Delayed cure: Mamata's plan to post quacks in rural clinics hits hurdles

An effective ‘cure’ that West Bengal Chief Minister Mamata Banerjee had proposed, to address the challenge of acute shortage of doctors in the state’s rural areas, is yet to see the light of day. This has put the Bengal health department in a quandary, as it tries to find a way to implement the plan.

Last August, Mamata had announced that unregistered medical practitioners, or “quacks”, would be deployed in rural health centres to handle the preliminary treatment of patients, as there are not enough qualified doctors for those centres.

After taking charge for the third consecutive term in West Bengal, Mamat’s Trinamool Congress government roped in quacks as the first line of defence in its fight against COVID in rural areas. They were used during the onset of the second wave of the pandemic in May 2021. The CM had christened the state’s estimated 275,000 quacks ‘Swastha Suraksha Bandhus.’

Satisfied with their role in containing the spread of the virus in villages, Mamata proclaimed that their services should be utilised at the preliminary stage of all medical treatment after giving them some basic training. 

A government doctor in West Bengal caters to 10,346 patients, which actually is slightly better than the national ratio of 1 government doctor to 11,435 patients.

No roadmap in sight

However, six months after the grand announcement, the health department, it seems, is yet to draw up a roadmap on implementing the proposal. Meanwhile, various organisations representing the unregistered medical practitioners are applying pressure on the government to execute the CM’s promise.

On the status of the plan, state health secretary Narayan Swaroop Nigam told newspersons: “We are discussing how far medical practitioners can be deployed.” However, an official of the state health services revealed that a final decision on their appointment had not yet been taken due to some inherent challenges.

Pointing out that most of these practitioners do not even have a college degree, let alone a medical degree, there is a big disparity in their educational qualifications, said the official.

Also read: West Bengal bolsters health sector, but gaps remain

“Some practitioners are school dropouts, others have diplomas in pharmacy, while some are graduates. We are yet to figure out how a uniform appointment procedure can be worked out without any legal complications,” admitted the official.

Limited scope of services

Moreover, as per the existing guidelines, the practitioners,  after completing a six-month government training, can only diagnose a disease and refer a patient. They are not authorised to prescribe any medicine or administer even an injection or intravenous support.

Utilising their services just for referral purposes and creating awareness —  as was done in the fight against COVID — will not be of much use, pointed out the official, adding that more comprehensive guidelines need to be worked out.

There is also strong opposition to the move from the West Bengal Doctors’ Forum. The forum viewed the announcement as an attempt to “mainstream quackery” and has threatened to launch an agitation if the quacks are recognised and made a part of the formal healthcare system.

Doctors divided

A 1996 Supreme Court ruling defined anyone practising modern medicine without training as ‘quacks’. Some reputed senior doctors, however, backed the government’s announcement saying it would be a force multiplier. The Liver Foundation, West Bengal has been providing basic training to such informal medical practitioners to integrate them in the peripheries of the healthcare delivery system since 2013.

Dr Abhijit Chowdhury of the foundation said the role of these rural medical practitioners in providing essential healthcare to patients in remote areas cannot be undermined.

Meanwhile, the Progressive Rural Physician Welfare Association, an organisation representing the unregistered medical practitioners, made a representation to the CM, stressing the need to expedite the appointment process.

The Bengal unit of the Progressive Medical Practitioners Association of India (PMPAI) and Bengal Rural Physicians Association made similar demands in separate communiques to the state government as well. “About 1.10 lakh informal healthcare providers, out of over 2.5 lakh in the state, have been enlisted by the government. We have been demanding that they be immediately appointed in rural health centres,” said Dilip Pan of the rural physicians’ association.

Corruption charges

Amidst the stalemate over their appointment, allegations abound in many areas of the state that some ruling TMC members have taken money from some quacks, promising them jobs at the primary health centres.

This point is underlined by Tarun Mandal of the PMPAI. “After the CM’s announcement, some people associated with the ruling party started taking bribes in the name of providing jobs to rural healthcare practitioners,” alleged Mandal without divulging any details.

The association recently approached the health secretary, urging that action be taken against those trying to dupe people by taking advantage of the delay in the appointments of these quacks, whose role in containing the pandemic cannot be undermined.