reasons for juda strike 2014

6. Mandatory rural service
Facts v/s myths
Its adverse impact on health system

7. Brief overview of the health system
Tertiary
Secondary
Primary

8. Brief overview of the health system
Teaching hospitals
CHC, Area Hospitals,
District Hospitals
PHC, SC
MCh/DM
MD/MS
MBBS
MD/MS
MBBS
MBBS

9. What is Mandatory rural service?
• AP medical registration act (Act no 10 of 2013)
– One year of rural service is mandatory for
registration under AP medical council

10. What is its relevance?
• To address shortage of doctors in rural areas
• To overcome reluctance of the doctors to serve in
rural areas?
• But today
– 3000 MBBS doctors pass out each year (in Telangana)
• (more than 3 times the number of PHC’s in Telangana)
– Doctors are ready to serve in rural areas
• 16,000 applications for 1100 posts of CAS!!! (Dec 2013)

11. The big question??
• Then why is the Govt still insisting to impose
mandatory rural service on junior doctors?
– To use junior doctors as cheap alternative to
permanent employees (doctors)

12. IMPACT ON PUBLIC

13. Impact on public
• With mandatory rural service, the govt tries to
fill up all the vacancies with fresh batch of
inexperienced doctors every year.
• Permanent recruitments will be done on ad
hoc basis or even not at all.

14. Impact on public
• Doctors assigned to particular area should
– Get familiar with the patients and their health status
– Get familiar with the basic health parameters
(drinking water supply, sanitation etc)
– Develop cordial relations with the patients (mutual
trust is very much essential between the doctor and
the patient)
• It takes a few months to establish ourselves as a
trustworthy doctors among the general public.

15. Impact on public
• But, with temporary appointments, people
lose faith in the entire public health sector.
• This drives them toward alternate options
(RMP etc)

16. Impact on public
• Risk of driving doctors away from tribal and rural
areas.
• In early 2000’s, a scheme was introduced to offer
reservation (30 % in clinical and 50 % in Non
Clinical subjects) to an MBBS graduate if he
serves
– 2 years in tribal health centers
– 3 years in rural health centers
– 5 years in urban health centers
• Because of this scheme, we are one of the very
few states with no vacant PHC

17. PG reservation scheme in AP -
Its positive impact on rural health

18. Increase in MBBS seats

20. Decreasing vacancies in PHC’s

21. Impact on public
• The PG reservation incentive encouraged the
doctors to reach out to the most remote
areas.
• If the mandatory rural service is imposed on
every one, the above said scheme will lose its
relevance.
– Doctors will move towards urban and peri-urban
areas
– Rural and tribal PHC will suffer lack of doctors

22. Impact on public health
• If there is no vacant PHC, then why are the
services poor in rural areas?
– Failure of the supervisory system of the govt
– Absence of adequate para medical staff
– Inadequate infrastructure
Without addressing the core issues, will posting
the doctors on temporary basis help to
improve rural health services?

23. Impact on public health
• Financial burden by temporary MBBS doctors
at PHC
– 2900 x 20,000 = 580,00,000/ month (72 crore/
year)
– Is it not appropriate to allocate this amount to
address other issues which need immediate action
• Recruiting paramedical staff
• Providing infrastructure etc

24. IMPACT ON MEDICAL STUDENTS

25. Impact on medical students
• Medical education is the most toughest and
lengthiest of all.
– It takes an average of 12 – 15 years to become a
superspecialist.
– Adding one more year is nothing but to snatch
away one more year of stress free life.
– Puts a brake to academic life
– Discourages merit

26. Impact on medical students
• Risk of losing entire life’s hard work
• Chances of medico legal tangles that will scar
one’s entire career

27. Risk of losing entire career
• All these medical students DO NOT have
license/registration to practice independently.
• Yet, they are posted in hospitals without qualified
superior.
• Treating a patient without registration amounts to
medical negligence
– Equal to attempt to murder
• Is this fact unknown to higher officials?
• If not, are the medicos being made scapegoats just to
entertain political ambitions

29. If public money is spent ?????

30. IMPACT ON PARENTS
• WHY BOND WHEN WE ARE EDUCATING OUR
CHILD?
• HOW MUCH DIFFICULTY FOR A MIDDLE
CLASS PERSON?
• HOW MUCH DIFFICULTY FOR CLEARING OUR
LOANS?
• WHY THEY ARE USING OUR CHILDREN AS A
CHILD LABOUR?

40. Conclusions
• All the vacant posts at all levels of health care
should be filled on permanent basis
• Provision should be made to identify and fill
up vacancies on a regular basis
• NO MORE BOND SYSTEM IN THIS TELANGANA