Bridging Healthcare Disparities - Revitalizing Rural Healthcare

Healthcare is a fundamental human right; yet millions around the world lack access to adequate medical services, especially in rural areas. In many countries, including India, this urban-rural healthcare divide remains a pressing concern. To address this disparity and to ensure equitable healthcare access, the concept of compulsory rural service for medical professionals after completing their MBBS and postgraduation has gained traction. While this idea may seem burdensome to some, it is a vital step towards creating a more equitable healthcare system.

Rural areas often face severe shortage of healthcare professionals, leading to a lack of essential medical services for the local population. This disparity can result in preventable deaths, undiagnosed and untreated chronic conditions, and limited access to healthcare facilities. Medical graduates and postgraduates are equipped with valuable skills and knowledge that could make a significant difference in these underserved, underprivileged, and marginalized populations who need their expertise the most.

According to WHO norm, one doctor should be there for every one thousand population; that is 1:1000 ratio. But in India, we are having 1:834 considering allopathic and Indian system of medicine doctors. The ratio of allopathic doctors to population is around 1:1194.

Compulsory rural services do have some benefits in creating an equitable healthcare system, but it is necessary to address the disadvantages and challenges. Main concern regarding the rural service is that it can be a hindrance to the career. Rural healthcare facilities often lack essential infrastructure, medical equipment, and resources. Doctors may find themselves working in conditions that are suboptimal, which can be frustrating and challenging. Doctors may have personal or family considerations that make it difficult for them to relocate to rural areas. Other challenges in enforcement include inconsistencies in enforcing compulsory rural service, with some healthcare professionals receiving preferential treatment or finding ways to avoid service, while others face stricter enforcement.

In Karnataka, it is implemented under Completed Medical Courses Act, 2012 (Karnataka Act 26 of 2015). The students admitted under Govt. quota seat in a Govt. college and Govt. seat in any private college are to mandatorily undergo one year compulsory rural service after successful completion of MBBS and one year of internship, through a counselling conducted by Ministry of Health and Family Welfare. Rural service is to be done in Government Primary Health Centres or Government Hospitals in rural areas allotted based on merit through process of counselling. During such service, the doctor is called as Junior resident. Each candidate is required to complete a one-year mandatory rural service, shall receive a stipend equivalent to the minimum gross salary of general duty medical doctors in Health and Family Welfare Services, minus one hundred rupees.

Individuals who have successfully obtained a postgraduate diploma or degree are required to complete a one-year mandatory service in a government hospital situated in an urban area. The selection and placement in such hospitals will be based on merit through a counseling process established by the State, as per the regulations. While performing this service, he/she will be referred to as a Senior resident and will be entitled to a stipend, as specified, which will be one hundred rupees less than the minimum gross salary of specialists in the Health and Family Welfare Department.

Anyone found in violation of the regulations outlined in this Act will face a fine ranging from a minimum of fifteen lakh rupees to a maximum of thirty lakh rupees.

This editorial solely reflects the author’s perspective on the subject.