Last some years were very volatile for the public health sector. Corona crisis shook the entire sector but in another way it also lead the sector to come out of it with the strength. Before the pandemic Indian government introduced the ambitious plan of Ayushman Bharat. The major bullets of this scheme were Ayushman medical insurance card and Health and Wellness Centres (HWCs).
HWC is the new structure of rural health and that is why it takes some hard controversies at the time of introduction of NMC bill. The major controversy of this new system was the qualification of the Community Health Officers (CHO) appointed on HWC. Especially doctors opposed with strikes on this new idea of NMC bill. They were totally offended by the decision made by govt to provide a doctor like service from a noncapable paramedics who were just nursing personals with six months of bridge course. The qualification as well as responsibilities given to the CHO was actually a master stroke from government to patch up the shortage of doctors in rural India.
[ Also read: NMC બિલ: કેટલી ખેંચ કેટલી ઢીલ? ]
Does that patchwork add any value to the system? In terms of value I may say no but as an additive component CHO fulfills some gapes of the system. The qualification of CHO was the most controversial part and it also touched the treatment part of the duty. On the name of schedule K the dangerous molecules of medicines were given in the hand of CHO who even don't know with what they are dealing. Though initially it was noted for the primary care medicines only will be provided in HWCs, gradually narcotics and higher antibiotics were introduced for them to use. Improper use of these medicines may lead to very serious crisis in long-term period but our bureaucrats don't see it or if they can see, they can't convince the decision makers to make any changes to this bill. Unfortunately we can't expect this from them nowadays.
Primary care isn't the solo purpose of HWC. Prevention of non communicable diseases (NCD) is also a key point to work upon. The best thing I personally see in the tasks of HWC is Yoga. The major purpose of HWC is preventing the NCD and boosting the immunity by Yoga. Medicines and treatments should be the secondary things for them. But nowadays Yoga is just a formality of these centres. Yoga is organised once in a month for photography purpose only. I don't know Yoga without consistency makes any sense. Boosting the community health with Yoga is a very long term process and to convince the community for it should be the major purpose of CHO. The purpose of this new structure isn't wrong but the execution part is too weak. From last few years government concentrated on vaccines and that's why in last five years rotavirus, measles rubella, pneumococcal etc vaccines were introduced into routine vaccination program. It will reduce the burden on hospitals from the respective diseases. The cost of vaccination is far lower than the cost of hospitalisation of a large community and that is what government is looking forward to deal with community health. The same principle should be executed for the Yoga in HWC because lifestyle modification is the only way to prevent non communicable diseases like hypertension, cancer, diabetes etc. But unfortunately this principle don't work like vaccination program till date.
Which diversions do HWC make nonproductive to its purpose? CHOs considering themselves as an alternative of doctors is the major misconception of this program. On another hand system also wants to patch the gapes without quality. CHO are assembled into the same numerology the other departments were providing till date. Numbers matters the most for the system but at the root numbers can't withstand. If the human resources are utilised as per the capabilities, HWC concept can be the game changer for rural health in India. As we can see the numbers of medical colleges are increasing day by day, there will be no shortage of 'real' doctors in rural India within next decade. But till date we have to ensure that the system patched by CHOs won't detoriorate public health with above mentioned long term crisis.
Final Funda: The most common rural health joke,"I'm a doctor of health and wellness centre."
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