Why is rural India suffering from doctor deficiency?

 

We are moving towards the development. Indian people have changed their lifestyles rapidly in last decade. Our urban and metro areas are filled with luxurious lifestyle and at the same time villages are shrinking day by day. The only reason is the lack of the speed of development. Rapidly the cities are growing but the same thing and pace doesn't apply to the rural areas. That's why lots of inconvenience stops the people to spend whole life in village especially public servants. If public servants don't want to stay here, how will be the development of rural areas possible?

 

We can figure out other rural problems slowly but we can't neglect the health services. To the last person health is the most serious and necessary service for the survival and healthy lifestyle. Unfortunately we are still a little slow on it. Ayushyman Bharat Yojana tried to patch this void space but a lot of things need to be done rapidly. Almost on every 1 lac population there should be a Community Health Centre consisting 4 specialists doctors but we can see rarely the specialists at CHC. On every 30000 population there is Primary Health Centre containing one Ayush doctor and one MBBS but still both of them aren't always fillled for long time. At 5000 population there is a subcentre structure which mainly belongs to vaccination and prevention healthcare activity. These centres are now developed as Health and Wellness Centres but with the patchwork of nursing staff. Every year almost 60000 to 70000 students complete MBBS but most of them don't join the rural service area for more than the bond period. 

 

The most important part of the healthcare system is a doctor. In absence of qualified doctors quacks ruin the atmosphere and habits of rural people. Sometimes these quacks don't refer their critical patients to the specialists just for some profits and glory and the time slips away from the life. In such circumstances a qualified doctor must be provided full time in rural areas by government because none of the private qualified doctors want to spend their lives in a village and the same is true for government doctors. To accommodate doctors in rural areas government forces bonds, penalties and mandatory period appointment in rural health centres but still after this mandatory period or paying the bonds every doctor wants to catch the urban life. Everybody likes Swadesh movie or Panchayat series but nobody permanently wants to serve the rural India. Why? 

 

 

Here are some major bullets to this problem:

 

Infrastructure

Rural area lacks basic facilities. That's why professionally trained doctors don't want to work there as they haven't enough resources to save the patients. A doctor can't work without necessary infrastructure and instruments. In rural area a well set Primary Health Centre with all the basic facilities must be available to handle the primary crisis of patients. Though in last some years new infrastructure and facilities at hospitals are made available by government, a lot of hospitals in rural areas have just 2 or 3 rooms. Even some centres haven't separate male and female toilets for patients as well as staff. With such limited sources a doctor can't perform the duty satisfactory. That's why they avoid to spend their service time here.

 

Living facilities 

Not only hospital facilities but the facilities of accommodation is also missing in most of villages. A doctor must stay 24 by 7 on hospital. This is the expectations of local people and they want to access the health facilities beyond the OPD time whenever they want. A single doctor can't perform round the clock duty alone. There must be another doctor to handle the critical cases at night but unfortunately here we are missing a single doctor in rural area then how can we predict more doctors?

Every doctor wants a fabulous lifestyle which is not exactly possible in rural areas. Even some remote areas of India don't possess active transportation facilities. Doctors may like to spend their holidays on hill stations or villages or farms but don't like to stay there forever for the service purpose. This is a harsh reality of the rural health centres. Most of the doctors make their minds to live luxurious life with the handsome salary they earn but unfortunately it's not possible in remote rural area.

 

Enough staff 

Government is gradually working on infrastructure of rural hospitals but there will be none of the usage of the extended facilities untill the full supporting staff is made available to the doctor. Without enough man power a doctor single handed can't perform the duty. Vacancies in rural areas are almost permanent because every staff including doctor want transfer in urban area whenever it'll be possible. Lacking trained supporting staff also discourages the doctor to work at rural hospitals.

 

Learning resistance

A clinically qualified doctor has some dreams to diagnose and treat special diseases and conditions. But unfortunately in primary health centres a doctor have more preventive activities than treatment part. They have to focus on preventive community health rather than curing the patient. Even in treatment part they have very limited resources and mostly they depends on referral services for critical cases. Though a determined doctor can generate the other part of curative treatment simultaneously with preventive activities, most of them fail to work with both the hands against the system complexity. As a result a doctor gradually losses the major clinical experience in rural area and that is the reason why new doctors don't want to lose their momentum of the learning days.

 

 

What can be the solution of this problem?

Bonds and penalties are imposed by the government to enforce the doctors to serve in villages but it doesn't look impressive or permanent solution. In last decade government tried to improve the infrastructure facilities to the rural health centres and it's a mission on process but still it needs some pace to accomplish as soon as possible. Only building a infrastructure shouldn't be the final aim but time by time maintenance and new improvisation are also necessary to keep the health services updated. 

 

Enough trained staff also attracts doctors to work here. If facility demands 24 by 7 services, there should be enough staff to work round the clock without burden.

 

Local political hindrance also play a major role in rural areas rather than urban areas. Unnecessary and destructive mindsets and political elements should be kept aside to enhance the beauty of rural areas which attracts the doctors to serve flawlessly. 

 

Rotational duty of urban doctors and rural doctors can also help to distribute the workload. But it can serve as a temporary solution rather than a permanent solution. 

Final Funda: 

A hospital without doctor is a marriage ceremony without bride and groom.