Kounteya Sinha, TNN Sep 26, 2011, 02.57am IST
NEW DELHI: The controversial three-and-a-half year long medical degree Bachelor of Rural Medicine and Surgery (BRMS) -- has now got the backing of Planning Commission's all powerful high level expert group on universal health coverage.
The panel has in its report (finalized on Sunday and available with TOI) "endorsed" the all new BRMS cadre and said that as a career progression incentive, they should be promoted to the level of public health officers after 10 years of service.
According to the panel, by 2022, India should actually have BRMS colleges in all districts with populations of over 5 lakh.
The course should focus on "high quality of competence in preventive, promotive and rehabilitative services required for rural populations with focus on primary health care."
(Plan panel has "endorsed" the new BRMS cadre and said that as a career progression incentive, they should be promoted to level of public health officers after 10yrs of service.)
It also recommended that it should be mandated through legislation that a graduate of the BRMS programme is licensed to serve only in specific notified areas in the government health system.
The panel however was clear that the BRMS was not a mini-MBBS but rather a unique training programme aimed at the basic health care needs of its target population.
According to the Union health ministry, vulnerable populations in rural, tribal and hilly areas are extremely under-served. In 2006, only 26% of doctors in India resided in rural areas, serving 72% of India's population. Another study found that the urban density of doctors is nearly four times that in rural areas, and that of nurses is three times higher than rural areas.
As of March 2010, undue delays in recruitments resulted in high vacancies even in available posts at health centres over 34% for male health workers are not in position, while 38% of radiographer posts, 16% of laboratory technician posts, 31% of specialist posts, 20% of pharmacist posts, 17% of ANM posts and 10% of doctor posts are vacant.
Overall, human resources in health shortfalls range from 63% for specialists to 10% for allopathic doctors. The past few decades have also seen the disappearance of certain cadres village health guides and traditional birth attendants, first instituted in 1986. "They have now decreased to a point of non-existence," the report said.
The panel said, "The BRMS degree should be linked to State Health Sciences Universities. BRMS students should be taught in local settings where they live and work and the faculty should be drawn both from existing teaching institutions and retired teachers. The faculty should include non-physician specialists from the fields of public health and social sciences."
According to the panel, it is expected that full coverage of BRMSs at the sub-centre will be achieved by 2030. In order to support the production of this cadre, the panel recommended the production of 172 BRMS colleges in phase A, 163 BRMS colleges in Phase B and 213 BRMS colleges in Phase C.
"This would enable positioning of rural health practitioners at 1.14 lakh SHCs by the year 2022 and facilitate outreach to underserved rural populations. Similarly, nurse practitioners will be positioned to serve vulnerable urban population," the panel said.
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Institute of Technology, Banaras Hindu University
Varanasi 221005, UP