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Times of India
09 June 2010
By Nirmala M Nagaraj
Bangalore, India

Cross-practice crackdown to hit rural health services
Cross–practice may be a violation of medical ethics, but strict enforcement of this code may bring Karnataka’s rural health services to a standstill.

There are 715 AYUSH doctors serving in primary health centres (PHC) across the state, specially in rural and remote areas. And 50% of them are single doctors in charge of one PHC, each covering a population of over 50,000.

Considering the shortage and lack of willingness among MBBS doctors to serve in rural areas, the government recruited AYUSH doctors to vacant posts in PHCs.

Subsequently, under the National Rural Health Mission (NRHM) introduced in 2005, Ayush doctors were also appointed as additional hands in each PHC along with allopathy practitioners. Because of this, majority of AYUSH doctors were absorbed under the central scheme and continued to serve in health centres. According to AYUSH doctors welfare association secretary Manjunath Sajjan: “Earlier, we were appointed to the vacant MBBS state government post. Based on the Nanjundappa Committee report, we were appointed only in backward taluks mentioned in the report. Around 550 AYUSH doctors serving in the PHCs were absorbed under the scheme.”

Allopathy Drugs During Emergency
With each health centre having a single AYUSH doctor, in emergency situations like suicide, snake bite, road accident–related injuries, H1N1 flu, chikungunya and outbreak of other diseases, these doctors have no option but to prescribe allopathy drugs. In some districts like Raichur, there are 46 PHCs and 23 AYUSH doctors; in Koppal, of 47 PHCs, 22 have AYUSH doctors; of seven PHCs in Jhamkandi, three are served by AYUSH doctors.

Says Dr Manjunath Anagoudar of Sindhanur taluk: “I have been serving in this PHC for three years and conducted 350 normal deliveries. While attending to emergencies, we need to use allopathy drugs. During H1N1 flu outbreak, we had prescribe tami flu for several cases.”

Shortage of Ayush Drugs
“Though most of the ailments can be treated with AYUSH medicines, we need to depend on allopathy drugs during emergencies and also because there’s a shortage. I can’t allow a patient to die due to non–availability of AYUSH drugs. In three years, AYUSH drugs have been supplied to our centre only twice,” Anagoudar said. Under the Drugs and Cosmetics Act, integrated practitioners can prescribe emergency allopathy drugs. In fact, nine states, including Maharashtra and Gujarat, have passed a government order allowing doctors to prescribe the same.

Doctors a Deprived lot
Despite being the lifeline of rural healthcare service, AYUSH doctors are deprived of maternity leave, transportation/daily allowances; their salary is less than that of MBBS doctors serving in PHCs. While MBBS doctors are regularized on completion of three years of service in rural areas, AYUSH doctors, even after five years, remain on contract.

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