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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 4  |  Page : 383-387

Compulsory 1 year rural Service - Stance of interns and postgraduates of medicine and dentistry in Hyderabad City, Telangana: A cross-sectional survey


Department of Public Health Dentistry, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India

Date of Web Publication13-Dec-2017

Correspondence Address:
Prof. Jaidupally Ramvilas Reddy
4-2-969/a, Kanyalalbagh, Vikarabad, Vikarabad - 501 101, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_79_17

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  Abstract 

Introduction: India is the second most populated country in the world, with more than 68.84% of the people residing in the villages. There is no proper health services are available in these areas. To achieve this target of XII 5-year plan by 2017, a scheme of compulsory rural postings for doctors was implemented by the state of Andhra Pradesh. Aim: The aim is to know the stance of interns and postgraduates (PGs) of medical and dental profession on compulsory 1-year rural posting. Materials and Methods: A cross-sectional survey was conducted on interns and PGs in all the medical and dental colleges located in and around Hyderabad. The colleges which gave permission for the survey were included in the study. A pretested (Cronbach α = 0.81) self-administered questionnaire was developed based on the government order passed in the year 2011. Results: A total of 653 students participated in the survey comprising of 379 dental and 274 medical students. About 65.1% of medical and 59.9% of the dental students agreed that students get benefitted with the 1-year rural posting. Around 25.8% and 15.6% of students from medicine and dentistry, respectively, were willing to establish private practice in a rural area. Conclusions: Majority of the students were positive toward the 1-year rural posting. Students quoted the reasons such as less pay, lack of proper infrastructure, and higher salaries in the private sector for showing disinterest in joining rural service.

Keywords: Government order, interns, postgraduates, rural service


How to cite this article:
Reddy P P, Anjum MS, Monica M, Rao KY, Hameed IA, Reddy JR. Compulsory 1 year rural Service - Stance of interns and postgraduates of medicine and dentistry in Hyderabad City, Telangana: A cross-sectional survey. J Indian Assoc Public Health Dent 2017;15:383-7

How to cite this URL:
Reddy P P, Anjum MS, Monica M, Rao KY, Hameed IA, Reddy JR. Compulsory 1 year rural Service - Stance of interns and postgraduates of medicine and dentistry in Hyderabad City, Telangana: A cross-sectional survey. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2020 Dec 5];15:383-7. Available from: https://www.jiaphd.org/text.asp?2017/15/4/383/220723


  Introduction Top


Health care is the right of every individual but lack of quality infrastructure, dearth of qualified medical functionaries, and nonaccess to basic medicines and medical facilities thwarts its reach to 60% of the population in India. A majority of 700 million people lives in rural areas where the condition of medical facilities is deplorable. Considering the picture of grim facts there is a dire need of new practices and procedures to ensure that quality and timely health care reaches the deprived corners of the Indian villages.[1] Unequal distribution of health services is seen among rural and urban India. As per rural health statistics 2012, there were 148,366 subcenters, 24,049 primary health care centers (PHCs) and 4,833 community health care centers (CHCs) functioning in the country, whereas Telangana state alone has 675 PHCs and 114 CHCs delivering the health services.[2]

Andhra Pradesh government had passed a government order (GO) on 1-year compulsory rural service in the year 2011. The purpose of this compulsory government service for the trainee doctors is to see that the deficiency of the specialist doctors is reduced at primary and secondary health-care level. This scheme of rural postings has been implemented to achieve XII 5-year plan target as the infant mortality rate as 18/1000 live births and maternal mortality rate as 54/1 lakhs live births. To achieve this target by 2017, this scheme of rural postings should be implemented strictly. Another reason is to reduce the disproportionate and unequal distribution of the health-care providers and to improve the health standards of the people living in rural areas of undivided Andhra Pradesh. However, the government had given 1-year postings for postgraduate (PG) diploma students in 2010, PG degree students in 2012–2013, 2013–2014, and 2014–2015. In 2014–2015, the government gave 1-year postings to PGs, diploma students and superspecialty students. At present, the compulsory 1-year rural service is exempted for both the students of medicine and dentistry.

However, the students are against this compulsory rural service and agitated against the GO. Students argued that 1 year temporary rural service is definitely not an answer to the shortage of doctors in rural areas. In fact, by doing this, the government is putting the lives of the rural population in inexperienced hands. The rural population cannot be viewed as guinea pigs for gaining medical expertise. The only solution is a transparent, time-bound permanent recruitment of doctors to rural areas with increased strength of sanctioned posts.[3]

Information on career preferences and intended practice locations of the medical students provide useful insights into the planning of the healthcare workforce. Previous studies conducted have shown that medical students prefer hospital-based clinical specialties, want to practice in urban locations and work in the private sector.[4] This results in lack of doctors in the rural areas and public facilities. The present survey explored opinions of students pursuing internship and postgraduation of medicine and dentistry on compulsory 1-year rural posting, career plans, and job preferences.


  Materials and Methods Top


A cross-sectional survey was conducted in all the medical and dental colleges located in and around Hyderabad during July to September 2015 for 3 months. Six medical and five dental colleges are located in and around Hyderabad in which five dental and three medical colleges gave permission for the survey. Permissions were obtained from each institution to conduct the survey. As it was survey students from all the medical and dental colleges having interns and PGs were included in the study. Verbal consent was taken from the participants willing to participate.

Pilot study was carried out among 30 students to check the feasibility and to test for reliability of the survey instrument. A pretested (Cronbach's α = 0.81) self-administered questionnaire was developed based on the GO passed in the year 2011.[4] The questionnaire consisted of closed-ended questions with a 5-point Likert scale and obtained information regarding the career plans, job preferences, and opinions regarding 1-year rural service.

The data were collected by an investigator from house surgeons and PGs from medicine and dentistry using the questionnaire. Investigator distributed the questionnaire among the students and ample time was given to fill the questionnaire. To reduce bias, the students were made to sit apart so that the inter-participant discussion is avoided.

The collected data were analyzed using SPSS version 20.0 (IBM, United States). Microsoft excel was used to generate tables. Descriptive statistics Chi-square test and t-test were used to compare the opinions of the students from medicine and dentistry.


  Results Top


A total of 330 female students and 323 male students participated in the survey. Majority of the students from both the fields agreed that students get benefitted with 1-year rural postings. Both the medical and dental students are in agreement that rural postings help in the improvement of health standards of the rural people. Majority of the students, i.e., 30.3% of the medical and 33.5% of students from dentistry were against making the rural service as the part of their academic curriculum. About half, i.e., 50.8% of the medical and 45.9% of the dental students opined that increase in the pay will make students favorable toward the 1-year rural service [Table 1].
Table 1: Comparison of opinions on different factors of rural health services among medical and dental students

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There was no significant difference among interns and PGs of medicine regarding the opinions about different factors on compulsory rural service [Table 2] except on its benefit to students and reduction of the service to 6 months. No private practice during rural posting and 1-year rural posting should be reduced to 6 months, except for these statements [Table 3], there is no significant difference in the opinions among the dental internship students and PGs.
Table 2: Differences in opinions among medical interns and postgraduates on different factors about 1 year rural posting

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Table 3: Differences in opinions among dental interns and postgraduates on different factors about 1 year rural posting

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Immediate career plans of both medical and dental students were to set up a private practice [Table 4]. About 34.1% of medical interns and 15.8% of dental internship students wanted to join postgraduation upon the completion of the course. When compared with medical students, only 16.9% of the dental students wanted to join the government service. When coming to the long-term career plans, a significantly higher percentage of the medical students want to set a private practice in the rural area when compared with the dental students. Majority 31.1% of medical and 39.3% of dental students showed their eagerness in setting up a private practice in an urban area.
Table 4: Comparison of career plans and job preferences among medical and dental students

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  Discussion Top


Inadequate workforce and reluctance of the existing workforce to work in rural areas is the major problem in providing the services to the rural population. The purpose of this compulsory government service for the trainee doctors is to see that the deficiency of the doctors is reduced at primary and secondary health care level. Specialist doctors will be an added advantage for the rural health centers.[5]

Even though, the majority of the students agreed that students are benefitted from rural service only a few students showed interest toward compulsory rural posting. This may ensue lack of facilities, poor infrastructure, less pay, and improper career growth.

Majority of the students from both the fields opined that 1-year rural posting helps the rural people in improving their health standards. However, students were against making this as a part of their academic curriculum. These results are in contrast with the study done by Wiwanitkit V,[6] where the success of the Thai mandatory rural health service system largely solved the problem of an inadequate number of physicians and other health-care workers in rural areas.

The viewpoint of most students is to reduce the period of this service from 1 year to 6 months. In Kerala, India, a strike protesting against a 3-year compulsory service requirement influenced the government to reduce the service period to 1 year.[7]

A significant amount of disparities exist in the health services of urban and rural areas. The rural doctors have a low image among the medical fraternity. The well-established perception is that rural postings are taken up by those who are left with no other option, i.e., to specialize further or work in an urban area.[8] Due to the complex web of factors that influences the mobility of health workers, any efforts to scale up the health workforce in response to the crisis should be combined with effective measures to attract and maintain both existent and newly trained health workers where they are needed most.[9]

Increase in pay may encourage the students to work in rural areas. The special salary rate for rural physicians is another main financial tool to attract Thai physicians to work in rural areas.[10]

In the present study, the percentage of the students willing to join the government service is higher among medical students (22%) than the dental students (16.9%) as their short-term goal. Most of the students want to gain experience, and low cost of living and service quota in postgraduation may be the reasons for showing the interest in government service. The results are similar to the studies done by the Nallala S,[11] Gaikwad V.[12] Less interest is shown by the dental students, which may be due to the lack of proper infrastructure at PHC [13] and less pay when compared to medical students.

Majority of the medical and dental interns (55.9% and 35.7%) are willing to join postgraduation immediately after their graduation. Higher social and financial status of specialists as compared to general practitioners leads to an increased number of students opting for specialization every year.[4]

Nearly 900 PG medical students are being engaged to serve in rural areas every year in Telangana state alone. Because the government is receiving complaints against students that they are not taking the job seriously and it has become a namesake rural service. While some are skipping duties under one pretext or the other, some are leaving hospital soon after registering attendance.[14] The government is spending Rupees 60 crore on stipend for them. The government plans to recruit fulltime doctors in hospitals instead of wasting this Rupees 60 crore.[15]

Many other Indian states such as Karnataka, Odisha, Kerala, Maharashtra, Goa, and Chhattisgarh tried to introduce the compulsory rural service but because of the protest from students and most of the students were willing to pay fine instead of joining compulsory rural service many states exempted this compulsory rural service.[16]

Mandatory rural service has its own problems to be addressed. Students are against of making this rural service as mandatory. Instead of making it as mandatory, students willing to work should be encouraged. Moreover, the infrastructure should be escalated so that proper treatments and health services can be provided, which makes meaningful sense of this rural posting. Not only posting them in rural area but also proper strategies should be planned to retain them in the service. Because of the protests from the student's and realizing that the rural posting cannot be mandatory the government of Andhra Pradesh has discontinued the mandatory service. The medicine and dental curricula should be reframed according to the present challenges. Then, the mal-distribution of the health professionals can be minimized and the health for all is achieved.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rural Health Care: Towards a Health Rural India. Gram Vaani-Voice of the Village. Available from: http://www.gramvaani.org/?p=1629. [Last accessed on 2015 Oct 05].  Back to cited text no. 1
    
2.
Available from: http://www.nrhm.gov.in/nrhm-in-state/state-wiseinformation/telangana.html#health_profile. [Last accessed on 2015 Oct 05].  Back to cited text no. 2
    
3.
4.
Lal P, Malhptra C, Nath A, Malhptra R, Ingle GR. Career aspirations and apprehensions regarding medical education among first year medical students in Delhi. Indian J Community Med 2007;32:217-8.  Back to cited text no. 4
  [Full text]  
5.
Available from: http://www.dme.ap.nic.in/nodaldme/01.pdf. [Last accessed on 2015 Aug 25].  Back to cited text no. 5
    
6.
Wiwanitkit V. Mandatory rural service for health care workers in Thailand. Rural Remote Health 2011;11:1583.  Back to cited text no. 6
[PUBMED]    
7.
Bärnighausen T, Bloom DE. Designing financial-incentive programmes for return of medical service in underserved areas: Seven management functions. Hum Resour Health 2009;7:52.  Back to cited text no. 7
    
8.
Rao KD, Ramani S, Murthy S, Hazarika I, Khandpur N, Chokshi M, et al. Health Workers Attitude toward Rural Service in India: Results from Qualitative Research. HNP Discussion Paper; 2010.  Back to cited text no. 8
    
9.
Thammatacharee N, Suphanchaimat R, Wisaijohn T, Limwattananon S, Putthasri W. Attitudes toward working in rural areas of Thai medical, dental and pharmacy new graduates in 2012: A cross-sectional survey. Hum Resour Health 2013;11:53.  Back to cited text no. 9
[PUBMED]    
10.
Wibulpolprasert S, Pengpaibon P. Integrated strategies to tackle the inequitable distribution of doctors in Thailand: Four decades of experience. Hum Resour Health 2003;1:12.  Back to cited text no. 10
[PUBMED]    
11.
Nallala S, Swain S, Das S, Kasam SK, Pati S. Why medical students do not like to join rural health service? An exploratory study in India. J Family Community Med 2015;22:111-7.  Back to cited text no. 11
[PUBMED]    
12.
Gaikwad V, Sudeepa D, Madhukumar S. A study on career preferences and attitude towards the rural health services among the graduating interns of a medical college in Bangalore rural. Int J Biol Med Res 2012;3:1577-80.  Back to cited text no. 12
    
13.
Simon AK, Rao A, Rajesh G, Shenoy R, Pai MB. Oral health care availability in health centers of Mangalore taluk, India. Indian J Community Med 2014;39:218-22.  Back to cited text no. 13
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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