It has often been suggested that the focus on qualified doctors is one of the main reasons behind the lack of health care in rural areas. In 1975, the Group on Medical Education and Support Manpower suggested that there was a need to reorient medical education and develop a curriculum for health assistants who were to function as a link between medical staff and multi-purpose workers. It recommended training paraprofessional and semi-professional health workers from within the community itself. A three-tier system with multi-purpose health workers and health assistants between community-level workers and doctors at primary health centres (PHCs) was mooted.
The Janata Party government accepted these recommendations in 1977 and launched a rural health service. It adopted a policy of entrusting the responsibility of public health to the people by training community health workers chosen by the people themselves. Implemented in haste, the plan failed.
In subsequent years, several critical appraisals were made of health policies. In 1980, the Planning Commission constituted a working group on health for all by 2000 to identify specific goals, perspectives and programmes for the Sixth Five-Year Plan. Health for all principles and strategies were incorporated into the Sixth, Seventh and Eighth Five-Year Plans. Little progress was made.
The latest major initiative, the National Rural Health Mission (NRHM), was launched in 2005. It aims to provide comprehensive preventive and curative health care services to people, especially the poor in rural areas and urban slums in 17 states. More funds will finance training of health volunteers, provide more medicines and strengthen primary and community health centre systems.
NHRM envisages people's involvement at the grassroots level. The aim is to enlist accredited social health activists trained and paid by the Centre. These workers will be trained to tackle basic health problems in their villages. They will be in touch with the nearest private practitioner, whom they can approach for complicated cases. The workers will also link up with their nearest PHCs and have funds for emergencies, for which 1,700 round-the-clock block hospitals have been identified.
Abhay Bang, director, Society for Education, Action and Research in Community Health, says three-fourth of diseases don't need doctors. Communities can be trained to take care of problems. This would reduce dependence on trained doctors. NRHM could revive the community health movement in the country if implemented properly, he adds. But Debabar Banerji, emeritus professor at JNU, says the programme is not based on adequate research.
But given the track record, the jury is out.