medical treatment is modified. Continued dependence on unqualified practitioners is fraught with dangers of incorrect diagnosis, irrational drug use, resulting in the spread of multi-drug resistance. The reality that surrounds Allopathic practice by AYUSH doctors has also been described along with the educational underpinnings of accepting this approach. We opine that existing state policies that legitimise Allopathic practice by non-Allopathic practitioners do not help the r...