| The author proposes a reorganization of the rural health service in India: (1)every primary health centre (PHC)should be expanded to a 50-bed, well-equipped modern hospital staffed by six specialists, 15 nurses, and five pharmacists/dressers; (2)every PHC should be provided with four mobile dispensary vans complete with medicines and facilities for minor operations and staffed by a doctor and pharmacist (plus driver and cleaner); (3)under the auspices of the PHC, and in telephone communication with it, there should be a few subcentres, each staffed by a recent medical graduate and a qualified pharmacist; and (4)there should be one health unit in each village, again connected by telephone to the PHC and manned by a pharmacist (or villager)with training in first aid. With proper organization of a patient referral system and a rota of visits by PHC specialists to the outlying units, the quality of health services available to the villages would be improved considerably. But professional and other staff must remain highly motivated by being assured of adequate leave, salary, travel allowance, and living quarters, as well as opportunities for promotion. |