Wednesday, March 17, 2010

Joint Action Council against BRMS/BRHC

Dear Doctors
As a leader of medical profession you would have heard regarding the proposed short term course in modern medicine-BRMS renamed as BRHC.The central council of IMA has strongly opposed this move. However the Medical Council of India has approved and passed this proposal on 11/03/10.This is a serious development.There is a public interest litigation in High court of Delhi where IMA Kerala State Branch is defending the profession.
Government of India is going ahead with implementation of this suicidal project without respecting the sentiments of the medical profession. It is a matter of shame that the Government could find traitors amongst us to support them.
I am requesting you to study the issue deeply, assessing its implications.We owe it to generations of medical graduates and countrymen to steer the nation into the right direction.The situation is extremely serious and urgent. Only the combined might of the medical profession can stop BRMS/BRHC.
Thanking you
Yours sincerely


Dr V C Velayudhan Pillai
Chairman Joint Action Council
Daffodils,No.10,Sasthri Nagar
Karamana.Thiruvananthapuram-695002
Mob : 98470-67440
Email:vcvp@eth.net

Monday, March 1, 2010

The wrong way for rural doctors- Anbumani Ramadoss

The proposal to introduce a shortened medical course is a folly: it will aggravate the rural-urban divide and give a raw deal to villages.

The proposal put forward by the Central government to introduce a shortened medical course at the graduate level to serve the rural areas will only widen the rural-urban divide and impede India's role as an emerging global power. In seeking to virtually revive the Licentiate Medical Practitioners (LMP) scheme that was available before Independence, the government has taken a regressive step. And in the process it is resorting to discrimination against rural folk, who are taken for second-grade citizens deserving medical care by a brigade of ‘qualified quacks'.
The scheme involves a three-and-a-half year course that leads to a bachelor's degree in medicine and surgery. Doctors trained under this scheme will work in rural areas. They will be trained in district hospitals.
In the erstwhile LMP scheme, students were trained for around three years, awarded a diploma and asked to meet rural health care needs. It was considered a way to bridge the gap between demand and supply outside metropolitan India. The LMPs outnumbered the MBBS graduates and largely served in the rural areas. Following the Bhore Committee report of 1946, medical courses were unified into the standard five-and-a-half-year MBBS degree.
The issue is the impact of this scheme on the status of the rural Indian. In what way are rural Indians different from their urban counterparts? Do they deserve health care from medical personnel who are less qualified than those who attend to the health needs of their urban brothers? Are their well-being and lives less important than those in urban areas? This discrimination could sow the seeds of disunity and discrimination. The scheme is against the spirit of the Constitution and human rights.
The proposal is superfluous, too. Any State can introduce a short-term medical course. We do not need a centralised concept of rural service, governed by the likes of the Medical Council of India (MCI).
The need is to utilise existing personnel prudently. Today even medical colleges recognised by the MCI, numbering about 300, face faculty shortage. How is the government planning to equip the so-called rural-based institutions that will eventually churn out semi-qualified medical personnel, with faculty and infrastructure?
India has a wealth of alternative medical systems such as Ayurveda, Siddha, Unani, Homeopathy and so on, that brings in hundreds of thousands of qualified medical professionals into the health care industry. They qualify after more than four years of training. It would be easier to use this huge corps of medical manpower according to the needs of the local regions rather than create a new cadre.
Today a nurse undergoes four years of training during her or his course, whereas the proposed BRMS course is for three and a half years. The rural folk would be better off being catered to by nurse-practitioners who are more qualified than the ‘qualified quacks.'
The doctor-patient ratio in India is 1:1,700. Add to this the doctors under the traditional medical systems and the ratio comes down to about 1:700. The World Health Organisation's recommended criterion is 1:300. To reach that target, we cannot go for short-sighted and short-term measures to create a cadre of semi-qualified professionals.
We have the schemes and tools to enhance the health of our rural fellow-beings. With an exemplary scheme like the National Rural Health Mission, all that is needed is to revive and give new momentum to such schemes.
There are more than a million fully trained nurses and more than 3,00,000 Auxiliary Nurse Midwives in India. There are also more than 7,00,000 Accredited Social Health Activists (ASHAs). Then there are Village Health Nurses, Male Health Workers, Male Nurses, Anganwadi workers and so on. There is no dearth of paramedical professionals and qualified medical personnel to serve the districts and villages.
Adding one more cadre of workers who are neither here nor there will lead to state- acknowledged quackery. Already, nearly 75 per cent of India's population is treated by quacks. The proposal will only help strengthen the cause of the quacks, bestowing upon them respectability.
Already the urban-rural disparity in health infrastructure is huge. If the rural areas are catered to by BRMS personnel, it will deter qualified and experienced doctors from taking up rural assignments. It was after much thinking and cajoling that we put forward a compulsory scheme for rural service for those who desire to pursue higher medical courses. With one imprudent and rash gesture, we will do away with a good practice that was initiated with astute planning.
Ghulam Nabi Azad, my successor Union Minister of Health and Family Welfare, says BRMS personnel can be posted in Sub-Health Centres and Primary Health Centres. These already have more than enough qualified nurses who have completed four-year courses and done their practical training. So where is the need for a BRMS course that will produce medical personnel dismally equipped with only three and a half years of training?
The website of the Union Health Ministry provides details about the NRHM. Thousands of crores of rupees are being invested in the rural health sector under the NRHM to strengthen rural infrastructure. As Health Minister, in order to supplement the NRHM, I initiated a proposal for a one-year compulsory rural posting for each MBBS doctor after the internship. This faced stiff resistance from medical students. A committee under Dr. Sambasiva Rao was formed to deliberate on this issue around the country and give their recommendations. Finally, the recommendation was that anybody who aspired for a post-graduate degree should undergo a one-year compulsory rural posting. Unfortunately this recommendation came at the fag end of my tenure. Had this been implemented, every year we would get nearly 30,000 fully qualified doctors working in Rural Health Centres.
The need is to start more medical colleges in areas such as the northeast, Bihar, Uttar Pradesh, Madhya Pradesh and Jharkhand. The country has nearly 300 colleges, of which 190 are in Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, Maharashtra and Gujarat. Uttar Pradesh, with a population of 19 crores, has only about 16 colleges. Bihar, with a population of nine crores, has eight. Rajasthan with an eight-crore population has eight and Madhya Pradesh, with a population of eight crores, has 12. If the State governments open medical colleges in all the districts, we can have nearly 600 medical colleges, rolling out nearly 75,000 MBBS graduates a year.
We have another huge health resource pool to tap from: doctors trained in Russia and China. Their services can be utilised in the rural areas.
Many doctors settle abroad. The government should take steps to prevent this drain by offering them attractive remuneration, avenues to train and upgrade knowledge and due recognition.
One school of thought favours admitting two batches of medical students in each institution every year – in the morning and in the afternoon. Clinical sessions could be alternated. By resorting to the double shift, we can double the number of medical graduates using the same

infrastructure and faculty. This can be followed for medical, dental and nursing courses. This was accepted by the MCI for post-graduate courses when I put forward the suggestion that accommodates one more student per professor within the existing system, given the infrastructure available. Earlier one professor could take in only one postgraduate student; now one professor can take in two students without compromising on the quality of medical education, thereby doubling the intake of students to postgraduate courses, leading to optimum use of the existing resources and infrastructure.
My suggestions in a nutshell are here. Make one-year rural posting compulsory for all MBBS doctors after internship. State governments should start medical colleges in every district to create more medical graduates. Increase the number of medical graduates and post-graduates using the existing infrastructure and faculty. Focus more on the northern and northeastern States. Expand and invest more in the National Rural Health Mission. Start government-run nursing colleges in all districts. Public-Private partnership ventures can be initiated, using the district and sub-district government hospitals for the purpose. Preference should be given to students from rural areas for admission to the MBBS courses, and it should be stipulated that the graduates work for five to 10 years in rural areas. The harmonisation and utilisation of doctors who have been trained in Russia and China, who have undergone seven-year MBBS courses, to fit into the rural programmes could help. The utilisation of doctors from traditional systems for specific needs and programmes could be planned. Anyone who wants to join a post-graduate course in a government college should have done a minimum of three years in a rural posting.


This article is by former Union Health Minister; published by Hindu on 27/02/10

MCI Executive committee accepts alternative rural model of undergraduate education

During the course of deliberations in the workshop held by MCI in New Delhi on 4th and 5th Feb 2010,it was emphasized that entitlement to health is a human and fundamental right. The constitutional mandate vests the responsibility of actualization of same on the ‘State’ as an organ towards realizing the goal of welfare ‘State’. In spite of 6 decades of post independence developments, the vast multitude of rural masses which account for more than 70 % of the population are still out of the ambit of the desired health care. To address the inequities and disparities which exists in our health care system the National rural health mission was launched in 2005 with a commitment to strengthen primary health care and expand access to good quality health care. Despite 4 years of implementation of the National Rural Health Mission, more than 50 to 60% of the Community Health Centers, established for one lakh population, have vacancies of specialists and over 20-30% of Primary Health Care Centers do not have a MBBS qualified doctor. Out of nearly 1,46,000 sub-centers none of them has a MBBS qualified doctor while there are substantial vacancies of nurses lab technicians and male & female health workers. With such massive shortage of human resources in the primary health care facilities, the efforts to improve the infrastructure are having a suboptimal impact on disease burden.
It is also true that the trained health manpower generated by the present model of medical education is by and large urban centric and is reluctant to render rural health care. Clamour for postgraduate and super speciality qualifications, status and materialistic gains amongst the graduates are some of the significant inhibiting factors whereby rural masses stand deprived of the desired levels of health care.
The ‘Rural Model’ aims to tide over the crisis of the gross crunch of the trained health manpower for rural health care. It envisages creation of trained health manpower exclusively for rendering the health care services in the ‘Notified Rural Areas’. The course has been titled as ‘Bachelor of Rural Health Care’ which would be 4 years of duration inclusive of 6 months rotating internship.
It would be ‘Institutional’ in character conducted through ‘Medical Schools’ which would be tagged with Public District Hospitals in the Districts where there are no medical colleges as of now. The annual intake proposed for the said course is 25 or 50 students. The teaching would be ‘Modular’ in character at all the three levels and the ‘Competencies’ expected out of the Graduate at the end of the course would be well defined and notified by appropriate Regulations.
The eligibility qualification for admission to the course would be that the applicant should have had his entire schooling from a ‘Notified Rural Area’ and qualifying 10+2 examination from of the concerned district. Thus the admissions to the course would be ‘District Based’, yet the necessary relaxations in terms of the arising needs and situations would be evolved by the competent authorities in the States from time to time. The services rendered by the Graduates generated out of the model would be ‘State Based’ meaning that the Graduates would be required to serve in a ‘Notified Rural Area’ in the concerned State.
The Graduates would be registered by the concerned State Medical Council in a separate ‘Schedule’ created exclusively for the said purpose. The accruable registration shall be on ‘Year to Year Basis’ for a period upto 5 years, renewable at the end of each year on an appropriate certification by the designated authority to the effect that the incumbent has rendered rural health care services in the ‘Notified Rural Area’ of the State.
Each of the ‘Medical School’ would be affiliated to an examining university which would be conferring the ‘Bachelor of Rural Health Care’ degree on successful completion of the course by the incumbent.
The Graduates would be conforming to the disciplinary jurisdiction of the registering State Medical Councils vide ‘Code of Medical Ethics’ notified by the Medical Council of India. The proposed model would definitely provide trained health manpower for an effective rural health care delivery so as to fulfill the legitimate expectations of the rural masses of the country in a meaningful way.
After due and detailed deliberations, the members of the Executive Committee decided that the following additions be made in the consensus arrived at in the workshop:-

1. For first 5 years the Graduates should be required to be employed in Primary Health Center/Sub-Centers only. They should not be allowed to undertake any private practice during the period of first 5 years.

2. In order to attract better talent, an incentive in the form of “Rural Area Allowance” should be included in addition to the regular salary payable to such Graduates which would act as a major incentive.

In view of above, the members of the Executive Committee of the Council decided to accept the recommendations on Rural Model of Undergraduate Medical Education

Chairman's message

Dear Friend

Substantial ground has been covered in IMA after the central council resolution against BRMS on 27/12/09 in Hyderabad.The resolution was well drafted into a memorandum by a drafting committee.Later on 15/02/10 a special committee appointed by IMA National President fine tuned IMA’s position.Though yet to be ratified by CWC or central council,this remains IMA’s stand as of today

  1. The proposed nomenclature of “Bachelor of Rural Health Care” by MCI be changed as “Diploma in Rural Healthcare”.

  1. The term “Medical School” be changed to “Rural Health schools”.

  1. A separate mechanism should be provided for registering diploma holders from this Course other than the State Medical Register.

On 21/02/10 UP state working committee has reiterated the central council resolution.What has been achieved is only within IMA.It has to be noted that Government of India has not moved an inch.In these circumstances the agitation against BRMS has to be kept alive.

The action of JAC in this regard has shifted to political lobbying with members of parliamentary standing committee on health.We intend to engage them all in intense brain storming.

Simultaneously All India Medicos Association(AIMA)is spearheading the agitation amongst the medical students. Dissemination of information to all medical colleges is a huge task and is proceeding satisfactorily. The National convention of medicos is being held at Thiruvananthapuram on April 3rd and 4th of 2010.Only the student community can save the fraternity from the clutches of Government of India.

Let me assure you that even GOI cannot abolish section 15(2) B of MCI Act without 2/3rd majority in parliament.This clause states that the minimum qualification to practice modern medicine is MBBS.Vested interests are trying to bye pass this clause by getting a court order.We are fighting against this in High court of Delhi. If needed we will not hesitate to move the supreme court of India.

I appeal to all to stay united in this fight against assault on the profession

With warm regards

Dr.V.C.Velayudhan Pillai
Chairman,Joint Action Council

Daffodils,No.10,Sasthri Nagar
Karamana.Thiruvananthapuram
Mob : 98470-67440
Email:vcvp@eth.net