From the stick to the carrot. Instead of making a rural stint mandatory for doctors, the health ministry has now outlined a plan to incentivise them to work in villages. It is dangling a hefty quota in postgraduate diplomas after a three-year stint in a rural area. The Medical Council of India, which regulates medical education, claims this will address the rural-urban skew and would give those from rural areas an edge in postgraduate admissions. The other interesting plan is to introduce an MBBS (rural), for medical students in rural areas. These aspiring doctors will learn as they practice in a primary health centre and get a chance to immerse themselves in the particular needs of that village community. This is obviously an unqualified good, and the question of doctors’ willingness to work in rural areas is a serious one.

But these measures are unlikely to transform the state of rural healthcare because rethinking marks and resizing quotas doesn’t address the obvious problem — the fact that we are drastically short of doctors, and aren’t doing anything about producing more by creating new medical colleges. MCI has failed in a fundamental way — by not facilitating the creation of new training institutions. In 1946, the Bhore Committee adopted a three-tier healthcare model, meant to provide different levels of care across the country. But those goals have been long abandoned as the medical profession became increasingly urban-centric — 262 of our medical colleges are situated in urban or semi-urban areas. Seventy per cent of these medical colleges are located in the four southern states, and the regulatory clutch on these institutions has ensured that India is shamefully underserved, with a ratio of one doctor for more than 1700 people. The figures on nurses and paramedics are even worse.

... contd.