One of the main reasons for the crumbling Indian Healthcare system is a scary doctor-patient relationship, especially in rural areas. In rural areas, people have to travel miles just to consult an ordinary doctor. The pain of physician shortages is worsened with uneven distribution, with a large proportion working in urban areas ignoring the fact that rural India needs more medical attention as compared to rural. However, the government along with many medical colleges are trying to straighten out this crippled doctor-patient ratio via Bonded services of doctors in rural areas. Bonded service (the bond) is one of the policies aimed at addressing this unequal distribution. Under it, graduates of medical institutes are required to serve the public healthcare system after completing their MBBS degree for a stipulated period.
This policy may have seemed a simple and fruitful answer to help with the problem of the doctor-patient ratio, but it has time and again failed to fulfill its function. The bonded service of doctors has seen only limited success due to a variety of reasons. While many of the medical colleges and states have tried making the bonded service of doctors in rural areas compulsory, it just doesn’t work out as most of the practitioners opt out of it because of the improper implementation and less regard to personal facilities.
Here are the main reasons for the limited success of the Bonded service of doctors in India:
Faulty structure of the policy
The first government resolution (GR) available on the bond is from 1996. Since then the policy has been at least 10 times revised, laid back, canceled, and modified. This means where, at the time of admission in 2011, an MBBS student signed a bond (as a certified copy affidavit) that allowed them two attempts at their PG examination, the 2017 GR will either null or update the provisions of the previously signed document at the time of graduation. Frequent frameworks, cancellations, and modifications in GRs pertaining to bonded service clearly show the government’s lack of situational analysis and foresight.
Poor execution and development
At ground level, countless obstacles block the direction of fresh MBBS graduates ready to serve in rural regions. The evaluation process involves hours of waiting at government offices, a trip to Mumbai’s department of public health, and a waiting period of about a month, if not longer. Placement selection is carried out on a first-come-first-served basis, with a lack of accountability. Also, any student can get out of this policy by heavy monetary payments.
Limited facilities and behavioral problems in rural society
A specialist doctor who is enthusiastic about offering his services at the primary level finds his hands bound due to a lack of facilities needed. Poor living and working conditions, inadequate infrastructure, rigid behavior regarding treatment and medicines in rural areas, low payment to doctors, and disparate distribution of doctors in rural areas make it extremely difficult for the doctors to stay in the regions they are based in.
What should be done to repair this policy?
- Full implementation responsibility should be re-allocated to a single authority to minimize interdepartmental policy shortfalls.
- Digitizing the application process with transparent allocation requirements, published publicly, would ensure centralization, consistency, impartiality, and convenience at both ends of the process.
- Mechanisms must be in place to ensure sufficient infrastructure and staff support is available. Most specifically, doctors need to feel healthy at primary centers.
- A proper professional must be trained in the skill set to function optimally in the new environment.
- The government should provide doctors with perks and adequate pay and living facilities so that they can serve a few years in rural areas and feel financially sound and mentally safe.
Doctors are moving increasingly into the private sector and it will take a good and lucrative strategy to make them remain in the public healthcare system. It is the need of the hour for India to create properly structured models and implement one to make healthcare open to everyone. It’s time for the government to step in and fix infrastructure in primary health facilities, provide services and social institutions that doctors need, respect the degree of dedication to serving the rural community, and understand what doctors need.
