Hyderabad: The State health authorities and various associations representing doctors are looking at a confrontation following the decision to train Rural Medical Practitioners (RMPs) in the State.
RMPs are unqualified doctors who do not have an MBBS degree but have responsibilities similar to qualified doctors. Over the years, however, due to a host of reasons, the image of RMPs has been sullied and lost its sanctity.
There have been numerous cases where quacks or RMPs were involved in termination of female foetus, which is illegal under PCPNDT Act. They were charged of prescribing costly antibiotics where it was not required, leading to rapid rise in antibiotic resistance. In fact, a majority of them even hold license for operating ultrasound scanning machines which are abused to determine the sex of the foetus.
Understandably so, multiple associations representing the interests of doctors including Indian Medical Association (IMA), Telangana Government Doctors Association (TGDA), and Telangana Junior Doctors Association (TJUDA) have opposed the decision. Qualified doctors point out that allowing quacks to treat patients would only lead to misdiagnosis and risk the lives of patients.
Why RMPs are getting trained?
Over the years, much to their credit, RMPs have become a bulwark of healthcare service in rural Telangana and hold a lot of influence among patients in villages. By assisting senior doctors, they pick-up practical knowledge on protocols required to treat patients.
RMPs, also referred to as quacks, have also inherited the use of traditional systems of Indian medicine including Ayurveda, Unani, and Siddha, and, have worked as technicians in laboratories and learned from senior doctors on clinical applications of medicine.
There is huge population of RMPs in districts who simply can’t be ignored. Due to non-availability of qualified doctors, by rough estimates, there are between 20,000 and 30,000 RMPs in State, especially in remote villages, who are actively treating patients, have thriving business but have no MBBS degree.
There are an estimated 2.5 million RMPs in India who practice medicines without formal training or qualifications. At present, the country has close to 10 lakh doctors and authorities are hoping that the RMPs will be able to bridge the gap by providing basic healthcare services and refer patients with complicated ailments to a qualified doctors.
Public health experts, however, point out that if RMPs have to be given some legitimacy, then their ‘role of work’ or their limitations like no use of injectable drugs and conducting invasive procedures must be clearly defined. The stress must be on providing basic first aid or preliminary services and prompt and appropriate referral.
What is Community Paramedical Training?
During August-September last year, authorities had mooted the idea of upgrading the skill sets of Rural Medical Practitioners (RMPs).
In fact, in 2015, the State government had issued a Government Order (GO. Rt. No 428) that talked about holding ‘Community Para Medic Training’ (CPMT) training for RMPs and PMPs. To this effect, close to Rs 46 lakh was sanctioned by the government for conducting the programme.
The CPMT is a one year course after which the RMPs must clear or pass an examination conducted by Telangana State Paramedical Board to get Community Para Medic certificate.
As part of this initiative, the health authorities proposed that RMPs would be given training and later certificates that would allow them to extend basic preliminary healthcare services to needy patients.
Authorities maintained that giving due recognition to RMPs would not only allow authorities address the challenge of last mile connectivity but also help rehabilitate the sizeable number of families that depend on individual RMPs for survival.
Health Minister Dr C Laxma Reddy has proposed to start an exercise aimed at developing and strengthening skills and abilities of RMPs and PMPs, who have been providing services for a long time at village and district levels.
It was decided to set up a panel of experts who would provide training to the RMPs and later after completion of the course, a certificate and an identification card would also be provided. At present, the process of identifying the RMPs who have to be trained is underway.
What JAC Chairman Dr Narasinga Reddy has to say
A majority of RMPs in Telangana have not managed to clear Intermediate education. How can we give responsibility of providing treatment to patients with such low qualification? This issue is not that simple and such decisions are not permissible in a court of law
On the stand of IMA
On different occasions, we have represented our point of view on the issue to the health authorities. You are not setting a good example by training RMPs within a short period of time and then allow them to treat patients is not a good practice. What signal are you sending to hardworking nursing and other paramedical staff who slog for years to earn their degree? You can’t train RMPs overnight and then start giving them certificates to practice
Need for benchmarks
There is a need to have clearly defined benchmarks and regulations to check the functioning of RMPs in villages. The government should come with benchmark educational qualifications for RMPs, they have to introduce a three-year course for RMPs and then come-up with posts such as Rural Heath Assistants, allowing the RMPs to function. It’s just not possible to allow them to practice medicine overnight
Role of Rural Medical Practitioners
1. CPMTs can’t call themselves as doctors
2. They should not prescribe scheduled drugs
3. Should not dispense medicines other than over the counter drugs
4. Treat minor ailments within the ambit of protocols and training status
5. Refer patients to a qualified doctor
6. Give first aid, CPR, arrest bleeding and mobilise qualified doctor
7. Provide home care to handicapped, HIV positives
8. Maintain records of unusual occurrences of cases
9. Play the role of primary healthcare worker
Facts and statistics
1. Country struggles due to doctor shortage, hence promoting RMPs
2. According to WHO, ideal doctors to patient ratio is 1 : 1,000
3. Estimates and reports suggest India has 1 doctor to 1,700 population
4. In 2017, there were nearly 10 lakh doctors registered with MCI
5. Of 10 lakh, only 10 per cent work in government hospitals
6. On average, a single allopathic govt doctor provides services to 10,189 patients
Situation in Telangana
- Number of registered allopathic doctors: 4,123
- Number of govt dental surgeons: 201
- On an average, one govt allopathic doctor services 9,343 persons
- On an average, one govt dental doctor services 1,91, 642 persons
Indian Medicine doctors in TS
- Ayurveda: 9,585
- Unani: 4,638
- Naturopathy: 343
- Sidda (Not available)
- Homeopathy: 4,882
- Total: 19,448
- In 2015: AYUSH doctors: 7,44,563
- In 2016: AYUSH doctors: 7,71,468