Civil Service in India looks for glorified amateurs, jack
of all trades but masters of none, generalists and paper pushers and
the list of the usual diatribes go on. Without any skills in a specific
field, they decide on matters related to banking, defence, culture,
environment and energy is the usual argument of specialists who want to
make decisions in these fields but are allegedly kept away by the apples
of the government's eye.
I have seen specialists (doctors, lawyers, accountants and
auditors) vehemently defend their position based on narrow
interpretation and interests generated by their profession. It is not a
fault or deficiency, but an essential pre-requisite in their
professions.
Citing anecdotes is not a scientific way,
but I do give them to explain what I am talking about. A doctor friend of mine, who
otherwise is quite liberal and forward-thinking, is sensible and took up
the profession as a service argued that introducing a course like
Bachelor of Rural Medicine would dilute quality, drive real doctors out
of their jobs and lead to poor health outcomes for rural population. It
is unfortunate that someone I respect a lot and hold in high regards had
to fall prey to a narrow view based on her profession. She expressed
her views during the strike organised by medical students across Kerala
in 2010 against the idea of a BRM course.
Doctors do
not want to be posted in deep, unreachable villages where pay is low and
living facilities are not adequate. Distance is also a
factor when it comes to doctors with families and many have a
post-graduate degree. It is primary and secondary care that villagers
need urgently, basic health interventions and first-aid- not super
speciality care and so appointing post-graduate doctors is not the need of the population
and the doctors would also find their skills unused making them look for
better opportunities. The only reason many
take up such posts is because it is a government job and the inherent
job safety.
But the majority of doctors do not turn up at their health
centres and have a flourishing private practice. This is true not just
of doctors in rural areas but those from medical colleges and hospitals
in city too follow this method. In the interior heartlands of the
red-belt or Left Wing Extremism affected districts the situation is
dire. Absence rate of doctors is more than 50% (validated by several
surveys), doctor-patient ratio is 1:25,870 on average in India and they are concentrated in the urban areas. To
enforce attendance, a monitoring mechanism by empowering local bodies,
who would also pay the salaries for doctors, is being considered. I hope
this works, but I am not so sure because I do not think local bodies
can pay the doctors enough to attract them to stay in a place with very
little amenities and also face the threat of violence.
In spite of lack of doctors,
high absence rate among existing doctors that amounts to dereliction of
duty and low interest in a rural posting, the current medical fraternity
are blocking an urgently needed reform in healthcare by providing for a
course that directly addresses the healthcare needs of rural
population. Their only solution is for the state to appoint more
doctors- the fact that doctors are not interested in these postings and are not attending to their duties are not heeded to.
An auditor who alleged corruption and scope of environmental damage in a government scheme that replaced incandescent bulbs
with CFL lamps due to their high mercury contend also argues that
crores have been invested in a mega hydro-electric power project and it
has been delayed due to denial of environment clearance. The concern is
not about environment, but merely about audit as an end to itself.
When it comes to holistic decision making- a case where the social,
environmental and economic impact is to be considered (I do not include
political factors since that is the job of the political executive)
someone who is not restricted by a narrow view must make that decision
and that can be done by generalists who do not owe allegiance to any
specific field.
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