Maharashtra mulls new scheme to groom rural health workers

Soumya Viswanathan - Mumbai

Having scrapped the "failed" community health volunteer scheme in April 2002, the Maharashtra government now proposes to launch a modified scheme early next year to address the issue of non-availability of healthcare professionals in rural parts of the state.

The new scheme, called the Gramin Lokswasthya Yojna, aims to eliminate the fallacies of the community health volunteer scheme of 1978 by involving the village panchayat and NGOs in training "health workers" for rural areas. For better co-ordination, the government will share responsibilities with Primary Health Care (PHC) Group, a conglomerate of nine NGOs, as far as selection and training of "health workers" is concerned, while village panchayats will be asked to provide minimum infrastructure support such as clinic space.

The new scheme, which has been drafted by the PHC Group as a part of the 10th Five Year Plan, will also do away with the archaic system of paying the rural "health workers" a sum of Rs 50 per month. Instead, they will now be able to charge within a prescribed fee structure. "The rationale being that the state will only support national health programmes, while it would be left to people to pay for their other healthcare needs," informed Dr Shyam Ashtekar, member of the study group constituted by the Planning Board of Maharashtra and the coordinator of the PHC group for the new scheme.

The concentration of doctors/health workers in rural areas of Maharashtra is highly skewed. As high as 35,000 to 45,000 villages in Maharashtra do not have resident doctors, says Dr Shyam Ashtekar. A survey conducted by the PHC group in Nashik district of Maharashtra revealed that there exist 555 doctors across 737 villages. However, 84 per cent of the villages have no resident doctors. In other words, 555 doctors are clustered in 16 per cent of the villages, mainly because these villages were found to have a primary of community health centres.

The new scheme proposal has been submitted to the state government for approval, after which, it will be sent to the Union Government and also the European Commission to garner funds for the pilot project, which will cover 1000 villages in the first year. The total cost is estimated to be Rs three crore. Though the PHC group wants to run the pilot project in 5000 villages, the Planning Board has agreed for a smaller project covering 1000 villages, Dr Ashtekar said.

It is said that the community health volunteer scheme failed mainly due to improper selection procedures and lack of continous training. Even a fourth grade drop out was eligible for the training in the earlier scheme, it is learnt. An entrance exam and a certification course is being proposed under the new scheme. The certification course will cover training on 50 allopathic and 40 ayurvedic medicines and will be done part in-house and partly through distant learning programmes, Dr Ashtekar revealed.

The certificates will be awarded by the Yeshvantrao Chavan Maharashtra Open University. The certification course will be authorised by the Maharashtra University of Health Sciences. Provisions for imparting CMEs once every six months is also contained in the draft proposal. "We have looked at the legal provisions of awarding a certificate and it can be recognised by Maharashtra Medical Council, which can also offer, renew or revoke registration," Dr Ashtekar said.

The scheme, following the state’s clearence, will be implemented by early next year, committee members say. The project will be monitored by gram panchayats on a constant basis to assess its workability, they add.