Dear sir, 

Actually we have trained people in our system as ASHA, ANM, AWW they are supposed to provide the health care facility in outreached area, government spending lots of money for their training. But after training no proper supervision and no proper refresher training for them. If we are solving this problem, we may provide some good health care facility to people living in rural and backward community

Respected sir, 

      you have rightly pointed out the existing situation. my suggestion would be to train the present doctors who are posted in those rural areas. the training should be on improving their attitude towards service(difficult though). the doctors should be employed based on their home. their work area and place of stay should not be far away. the strength of doctors has to be increased. We cannot blame the poor people, when there is no proper guidance they will try to seek any source available  which takes care of their timely need. 

most often the training which are carried out nowadays are Target oriented and not service oriented. Training of rural people is of no use. Training of Doctors on importance of their role may enlighten their thoughts. Sufficient staff strength if made available will automatically take care of the situation.

I thank both Dr. Bharthy & Dr. Tamizhkumaran J for their responses. Our problem is very high inadequacy of Doctor Population ratio in West Bengal, which is a highly populated state with continuous migration through porous Indo-Bangladesh border as well as from adjacent states of India.

Doctors posted at PHC or SC are usually over-burdened and their numbers are grossly insufficient as per requirement. Secondly distance from a PHC/SC is >20 - 30 Km from many villages with lack of transport to carry patients often particularly in odd hours. Lack of awareness & health seeking behaviour are other challenges.

Another determining factor is lack of understanding of perceived health needs of the community by the health planners or policy makers. So utilisation of health services is affected. For example, problem of Arsenicosis is highly prevalent in many villages of Malda district due to contamination of ground water by arsenic from soil. Unfortunately, there is no treatment facility of Arsenicosis even at District hospital.

So, rural health services are given by quacks to a great extent, which can not be ignored at present. Scenario is not going to be changed in near future because of a no. of factors.

So, how to handle these quacks and combat their irrational way of treating patients, misuse of medicines/antibiotics resulting development of drug resistance, increased morbidity & mortality etc. So, there is a need of re-structuring of health care delivery services based on felt need of the community. 

Respected sir, 

  I agree with your valuable comments, the situation is the same throughout the country. Lack of manpower , distance to be traveled, lack of awareness are the main reason for Quacks exploitation.

there are many doctors who are unemployed at the same time there are lot many vacancies.

people might be given a awareness campaign on what first aid to be given. whom to contact on emergency situiation etc., will it improve the situation, I don think so. because even the educated people go to the medical shop for their cure without consulting a doctor they take the medicine. why? the cost of treatment is less. he/ she needs to give only the medicine amount and the doctor fee is saved. when educated people do this. we can't expect the rural people to consult a doctor until and unless the service of that particular doctor is overwhelming and service oriented. 

there are numerous factors to be discussed. the factors extent like a branches of banyan tree.

Unless and until everyone change themselves there is no way out of this situation. 

Awareness campaign for the rural people will be one of the solution.

Hello, one other solution in addition to an awareness campaign for the rural people and an educational campaign for existing doctors is also to train local people as community health workers (CHWs). CHWs have been shown to be very effective at assisting medical doctors in remote communities in addition to be local and knowing the community they provide additional assistance for overworked physicians by carrying out some of the clerical tasks and freeing up the physicians to do the more complex medical tasks.  See attached the world health organization article on using Commcare mobile phone program to upscale CHWs or accredited social health activists (AHSHAs).

Doctor in Nepal the ratio is higher of bare foot doctor.The answer may be legal control of drug distribution , awareness to community and easy access of qualified doctors in population. Training to local barefoot doctor is not a good choice

 Dear Dr. Narayan Kumar,

Thank you for your response. If we think ideally we should not encourage training of unqualified health practitioners. But considering real situation of lack of sufficient qualified & motivated doctors in remote rural areas we may need to find some alternative mechanism. Secondly, whether you want or do not want unqualified health practitioners' and needy rural residents'' relationship will continue because of their availability, acceptability & affordability. If we ignore them & remain silent, it will create harm to the community silently. Their no. is very high, they are united, which may create some problem if some drastic action is attempted to be taken by the civil society. Hence, we need to think for betterment of community involving their services. This is a huge manpower, who are ready to serve rural community willingly. But they are not trained, having misconceptions, that may lead to irrational treatment . This need to be prevented.

Dear sir

I agree to your logic but in India COPRA is working and if you have analysed the situation you will find that when people approach hospital the patient has already visited the barefoot doctors srveral time . Virgin patients to hospital are few only. It is linked with future treatments for example acute cases not responding, steroid use,etc. Planning of future is required in due course of time initiation of such practice closure required. The choice for villagers are not available and if you will link the drug act of india you will find that the use of drug by them is illegal. India develop to a level when they stopped LMP degree from medical colleges. If still required then better to start the LMP course again for village doctors on the background of their education, so that they can treat in a better way.

If still required then better to start the LMP course again for village doctors on the background of their education, so that they can treat in a better way.

Above statement appears to be highly justified & action towards that is needed. Before that we need to have a national & regional debates on it to evaluate critically its merits  & demerits and come to a consensus.

Thanks a lot for ur response,  Ms Claudia