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This month, Haryana has been rocked by agitations and healthcare services have been disrupted, as medical students have been protesting against the State government's bond policy. Bond policies for students at government medical colleges, usually involve a mandated period of service at a State-run hospital for students after their graduation, failing which they pay a penalty amount.
In Haryana, the government's original policy said MBBS candidates had to pay an annual bond of Rs. 10 lakh minus the fee, at the start of every academic year, which the government would repay, if the candidate obtained employment with the State. The service period with the State is seven years. Following the protests, the Chief Minister had said the bond need not be paid at the time of admission, instead students would have to sign a bond-cum-loan agreement with the college and a bank. However reports indicate the students are still unhappy with the policy.
Many States have this policy for medical students, with the bond amount and the period of service varying from State to State. In general, the understanding is that since students at government medical colleges get an education subsidized by the State, they must provide service in return to the state, generally in rural areas where there may be a shortage of doctors.
In August 2019, the Supreme Court upheld the bond policy put in place by several States but said that some seemed to have rigid conditions, and suggested to the Centre that the country have a uniform policy regarding this. Now, there are reports that the Union Health Ministry plans to create guidelines to scrap the bond policy altogether, based on recommendations from the National Medical Commision - and perhaps incorporate mandatory rural through a non-financial mechanism.
While providing healthcare rurally is crucial - 75% of our healthcare infrastructure is concentrated in urban areas - students in parts of the country have complained of no State job guarantee once their degree is complete, and in some cases, no payment of salaries.
So does the bond policy for medical students need to be relooked at? How can State governments provide healthcare where it is desperately needed, while ensuring a policy that is fair for students? How do other countries handle their rural healthcare systems? And what else can governments do to provide accessible, quality healthcare in our villages?