Say no to non-MBBS rural / village / half doctors for rural India

Last Update: Tue, October 19, 2010
http://www.petitiononline.com/quackswb/
Don't play with life of villagers, MCI told The Times of India, Wed, Jan 13
http://timesofindia.indiatimes.com/city/mysore/Dont-play-with-life-of-villagers-MCI-told/articleshow/5441772.cms 
MYSORE: The Karnataka Government Medical Officers Association has taken objection to the Medical Council of India's proposal to offer short-term courses to attend to health needs in rural areas.

This could be suicidal as the MCI is playing with life of patients, Association president Dr H N Ravindra said on Wednesday. Instead, make rural services compulsory to study for PG courses. This can address the problem since some 23,000 medicos graduate every year. There is no dearth of those pursing medical education. But they are not going to rural areas because of lack of facilities, he told reporters.

The association has adopted a resolution against the MCI's move and petitioned the Union health and family welfare ministry.

While it is important to upgrade the health facilities in rural India and attract the doctors to serve in rural areas, short-term course is no solution. When medical graduates who study for some six years are liable to err how can those who have studied for lesser duration do better? This is nothing but encouraging quackery, Dr Ravindra noted.

The Union health minister should also make it mandatory for doctors to serve in rural areas under its various nation-wide programmes. There is also a need to bring in uniform health scale for payment, he stated.

The association welcomed the proposal of Union health minister Ghulam Nabi Azad to accord rural weightage to the graduates serving in rural areas for three years. Such measures will help attract the doctors to the rural areas, he contended arguing that the three-and-a-half years in institutes set up in rural areas as proposed by the MCI will not help.

He asked the state government to issue a GO on their pay hike as decided three months back. There is no follow-up action after the decision was made, he stated.

Opposition to village 'doctor' bill bulldozed The Telegraph Thu Dec 17

http://www.telegraphindia.com/1091217/jsp/bengal/story_11876673.jsp
http://www.telegraphindia.com/1091217/images/17zzsur.jpg

Govt plans to bring back diploma docs for villages - Kolkata ... Times of India, November 25 2009

http://timesofindia.indiatimes.com/city/kolkata-/Govt-plans-to-bring-back-diploma-docs-for-villages/articleshow/5265887.cms

Desperate to address manpower crunch in the rural healthcare system, the West Bengal state government has apparently decided to resurrect the 'barefoot doctors' of the early '80s in a new avatar through the West Bengal Rural Health Regulatory Authority Bill 2009.

Once the regulatory authority is set up, it will pave the way for insitutes that will train and issue diplomas to rural health practitioners.

During the '80s experiment, the diploma-holding 'doctors' had faced stiff opposition from the medical community. The latest bill, which will be introduced in the Assembly this Winter Session, is also likely to kick up a ruckus. Congress and Trinamool are ready to oppose it. As in the '80s, the medical community is again prepared to take on the government.

Eligible to practice in rural areas, rural health practitioners will treat patients and prescribe medicines according to a standard treatment guideline to be handed to them. They will also carry out minor surgeries and issue illness and death certificates.

Doctors have raised their voices against the move. The Medical Council of India doesn't recognise the diploma, neither does the West Bengal Medical Council. The state health department has cited the instance of Assam, where similar legislation was enacted in 2004.

"The government had tried this in the past and failed miserably. There is no doubt that Bengal has a shortage of doctors, but creating rural health practitioners is not the solution. More medical colleges - both government and private - should be set up," said Subir Ganguly, ex-president Indian Medical Association (Bengal chapter).

Recently, some IMA members met Trinamool MLA Aroop Biswas, a member of the Assembly's standing committee on health, and stated their objections. Objections have been raised on the usage of the term rural health practitioner and also granting them permission to issue death certificates.

"The government claims there is a shortage of doctors. How many times have they issued advertisements through the Public Service Commission for empanelling doctors? How many doctors have been recruited in the last five or 10 years?" asked a senior IMA (Bengal) member.

"Promode Dasgupta tried this and failed. I don't know why Buddhadeb Bhattacharjee is trying to do the same thing. We will oppose it," said Manas Bhunia, Congress legislature party leader.

Trinamool's newly-elected MLA from Serampore Sudipto Roy, former president of IMA (Calcutta), said the Bill discriminates between urban and rural areas. "Why should there be two sets of doctors for urban and rural areas? Government should identify the number of vacancies and fill them up," Roy said.

Doctors said the manpower crunch can be addressed by making all MBBS passouts serve a compulsory stint in villages. They also called for campus recruitment from medical colleges.

Docs, Cong slam Bill on 3-yr medical diploma course Indian Express, Friday, Dec 04, 2009

http://www.indianexpress.com/news/docs-cong-slam-bill-on-3yr-medical-diploma-course/549836/0

http://www.indianexpress.com/news/docs-cong-slam-bill-on-3yr-medical-diploma-course/549836/

The West Bengal government's move to table a Bill to allow for a three-year medical diploma course in Bengal in the winter session of the state Assembly has failed to find favour with doctors who say it must not be an alternative to a four-year-MBBS degree.

State Health Minister Surya Kanta Misra, while refusing to discuss the details of the Bill, said it will be a three-year diploma course.

Satyajit Chakrabarty, secretary, Association of Health Service Doctors, said, "We want it to be made clear this is not a short-term medical course. Since this diploma will not be recognised by the Medical Council of India, they cannot write 'doctors' before their names and will not be allowed to hand out death certificates. There is a lot of confusion about it. We want clarity."

He, however, said they were not entirely against the course since it could aid health care at the gram panchayat level.

"Those applying for the course should at least have a high school degree, much like the nurses' training course," said Chakrabarty.

Md Masiha, the chief government whip, said the state government had already drafted the entire Bill, which the subject committee has examined and submitted a report to the Assembly.

The state health department is likely to place the Bill in the Assembly on December 14 or 15," said Masiha.

Meanwhile, Congress Legislative Party (CLP) leader Manas Bhuniya said the proposed diploma course was "unscientific and detrimental".

"They did something similar around 10 to 15 years ago but the course had to be discontinued. How can the state government send people without MBBS degrees to villages to treat locals? This course will be illegal as it will not even have the recognition by the Medical Council of India (MCI). How can a person treat a patient without even the recognition from the MCI? There are enough village quacks...why does the state government want to increase their ranks," said Bhuniya.

He said the Central government is already planning to address the issue of inadequate doctors in the rural sector.

"The central government is planning to introduce a Bill in the coming session of Parliament which will make it mandatory for all the MBBS pass-outs to serve in villages before they take up post-graduation," he said.

Opposition to village 'doctor' bill bulldozed The Telegraph Thu Dec 17
http://www.telegraphindia.com/1091217/jsp/bengal/story_11876673.jsp

Calcutta, Dec. 16: Health minister Surjya Kanta Mishra today pushed through the Assembly a bill that will allow "half-doctors" to practise in villages, steamrollering a demand from the Left Front and the Opposition to defer the legislation.

The West Bengal Health Regulatory Authority Bill will permit "rural health practitioners" with a three-year diploma to treat patients in villages where qualified doctors are loath to go.

The "health practitioners" will not be called doctors, the minister said. (See chart)

The legislation had been introduced in the budget session last year and sent to a standing committee in line with procedure. The panel approved the bill after suggesting changes that the government accepted.

The committee's approval and the absence of precedent sunk the Opposition's case later in the day before Speaker Hashim Abdul Halim, who wondered aloud: "Were they in slumber for a year?"

The drama started unfolding at the Left Front meeting this morning with the Forward Bloc's Hafiz Alam Sairani and the RSP's Kshiti Goswami wanting the bill deferred.

Sources said CPM state secretary and front chairman Biman Bose admitted that it had not been discussed in detail in his party, too.

"The front wants the bill referred to the Assembly select committee to evolve a collective opinion. However, the House has to decide its business," Bose said after the meeting.

The select committee, meant to arrive at a political consensus on a sticky issue, is often given several extensions to ensure the slow death of a bill.

Health minister Mishra, however, said there was no precedent that allowed the bill to be sent to the select committee.

When the House began discussing the bill at 2.30pm, Trinamul leader Partha Chatterjee and the Congress's Manas Bhuniya demanded its withdrawal.

The bill, they alleged, is aimed at covering up the government's failure to provide trained doctors to villagers. The diploma holders will further endanger villagers' lives, they said, citing the standing committee report that had recorded objections from doctors' bodies and the Opposition.

Trinamul moved a motion asking for the select committee. The minister refused.

The deputy Speaker put the motion to vote but the electronic voting machines developed a snag and the Opposition refused to vote manually and walked out.

When the minister stood up to reply to the debate, even the treasury benches were empty. Mishra defended the bill, saying the Centre had prodded the state to make such a move and that there was no other way to ensure all rural health centres were manned.

As he finished, the Speaker adjourned the House and convened a meeting of its advisory committee to discuss the front chairman's statement which had almost echoed the Opposition's demand.

Mishra, however, held his ground, saying the bill could not be deferred after he had finished his reply.

The Speaker found no precedent of a bill cleared by a standing committee and discussed in the House being sent to a select committee.

However, let alone the Opposition, even the CPM's allies were not convinced. "It is unprecedented. In 32 years of Left rule, this is the first time a bill has been passed despite the front's objections," the Bloc's Sairani said.

Biman Bose called up the partners tonight in a bid to placate them.

Mishra said later: "I came to know about it (the front's reservations) when I was already in the House. Had it been communicated in time, I could have moved differently."

CPM stir over Health Bill Statesman, Kolkata Thu, Dec 17, 2009
http://www.thestatesman.net/page.news.php?clid=1&theme=&usrsess=1&id=278057

KOLKATA, 16 DEC: Though the controversial West Bengal Rural Health Regularity Authority Bill, 2009 was passed in the Assembly today without much uproar, the CPI-M government's problems are far from over.

As diploma holders of rural health care or rural health practitioners have been given the authority to issue death certificates, the Association of Health Service Doctors, the CPI-M backed doctors' body has decided to launch an agitation against the state government.

The association had earlier demanded that words like "medicine" and "medical" would have to be omitted from the proposed diploma course or institutions. The association had also demanded that diploma holders be barred from issuing death certificates as they are not doctors. Though words like "medicine" and "medical" were omitted in the amendment moved by the Left Front Chief Whip in the Assembly, the diploma holders were designated the power to issue death certificates.

Later in the evening, the secretary of the Health Service Association of Doctors, Dr Satyajit Bandopadhyay, told The Statesman: "We had demanded that medical and medicine words should be omitted from the Bill and the diploma holders should not be allowed to issue death certificates. We have to discuss the issue once again as we expected that all these would be amended before the Bill is passed. Now, if the diploma holders are allowed to issue death certificates, we have no other option than opposing the Bill."

Meanwhile, Dr Surjya Kanta Mishra, health minister, made it clear that the diploma holders, who cannot be considered doctors, would, however, be able to issue death certificates. He explained that the Bill has been framed as per the guideline set by the resolution accepted at the 9th conference of the Central Health Council of Family and Welfare in Delhi in 2007. "So we are just following the resolution and we have not added anything new," added Dr Mishra. Doctors argued that as these diploma holders are not being taught medical science properly, it is not possible for them to diagnose the reason behind a person's death. Furthermore, they are not being accepted as doctors so how can they be given the responsibility to issue death certificates, they added.

Docs protest rural practice bill The Telegraph Fri, Dec 18, 2009
http://www.telegraphindia.com/1091218/jsp/bengal/story_11880892.jsp
http://www.telegraphindia.com/1091218/images/18doctor1.jpg
Doctors protest outside Writers' Buildings. (Amit Datta)
Calcutta, Dec. 17: The government's bill to create a three-year diploma course to train "rural health practitioners" triggered protests from doctors today, who questioned the validity of such a diploma and threatened a statewide agitation.

The West Bengal Health Regulatory Authority Bill will permit rural health practitioners with the three-year diplomas to treat patients in villages where qualified doctors don't want to go.

The health practitioners will not be called doctors, health minister Surjya Kanta Mishra said yesterday.

But the Indian Medical Association (IMA) and the Association of Health Service Doctors, two leading organisations of doctors, criticised the bill, saying that it would worsen the condition of an already crippled rural health system. An IMA source said a ceasework call was one of the options being considered as a way to protest.

"There cannot be any short course for medical studies," said Satyajit Chakraborty, secretary of the Association of Health Service Doctors. "There is no point in putting MBBS qualified doctors in villages where there is no infrastructure. The government should train paramedic personnel instead of offering shorter medical courses," he said.

"We also demand that such doctors should not get the authority to issue death and illness certificates," he said.

Doctors on rural duty are generally posted in primary health centres - each meant for at least 10 villages that could have a population of 30,000 to 40,000.

"We don't recognise any medical degree or diploma below MBBS, which is recognised by the Medical Council of India and the World Health Organisation," said Sanjay Banerjee, a senior office bearer of the IMA's Bengal branch.

"We had expressed our reservations to the government before the bill was brought to the Assembly and we sought changes," he said.

The doctors pointed to loopholes in the bill. "It says the practitioners would be able to treat only select illnesses. Then what about critical care?" asked Sudipto Roy, Trinamul Congress MLA and working committee member of IMA.

He said the government should go for campus recruitment in medical colleges and choose doctors. "Every year 1,100 doctors pass out from medical colleges in the state but most of them don't get a job here. They have to go out of the state to seek jobs. Many of them will be glad to work in the rural hospitals and health centres," said Roy.

Whether the government will try any course correction is yet to be seen, but the doctors' protest today made the chief minister's convoy change its route. Buddhadeb Bhattacharjee, returning home for lunch, took the N.S. Road instead of BBD Bag East when he was leaving at 1.20pm because of the protest by the IMA near the east gate of the Writers'.

Bloc ire

The Forward Bloc today accused the CPM of imposing a "one-party rule", citing the passage of the rural health bill in the Assembly.

Docs on the warpath - The Statesman Fri, Dec 18, 2009
http://www.thestatesman.net/page.news.php?clid=1&theme=&usrsess=1&id=278167 
KOLKATA, 17 DEC: Though the West Bengal Rural Health Regularity Authority Bill, 2009 was passed in the Assembly yesterday with a promise that the diploma holders in rural health care would never be considered as doctors, senior officials of the state health department apprehend there could be a demand in future to consider these practitioners as medical officers.

Officials said they apprehend such a demand as the state government has earlier recognised diploma holders in community health care as additional medical officers and they were posted in different rural hospitals. The officials fear that history may be repeated.

The CPI-M-led state government had introduced a diploma course in community health care in 1978 to combat the shortage of medical officers in rural areas. A hundred students were enrolled in the first batch but the course was scrapped the next year after the Medical Council of India refused to give its approval.

But by that time 100 students had already completed one year at the institutions. They became the headache of the government. After the batch passed out they were attached to National Medical College and Hospital for another three years training. Soon after the training was completed, the students demanded regular registrations just as MBBS pass-outs. But the Indian Medical Association refused to accept the demand and the students went to court against the decision. Following a court directive, the students were registered as doctors but they were not given the MBBS degree.

Soon after this, the state government deployed them in the rural hospital as additional medical officers, earlier known as community heath workers. Officials apprehend a similar kind of situation this time also. The state health minister, Dr Surjya Kanta Mishra, clarified on this at the Assembly yesterday saying at that time the course was started without framing an appropriate Act. Instead, the course was initiated by a government order.

"But the situation is different this time. The course is going to be introduced after an Act is framed," added Dr Mishra.

But several doctors' organisations including the CPI-M-backed Health Service Association of Doctors had demanded that it should have been mentioned in the preamble of the Bill that the course is not a medical one by any means.
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This petition's been addressed to the MOHFW / Ministry of Health & Family Welfare, Guv/Governor of West Bengal / WB, Chief Minister or CM of West Bengal / WB, Medical Council of India or MCI, West Bengal Medical Council or WMC, Indian Medical Association or IMA,