Primary health care delivery in rural India : examining the efficacy of a policy for recruiting junior doctors in Karnataka.

This thesis examines the role of primary health care delivery in rural India but specifically focuses on aspects from Karnataka state. It broadly reflects on the differences that exist between urban and rural populations' access to healthcare. The concept of primary health care appears to have lost its lustre at present, it was once enthusiastically promoted in the late 1970s and 1980s but as chronic problems appeared to affect the smooth delivery of healthcare and nowadays major global bodies like the WHO and IMF have relegated primary health concept to a lower level. However in countries like India, which adopted this concept although its implementation has been riddled with complex ongoing problems, there are not sufficient grounds to abandon it completely. These problems are mainly due to the slow implementation, which has left a vast rural population with little or no access to healthcare. Primary health care strongly promotes equity of access hence is vital in many developing nations. Recruiting highly skilled personnel to work in rural health centres has been an ongoing problem, which hinders the effective delivery of healthcare. A policy followed by Karnataka state tries to rectify this problem by offering postgraduate positions to junior doctors who are willing to work in rural areas. The efficacy of this policy is closely examined from two perspectives. Those who consume healthcare in rural areas are given an opportunity to voice their concerns and also the doctors who work there represent the views of the providers of healthcare. This study was conducted in Bidar district, which lies in the north of Karnataka. Bidar is identified comparatively as a less developed district that has many problems associated with poverty and poor health status. In the process of conducting research a variety of interesting aspects have been highlighted. My hope is that relevant authorities identify with the problems and take measures that could benefit many people's lives. Interestingly it transpires from the views expressed by the rural population that they have a good grasp of what they think they will need to access a better form of healthcare from the existing system. However it appears that there is almost a universal fatalistic acceptance of them being helpless and voiceless about making any to change by their suggestions nor did most of them have a hope of influencing future prospects. The studies also indicated that where there is a better level of provision there the people tend to access healthcare from authentic sources as opposed to unregistered and unqualified personnel. The doctors suggested that the policy is very useful provide certain intrinsic changes are made. On the one hand they did accept that their cost benefit and academic value of this policy is great. On the other hand they suggested the hurdles put in the course of achieving the postgraduate position are arduous and often vague sets of guidelines are imposed, making it very hard to make a straightforward transition from working in rural areas to getting a postgraduate position of choice. The doctors working on temporary contracts appeared to suffer genuine discrimination especially due to number of years they spent trying to get permanent position, years which were not counted towards their ambition of further education. Where it appears there is very little difference in the roles and responsibility between permanent and temporary contract doctors the question of why it does not occur to the authorities to redress this issue is discussed