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