COMMENTARY
note that many of the major ­revelations
and recommendations of the NCEUS do not
find any place in the analysis or in the
strategies suggested in the ­report. If these
shortcomings are addressed, the “Annual
Report to People on Employment” has the
scope to become one of the key policy
­documents in the context of labour and
employment in the country.
Notes
1 Other reports are on health, education, environ�
ment and, infrastructure.
2 � The
�����������������������������������������������
overall sample size of 64th round is compa�
rable to that of NSS 61st round. The present round
The ‘Basic’ Doctor for Rural
India: A Failed Promise?
Meenakshi Gautham, K M Shyamprasad
An analysis of the landmark 1946
Bhore Committee report suggests
that vested interests may have
played a role in shaping India’s
health system and the medical
profession in such a way that
the majority of the population
remains totally neglected.
Nothing short of legal action can
begin to reverse the existing crisis
of health human resources that
rural India currently faces.
We gratefully acknowledge the help and
inputs of Supreme Court advocates Prashant
Bhushan, Indira Unninayar, and Pranav
Sachdeva into leading this debate towards a
legal platform.
Meenakshi Gautham (gautham.meenakshi@
gmail.com) is a post-doctoral fellow with the
Institute of Health Policy and Management,
Erasmus University. K M Shyamprasad
(chancellor@mlcuniv.in) is Chancellor
of the Martin Luther Christian University
in Meghalaya, India and a cardio-thoracic
surgeon.
Economic & Political Weekly  EPW   september 18, 2010  vol xlv no 38
covered a sample of 1,25,578 households (79,091
in rural areas and 46,487 in urban areas) and a
sample of 5,72,254 persons (3,74,294 in ­r ural
­areas and 1,97,960 in urban areas). In the 61st
round 1,24,680 households (79,306 in rural ­areas
and 45,374 in urban areas) and 6,02,833 persons
(3,98,025 in rural areas and 2,04,808 in urban
areas) were covered.
3 Regular employees as per NSS definition (which
is given in a special box in the report) are those
who work in other’s farm or non-farm enterprises
(both household and non-household) and in turn,
receive salary or wage on a regular basis. This
­category includes not only persons getting time
wage, but also persons receiving piece wage or
salary and paid apprentices, both full-time and
part-time.
4 If absolutely essential, such information could have
been more appropriately included as appendix.
5 The
��������������������������������������������������
report is grossly silent on the details (espe�
cially, the methodology and concepts) of this
I
ndia is the largest supplier of foreign
medical graduates to the United States
(Educational Commission for Foreign
Medical Graduates 2008) and UK (General
Medical Council 2010) but its own rural
a­reas have been chronically deprived of
professionally trained doctors. We trace
the antecedents of this situation to India’s
first health policy drafted by the Bhore
Committee in 1946. The committee im�
posed the construct of a “basic” doctor,
trained through 5½ years of university
education, on a country not yet ready for
it. It abolished the shorter licentiate quali�
fication and disregarded systems of indi­
genous medicine, even though licentiates
formed two-thirds of the country’s regis�
tered doctors, and, together with indige�
nous practitioners, provided the bulk of
rural healthcare. A few of the commit�
tee’s members put up a strong dissent
against these recommendations. We
present the dissenters’ comments and
a­rgue that even today India needs an
a­lternative cadre of primary healthcare
providers for rural ­areas.
The Bhore Committee Report
In October 1943, the government of British
India appointed a Health Survey and Deve­
lopment Committee to study the state of
public health in the country, and recommend
s­urvey, which we assume is already in progress as
reported in the document.
References
GoI (2010): “Annual Report to the People on Employ�
ment”, Ministry of Labour and Employment,
­Government of India, New Delhi.
NSSO (2010): “Employment and Unemployment Situ�
ation in India – 2007-08”, 64th Round, National
Sample Survey Organisation, Report No 531, Min�
istry of Statistics and Programme Implementa�
tion, Government of India, New Delhi.
Neetha, N (2008): “Women’s Work in the Post Reform
Period: An Exploration of Macro Data”, Occasion�
al Paper No 52, CWDS, New Delhi.
Palriwala, R and Neetha N (2009): “The Care
­Diamond: State Social Policy and the Market”,
­India Research Report 3, Project on the Political
and Social Economy of Care, UNRISD, Geneva.
future developments. The committee
chaired by Joseph Bhore, a senior civil
servant, comprised eight British and 16
Indian members. The Bhore Committee
report, published in 1946, was meticu�
lously drafted and reflected its members’
profound understanding of health mat�
ters. It presented valuable statistics on the
country’s disease burden and attributed
its poor state of health not only to inade�
quacies in medical services and health
personnel but also to the prevailing social
ills – poverty, illiteracy, poor nutrition and
unsanitary conditions.
The report, best known for drafting the
blueprint of a modern public health deliv�
ery system, also recommended that a
“basic” doctor of modern medicine, with
a 5½ year university education, would
be central to this system. These were
far-reaching recommendations that
shaped the course of public health and
medicine in independent India. However,
a small group of the committee’s mem�
bers raised serious misgivings about
these recommendations and recorded
their dissenting notes (Boxes 1-3, pp 26
and 27). On closer examination of the
dissenting notes, we see the fundamental
flaws in the Bhore recommendations.
1946 Scenario: Two Classes of Practi-
tioners: There were two classes of medi�
cal practitioners (of western medicine) at
the time of the Bhore survey: University
graduates who went through a 5½ year
degree course in medical colleges, and
l­icentiates who went through a shorter
three-four year course at medical schools,
graduating with a Licence of Medical
25
COMMENTARY
Practice (LMP). According to the commit�
tee’s ­estimates, there were 47,524 regis�
tered medical practitioners in the country
of which the majority-nearly two-thirds
(29,870) were licentiates and one-third
(17,654) were graduates.
From descriptions of health services in
the report we learn that registered medical
practitioners were unequally distributed in
rural/urban areas. For example, in Bengal
the ratio of doctors to population in urban
areas was 3½ times more than in rural
areas and in urban Sind it was 49 times
more (p 14, Vol 1). Nonetheless, much of
rural healthcare was delivered through
subdivisional hospitals and dispensaries
that were managed mostly by licentiates.
Indigenous practitioners formed another
large body of healthcare providers who
according to the report provided affor­
dable and accessible healthcare to the
masses (ibid).
Blueprint for a Modern Health System –
No Role for Licentiates or Indigenous
Systems: The Bhore Committee pro�
posed a three-tier district health scheme
for post-independent India. A primary
unit would be at its periphery, a second�
ary unit at the subdivisional head­
quarters would provide more specialised
services, and a district headquarter
o­rganisation would supervise all health
activities in the ­district.
Though conceptually well organised, a
primary flaw in this scheme was that it
was designed to cover only around one-
fourth of the population in the first five
years (78,080,000 out of projected 315
million in the report) and less than half
the population over the next 10 years
(1,56,200,000 out of projected 337.5
­million). The report was silent on how
health needs of the remaining population
would be met.
Nevertheless, the committee decided
to abolish the licentiate qualification and
recommended the upgrading of all medi�
cal schools into colleges. It reasoned that
as resources were stretched, they should
all be directed into the production of
only one type of doctor in the country
(Box 1). He or she would have the highest
level of training – 5½ year university
training, similar to what the Good­
enough Committee had proposed for
26
Great Britain as the gold standard. The new scheme would benefit only a section
committee also rejected the inclusion of of the Indian population, “Public health
indigenous systems of medicine and its over the remaining four-fifth to one-half
practitioners in the new medical scheme; of the country…will atrophy. There will be
they considered these systems “static in no personnel like the licentiates even to
conception and practice” (Box 3). help the regions and institutions which
will come under neglect” (Box 2).
Cassandras in the Committee: Six mem�
bers of the committee, five Indians and Post-Colonial Migration of Doctors:
one Briton, put up a brave dissent. They The dissenters’ views proved prophetic.
repeatedly argued that in view of India’s They said that the “basic doctor would
manpower shortages, the country should not ­w illingly fit into the rural scheme”.
use every possible means, including the History stands witness that Indian
shorter licentiate course, to increase the d­octors have integrated more easily into
number of trained personnel. They pointed the health systems of the richer western
out that England had abolished licentiate countries, than they ever did in rural
teaching only after 100 years and Russia I­ndia. In the 1960s, when the rural health
relied extensively on “feldshers” (medical scheme, as envisaged by the Bhore Com�
assistants) to run 48,000 dispensaries. mittee, should have served at least half
They noted with anguish that since the the Indian population and employed
Box 1: Only One Type of Doctor and Single Portal of Entry
Bhore Committee: Having regard to the limited resources available for the training of doctors, it would be to
the greater ultimate benefit of the country if those resources were concentrated on the production of only one
and that the most highly trained type of doctor, which we have termed the ‘basic’ doctor.
There should hereafter be a single portal of entry into the medical professions and that portal should be
the Universities….We are confirmed in this view by the reasons advanced by the Inter Departmental
Committee (the Goodenough Committee) on Medical Education in Great Britain in support of University
Medical Education.
Dissenters’ Comments: In view of the overall shortage of doctors we feel that the early realisation of this
ideal must be sacrificed to the immediate needs of this country…We should be prepared to use every possible
means in India, including the adoption of a shorter licentiate course, to increase the production of trained
medical personnel. Once the output of such personnel has sufficiently increased, then it will be possible to place
greater emphasis upon the quality and length of training and to insist upon the production of basic doctors only.
Nearly two-thirds of the total number of registered medical practitioners in India are licentiates and the rest
graduates. The former have been an important feature of the growth of western medicine in India and no section
of the profession in the country have greater service of humanity or medical science to its credit.
The “basic doctor” will not willingly fit into the rural scheme, except under conditions of destitution.
The decisions of bodies, like the Health Survey and Development Committee, are often taken not so much
on facts garnered or their evaluation, but on ideologies which dominate the minds of their members. They
must have the Goodenough Committee findings prevail, even though there be so little in common between
the educational, economic, political or medical developments of England and India. Russian experience and
achievements must be ignored, nay rejected, even when the fate of institutions common to both Russia and
India, such as medical schools for licentiates, was concerned.
The question of post-war improvements in medical education has been considered recently in England by
the Goodenough Committee. Two classes of medical practitioners, licentiates and graduates, have existed in
England, as in India, for over a century. The Goodenough Committee has recommended the abolition of licentiate
teaching in England. This recommendation has influenced greatly several members of our committee. In a hurry
to conform they have unfortunately ignored the fact that the GE Report describes the abolition of licentiate
teaching as the “final stage” of an “evolutionary development”. We are of the opinion that the final stage of
evolutionary development is not one of India’s achievements yet. From the point of view of medical development,
India is said to stand today where England stood 100 years ago, the USA 75 years ago, and Russia in 1917. England
was in no hurry in the last 100 years to abolish the production of licentiate doctors, why should India be coerced
to take this step on the eve of momentous changes in its future?
An important feature of evolutionary development in England was progressive urbanisation. Only 20% of
England’s population was rural before this war. It is 90% in India. England with her high urbanisation percentage,
is only contemplating giving up licentiate production now. If Japan with 50% urbanisation stuck to licentiate
production, if Russia with vast stretches of territory and a vast rural population has perfected rural medical relief
by strengthening enormously her production of Feldshers (medical assistants), why must India abandon a well
tried and useful institution?
Keeping in view the very urgent need for doctors and more doctors, we are strongly of the opinion that the
production of Licentiates should continue till the increased number of medical colleges has produced “basic
doctors” in the proportion of at least 1 to 1,500 of the population. Until such time provinces must not be coerced
into closing the existing Medical Schools – Sir Frederick James, Vishwanath, P N Sapru, N M Joshi, Pandit L K Maitra,
Khan Bahadur A H Butt
september 18, 2010  vol xlv no 38  EPW   Economic & Political Weekly

Box 2: On Abolishing Licentiates
Reason 1: Competence of Licentiates
Our basic doctors’ training includes, as an inseparable
component, education in the community and preven-
tive aspects of medicine. A hastily manufactured doc-
tor is not likely to be able to find time for effective
training in these departments of health activity…
…Whether the ultimate benefit derived from a small-
er number of better trained doctors, will not be great-
er than that resulting from a larger number of doctors,
who by their inadequate training, would be unfitted
for the wider duties which the doctor of the future
must be capable of discharging.
Reason 2: Consequence of Increasing Numbers
by Reducing Training Standards
The value…(of having a corps of less completely
trained medical men)…even as an interim expedient,
is open to varying assessments. Whatever may be the
intentions of the exponents of the view that there
should be two grades of doctors, there will always be
the temptation to increase numbers by lowering the
standard of training. Such a tendency might well lead
to deplorable consequences.
around 29,000 graduate doctors, there
was a large-scale migration of Indian
d­octors to the UK. They went in response
to Health Minister Enoch Powell’s call to
save a rapidly ­expanding National Health
Service (NHS) from a staffing crisis. In
N­ovember 2003, a BBC documentary
“From the Raj to the Rhondda: How Asian
Doctors Saved the NHS” researched and
documented the contributions of nearly
18,000 such migrant doctors from the
I­ndian subcontinent, many of whom
worked in Britain’s most deprived and
difficult areas. One such area was the
Rhondda valley – a former coal mining
valley in South Wales.
Today, the second largest proportion of
doctors registered with the UK’s General
Medical Council (GMC), are those quali�
fied in India. They form around 11% of all
doctors registered with the GMC, second
Economic & Political Weekly  EPW   september 18, 2010  vol xlv no 38
Dissenter’s Counter Arguments
We do not regard the licentiate as an imperfectly or
hastily manufactured doctor. It is true that his training
is not as complete as that of the basic doctor, but it has
enabled him to render meritorious service in the past.
The community and preventive aspects of medicine
are merely the applied aspects of fundamental sciences
which are to a substantial extent, integral parts of the
existing curricula of licentiate teaching.
One may….designate groups as more or ‘less completely
trained’, but after one has begun medical practice the la-
bel may soon shift. The licentiate may prove, as he not
unoften does, more completely trained than the graduate.
In a statistical study spread over six years in Bhopal
state, it was found that 83% of the total ailments were
amenable to simple treatment, if given in time, 13%
needed hospital care and 4% required specialised
treatment. This investigation suggests a range of
­usefulness for licentiates which must make opposi-
tion to their employment at primary centres a pure
exhibition of prejudice.
Dissenters’ Counter Arguments
Since the Scheme proposed for Medical relief and
Public Health is to benefit only a section of the popu-
lation (one-fifth for the first three years and one-
half slowly in 10 years) and is supposed to absorb the
entire output of all the Medical Colleges as well as the
sublimated Medical Schools, Public Health and Medical
Relief over the remaining four-fifth to one-half of the
country….will atrophy. There will be no personnel like
the licentiates even, to help the regions and institu-
tions which will come under neglect. The chaos created
by the end of 10 years need not be considered, for the
country by then would have entered the period of the
long-term programme, the details of which…. must
of necessity remain nebulous.
If there be any force in these prognostications (that
there is danger in the production of more than one
category of doctors), Russia – the foremost exponent
of the two grades – should have been ruined from a
health point of view. On the contrary, its perfection of
public health and medical services …have been the
envy of the whole world.
only to British qualified doctors. India also
provides the largest pool of International
Medical Graduates to the United States.
There are more than 50,000 doctors regis�
tered with the American Association of
Physicians of Indian Origin (2010).
Box 3: No Place for Indigenous Systems of Medicine and Practitioners in Organised Medical Relief
Bhore Committee’s Recommendation Dissenter’s Views
We realise the hold that these systems exercise not
merely over the illiterate masses but over considerable
sections of the intelligentia (sic). We have also to
recognise that treatment by practitioners of these
systems is said to be cheap…..We are unfortunately
not in a position to assess the real value of these
systems of medical treatment as practised today…
We do not therefore propose to venture into any
discussion in regard to the place of these systems in
organised State medical relief in this country.
COMMENTARY
Aneez Esmail (2007), in his work on
emigration of Asian doctors, has pointed
out that the move to enforce a single
m­odel of medical education for India,
identical to that followed in Britain, was
geared more towards meeting GMC
r­equirements. In a lecture based on his
r­esearch he argued that Indian degrees
were quite suitable to working in England,
but “probably totally irrelevant for work�
ing to the benefit of the vast majority of
the Indian population”.
Need for a Mid-Level Cadre
In its present design, India’s rural health
infrastructure consists of a sub-centre
with an auxilliary nurse midwife (ANM)
for every 5,000 population, a primary
health centre (PHC) for every 30,000
population with at least one medical
d­octor, and a community health centre
(CHC) for every 1,20,000 population that
should offer specialised care through
four specialist doctors (GoI 2008). Con�
sistent with the Bhore recommendations,
the “basic” medical doctor at the PHC
provides the first level of comprehensive
outpatient care for village communities.
However, with only 23,458 PHCs and
4,276 CHCs, this infrastructure is far
from adequate to address the health
needs of India’s rural population of more
than 700 million (Census of India 2001).
The system has, moreover, suffered
from chronic shortages of doctors, as
l­amented in many of the country’s
five-year plans (GoI 2008b). Currently
there are 18.8% vacancies in the posi�
tions of PHC doctors and 51.6% vacan-
cies in the positions of CHC specialists
(GoI 2008a).
…While a majority on the Health Survey and Deve­
lopment Committee can abolish the licentiate, they
cannot prevent other practitioners, practising a variety of
systems of medicine, taking his place. This has already
happened in Congress Provinces, particularly those
that have banned licentiate teaching. So far as the
indigenous systems of repute like the Ayurvedic and
Yunani are concerned, their teaching is passed on to
institutions which combine elementary courses of
training in basic subjects of the medical curriculum
with Materia Medica and Therapeutics of the indige-
nous systems. Sociology and economics often deter-
mine the patient doctor relationship. Under existing
conditions the licentiate will be replaced mainly by
Vaids and Hakims.
27
COMMENTARY

More than 75% of India’s medical pro�
fessionals work in the private sector, and
these are no more available in rural areas
than those in the public sector. Most private
medical professionals are concentrated in
urban areas (GoI 2005).
In the absence of professionally
trained doctors, informally trained and
unlicensed private practitioners deliver
much of healthcare at first contact in
r­ural India (Kumar et al 2007), treating
common illnesses mainly with allopathic
medicines. The Bhore Committee dis�
senters had argued that “while a majority
on the Committee can abolish the licen­
tiate, they cannot prevent other practi�
tioners, practising a variety of systems
of medicine, taking his place”. Time
has proved this also to be a prescient
o­bservation.
Village-based practitioners provide
their neighbourhood communities with
easy and all-time access to basic health�
care; an enormous advantage in rural
a­reas where road and transport infra�
structure is deficient, and the best way to
travel is on foot. The clear message that
comes through is that rural communities
need a primary healthcare provider
within easy walking distance from every
village home.
There are around 6,00,000 inhabited
villages in India, and around 60% of
these are small ones with less than 1,000
population (Census of India 2001).
V­illages are scattered and each village
may have smaller hamlets at a distance
from each other. As this situation repre�
sents a huge need for primary healthcare
providers, we consider it unlikely that
the country’s present medical education
model with its annual production of
30,000 urban centric doctors (Sood
2008), trained through an expensive 5½
year course, can meet this need substan�
tially or cost effectively.
An efficient alternative for the long
term would be to draw from the experi�
ences of developing mid-level practition�
ers like clinical officers, medical assist�
ants in Africa, and various types of nurse
and non-nurse practitioners (Lehmann
2008), with clearly defined competen�
cies. Mid-level cadres are usually trained
for an average of three years following a
basic schooling. They are not doctors but
can diagnose and treat a variety of com�
mon illnesses. Studies (ibid) suggest that
their performance and outcomes are in
no way inferior to that of conventionally
trained doctors.
Legal Scenario and
Current Developments
The idea of mid-level practitioners
trained over shorter periods has been
mooted in the past in India too: by the
country’s National Health Policy 2002,
and more recently by a Task Force on
Medical Education for the National
Rural Health Mission (GoI 2006). Each
time it has been shot down by the medi�
cal fraternity, supported by the Indian
Medical Council (imc) Act of 1956 that
prohibits any health cadre without a
graduate medical qualification from
practising modern medicine. Nonethe�
less a few I­ndian states have e­nacted new

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28 september 18, 2010  vol xlv no 38  EPW   Economic & Political Weekly
 COMMENTARY

legislation to start such courses. Chhat�
tisgarh and West Bengal have invoked
their special state powers under the
Drugs and Cosmetics Act, to d­evelop
three year diploma courses for “Practi�
tioners of Modern and Holistic Medicine”
in Chhattisgarh (GoC 2008-09) and
“­Rural Health Providers” in West B­engal
(GoWB 2009).
In November 2009, the authors of this
article initiated a public interest litiga�
tion (PIL) in the Delhi High Court chal�
lenging the IMC Act and asking the gov�
ernment to take action on developing
primary health providers for rural areas,
more specifically along the lines of its
Task Force report ­recommendations. The
health ministry responded positively, but
chose to ignore the greater wisdom and
expertise of its own Task Force report by
placing the ­entire responsibility for this
innovative and socially oriented endeav�
our on the Medical Council of India
(MCI). The MCI is a professional associa�
tion of medical doctors, with a long his�
tory of corruption in medical education
(Pandya 2009). On these and other
grounds the high court rejected the
m­inistry’s rejoinders and sought repeat�
ed clarifications on the Task Force recom�
mendations (Meenakshi Gautham and
Anr vs Union of India 2010). The matter
We also hope that this article will
e­ncourage health practitioners and acti­
vists to question the relevance of existing
medical education models and press for
reforms that respond to local needs.
References
American Association of Physicians of Indian Origin,
Member Benefits (2010): Weblink: http://aapiusa.
org/members/member-benefits.aspx (accessed
3 May 2010).
Bhore, J Report of the Health Survey and Develop�
ment Committee (1946): Vol 1: Survey, printed
by the Manager, Government of India Press,
C­a lcutta.
Bhore, J Report of the Health Survey and Development
Committee (1946): Vol II: Recommendations,
printed by the Manager, Government of India
Press, New Delhi.
Bhore, J Report of the Health Survey and Develop�
ment Committee (1946): Vol III: Appendices,
printed by the Manager, Government of India
Press, Simla.
Educational Commission for Foreign Medical Gradu�
ates (2008): Annual Report, US, 2009: 13.
Esmail, A (2007): “Asian Doctors in the NHS: Service
and Betrayal”, British Journal of General Practice,
57: 827-31.
General Medical Council (2010): List of Registered
Medical Practitioners – Statistics (2010), Doctors
by Top 10 Countries of Qualifications: General
Medical Council, United Kingdom. Web site:
http://www.gmc-uk.org/doctors/register/
search_stats.asp (accessed 3 May 2010).
GoI (2001): Census of India, Government of India,
Web site: http://censusindia.gov.in/.
– (2005): Report of the National Commission on
Macroeconomics and Health, Ministry of Health
and Family Welfare, Government of India.
– (2006): Task Force on Medical Education for the
National Rural Health Mission, Ministry of Health
and Family Welfare, Government of India, New
Delhi, Weblink: http://www.mohfw.nic.in/
NRHM/Documents/Task_Group_Medical_Edu�
cation.pdf (accessed 3 May, 2010).
– (2008a): “Bulletin on Rural Health Statistics in
­India”, updated as on March 2008. New Delhi:
Ministry of Health and Family Welfare, Govern�
ment of India, web site: http://www.mohfw.nic.
in/Bulletin on RHS – March 2008 – PDF Version/
(accessed 3 May 2010).
– (2008b): Five-Year Plans (Planning Commission,
Government of India, Yojana Bhavan, New Delhi),
web site: http://planningcommission.nic.in/
plans/planrel/fiveyr/index9.html (accessed 3
May 2010).
Government of West Bengal (2009): The West Bengal
Rural Health Regulatory Authority Bill, The Kolk�
ata Gazette, Tuesday, 19 May. Weblink: http://
www.wbhealth.gov.in/notice/let_to_aso.pdf (ac�
cessed 3 May 2010).
Kumar, R, V Jaiswal, S Tripathi, A Kumar and M Idris
(2007): “Inequity in Health Care Delivery in
I­ndia: The Problem of Rural Medical Practition�
ers”, Health Care Anal, 15: 223-33.
Lehmann, U (2008): “Mid Level Health Workers: The
State of the Evidence on Programmes, Activities,
Costs and Impact on Health Outcomes”, a litera�
ture review, Department of Human Resources for
Health, World Health Organisation, Geneva, July,
Weblink: http://www.who.int/hrh/MLHW_re�
view_2008.pdf.
Meenakshi, Gautham and Anr vs Union of India and
Anr (2009): WP (C) 13208/2009. Court Orders of
10.03.2010 and 07.04.2010. Delhi High Court,
2010, weblinks: http://courtnic.nic.in/dhcorder/
dhcqrydisp_O.asp?pn=43432&yr=2010 and
http://courtnic.nic.in/dhcorder/dhcqrydisp_O.
asp?pn=64410&yr=2010 (accessed 3 May, 2010).
Mudur, G (2010): “Top Education Regulator in India Is
Arrested on Bribery Allegations”, BMJ; 340:c2355.
Pandya, S (2009): “Medical Council of India: The Rot
Within”, Indian Journal of Medical Ethics, Vol VI,
No 3, July-September, 125-31.
Sood, R (2008): “Medical Education in India”, Medical
Teacher, 30:6: 585-91.
State Health Society (2008): “Project Implementation
Plan: Chhattisgarh”, State Rural Health Mission,
Department of Health and Family Welfare, Gov�
ernment of Chhattisgarh, 144.

is c­urrently sub judice. However, in

another recent development, the Central
Bureau of Investigation (CBI) has finally
arrested the MCI president on corruption
charges (Mudur 2010) and the entire
body is u­nder the CBI scanner. We hope
that this indictment of the MCI will urge
the ministry to reformulate its response,
unfettered by any direct or indirect MCI
influence, and guided only by the greater
common good.
Ideally, state governments, guided by
a central advisory body, should develop,
implement and regulate the shorter courses
so that they can be responsive to local con�
ditions, rather than follow a one-size-fits-
all formula prescribed by a central body. To
bring immediate relief to our rural commu�
nities, such courses should necessarily
b­egin by recruiting, training and certifying
existing informal practitioners, ANMs,
pharmacists and practitioners of indige�
nous systems who already live and practise
in rural and r­emote areas.
Economic & Political Weekly  EPW   september 18, 2010  vol xlv no 38
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