India is emerging as the most populous country of the world with around 72% of Indians living in rural areas. The health care facilities in Indian villages are hardly impressive and the Indian government has significantly failed in providing any proper infrastructural setup to offer quality health care for the 72% of Indian citizens. Even in urban areas, while rich people can attain quality services, there are hardly any sensitive health care help lines to offer quality services for poor slum dwellers. The current situations openly express the inability and futility of Universal Health Care program which is being run by the Indian states and local governments.
One of the major issues of Indian medical sector is the unwillingness of doctors to work in villages. While it is certainly a tough task, Indian government has certainly failed in getting doctors in villages. Indian government controls the medical education system and many strategies have been experimented to promote doctors to work in rural areas. Government medical colleges have been started in Indian villages, admission policies have been influenced deliberately to promote admissions of students from rural areas in medical colleges through reservation, innovative educational programs have been introduced to make MBBS students realize the working conditions in Indian villages and how they can provide proper healthcare in rural areas. However, most of such promotional strategies proved to be a failure and hence, government introduced compulsory duties for doctors to serve in villages by making rural placement (for two years) a prerequisite for post-graduation.
Yet, the problem of lack of medical experts working in rural India remained unchanged. All such strategies experimented in semi-rural environment were designed to encourage and entice community-based practice but the strategies failed miserably. Even the students attaining admissions in medical colleges through reservation for rural areas find it beneficial to work in cities rather than serving people in their own villages.
In 2007, the Union minister of Health and Family welfare proposed a compulsory law for all MBBS students to work in rural areas for at least 12 months before attaining their MBBS degrees. The government also penalized doctors for not fulfilling their rural bonds. However, just like the compulsory rural placement law failed in case of post graduation, such an enforceable duty in undergraduate programs is also likely to fail.
Why Do Medical Students Avoid Serving in Rural Areas?
There is certainly a dearth of doctors in rural areas. There are around 269 medical colleges in India which produce 30,922 doctors each year while there are 683,582 licensed and registered allopathic doctors working in India. Indian population is around 1.21 Billion. Only one in 10 doctors is working in rural area. Only a small percentage of health care centers in rural areas have the working physician, surgeons and other medical personnel.
While the Indian government has tried to implement community placement programs, doctors completing such courses do not find it attractive to work in rural areas as they fail to attain any personal enrichment or professional enticement.
The 30,922 graduates passing out through medical colleges each year, often find it conducive to work in urban areas and metropolitan cities where they can earn better and can have better living conditions with schools for their children and other facilities. They also attain social recognition and opportunities to develop their experiences while attaining higher job satisfaction1 .
Working in rural areas is unattractive for most of them because they feel that they will be alienated from their friends, families and professional colleagues which may attain better opportunities while working in cities. This creates a fear of social isolation and lowering professional status. Doctors in rural areas also suffer lack of proper mentors and students and they find it difficult to acquire technological skills in rural settings. Many doctors believe that by working in rural areas, they cannot improve health care facilities in rural areas. They also raise the question; why should medical students be forced to make greater sacrifices than other professionals and why should it be compulsory for them to work in substandard conditions?
Politics of Social Compulsion
Policy makers often stress over the fact that the government is hugely subsidizing the medical education and those medical students who are graduating from government colleges or colleges aided by government enjoy the benefits of these subsidies. There is no possible mechanism for ensuring that the students are actually repaying these subsidies after completing their education. Policy makers claim that the basic motive of medical education is to provide health care benefits for the society which has been taxed for subsidizing their education. Hence, medical professionals have a certain moral obligation to make it sure that health care facilities and life-saving and enhancing opportunities are being distributed equally in various sectors of the society at an affordable rate. This is why government often try to enforce compulsory rural placement law.
Thus, just like defense, government believes that health care sector should be a public sector and there should be an enforceable Universal Health Care program forcing medical professionals to provide services for the citizens equally without any preferences in such a way that citizens may not be required to pay for medical services while doctors may earn through governmental salaries, compensation and rewards. Government is in favor of making medical services free of cost for citizens because it feels that by allowing private practice and private payments for health care and life saving facilities, government will promote the idea of securing life of the person who can pay the most2 .
Failure of Universal Health Care Program
Abolishing cost of any service makes it impossible for the service provider to work honestly up to their potentially. It has been noticed that making health care services free of cost makes it difficult for the poor to attain any medical care at all and even the richer people fail to attain any quality services. The reason why universal health care program fails to serve the purpose has been discussed here Free Health Care System is Fraud. Current condition of Indian medical sector is prime example of failure of public or universal health care programs. 80% of all medical facilities available in India are provided through private sector while the government has succeeded in supporting and providing just 20% of the total health care and medical facilities in India. Compulsory laws for medical students to serve in rural areas not only increase corruption, they also discourage bright students to opt for medical sector.
Such free medical facilities often proves to be lethal because of the unavoidable corruption and negligence that is mandatory if healthcare sector is forcibly made as a welfare program. Recently, 45 elderly patients lost their eyesight while they were gaining benefits of free medical checkup and surgery for eye problems by governmental doctors3 .
What is the Solution?
The major problem is the scarcity of medical experts in India with such a huge population. Nationalizing the health care sector has been proven a fault again and again, there is a certain way to promote and provide quality health care services for every part of Indian society. The basic thing required for improving health care facilities in India is to privatize and improve the medical education system. Autonomous medical colleges and universities should be allowed to gather enough resources to manage themselves with a freedom to redesign various medical courses. This will help medical colleges to produce more doctors and as the supply of medical service providers will increase, the cost of health care facilities will decrease and doctors will find it beneficial to serve poor slum dwellers and villagers at affordable costs.
In past, medical experts were only available in big cities but as the government decided to partially allow private medical colleges to produce doctors, the shortage of doctors have been reduced to some extent and that is why now it is possible to attain highly qualified doctors even in smaller cities and towns. This progress can be extended to the rural and backward areas of India too by completely privatizing medical education and health care sector.
By removing subsidies for medical education and by abolishing the license rule for initiating a medical college, government will certainly help the process of producing more doctors at higher rate and as the point of saturation will be attained where supply of doctors will be nearly equal to demand of doctors, the lack of medical help and health care facilities will become a past. As we will reduce the shortage of doctors, the high prices of proper medical services will also go down and there will be willing expert doctors to live and serve in rural areas.
Private and autonomous medical colleges will have proper incentive to promote such medical courses that will offer opportunities of job creation in rural areas. These colleges will succeed in designing training courses that will help students to learn ways to provide essential help for people facing scarcity of resources and money and these students will also be trained to deal with living conditions and adoption of rural areas. Since these colleges won’t be subsidized by the government, there won’t be any moral obligation for students taking part in education programs of these colleges but they will certainly have an incentive to make a living while working in villages as they won’t find it equally profitable to lead a life in a metropolitan area.