The government proposes to revive the thorny issue of making a one-year rural stint compulsory for medical graduates, said Health Minister Anbumani Ramadoss Friday.
A proposal on the issue would be drafted by December and placed before the cabinet, the minister told reporters after the second meeting of the ministerial steering group of the National Rural Health Mission.
"By December we hope to go to the cabinet for clearance of the proposal," he said.
In order to meet health targets and bridge the acute shortfall of trained doctors in rural healthcare centres, it is proposed that medical students would not be given the licence to practice or go in for further studies till they have completed one-year rural posting after internship, said Ramadoss.
"We are proposing to bring in a legislation for compulsory one-year posting in rural areas after internship, when the medical student would be given temporary registration. During the one-year rural posting, the medical graduate would be given a stipend but no salary," said Ramadoss.
In effect, this would mean that medical graduation would take six-and-a-half years instead of the current five-and-a-half years including internship, said Health Secretary P.K. Hota.
Every year around 28,000 graduates pass out of the 240 medical colleges, including private institutions.
To win over the Indian Medical Association (IMA), which had opposed a similar proposal in the past, Ramadoss said they would be invited for discussions next month.
The National Rural Health Mission is being scaled up to improve healthcare and sanitation in rural areas. The cabinet had last month approved a health ministry proposal to provide more financial and structural flexibility with the target of reducing maternal and child mortality, improving nutrition and reducing the burden of diseases in rural areas.
The health ministry also plans to train medical students in carrying out safe deliveries and in neo natal care. Through providing doctors with multi skills, it hopes to meet the acute shortage of trained personnel in rural areas.
"Of the 3,222 community health centres in the country, 981 are being upgraded to first referral centres to provide gynaecology, paediatric and anaesthetic services as well as emergency obstetrics services," a health ministry official said.
In the discussions Friday with the ministry of rural development and state representatives, Ramadoss said it has been decided to employ the services of chartered accountants for monitoring the flow of funds. Similarly, the Indian Institute of Public Audits had been engaged for Rs.6.5 million annually for a proper audit of fund utilisation.
These steps were being taken in view of reports of large-scale leakage of funds meant for public health programmes.
Some of the other changes proposed by the health ministry include giving more financial incentives to the accredited social health workers or ASHAS to motivate pregnant women to seek medical check-ups and delivery in hospitals, ensure proper immunisation of children in the villages under their charge and promote use of indoor toilet facilities.
Instead of a regular salary, the 227,000 ASHAS would receive incentive-based monthly remuneration, Ramadoss said.
For the safer motherhood programme, the government has decided to raise the incentive to mothers from Rs.700 to Rs.1,400. Funds provided to the district hospitals, particularly in the northeast, are being increased to improve the facilities.
The rural development ministry has agreed to support the efforts by focusing more on sanitation and better access to clean drinking water.