Rural Medical Practitioners: The first line of defense in rural healthcare (Part 2)

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After informally interviewing about a dozen RMPs, the one question that kept nagging us was the quality of the treatment provided by rural Bangladesh’s most frequently consulted health practitioners. As we mentioned in our previous post on rural health practitioners, as of 2011, there were 130,000 RMPs operating in rural Bangladesh. So we thought that it was time to look into the training institutions that bestowed the RMP certifications. Within Gaibandha, we came across 5 such institutions that conferred three different types of certifications-

1. Rural medical Practitioners (RMP)
2. Local Medical Assistant and Family Planning (LMAFP)
3. Paramedic

The standard RMP certificate is a 6 month long course during which students are educated (for one month each) on six different areas. These areas include pathology, anatomy, surgery, OB-GYN, pharmacology and medicine. Understandably, there isn’t much, save the very basics, that can be taught on any of these topics within a month. The LMAFP on the other hand is a one year degree that deals with the same topics, albeit in slightly more depth, with an added course in dentistry.

The managers at these institutions assured us that RMPs and LMAFPs were not equipped to deal with any conditions except for the very basic of ailments such as fevers of unknown origins, common colds, sore throats, etc. The certificate does NOT grant them the ability to prescribe medication. While it trains them to deal with certain complex situations like child birth or severe injuries, it is always highly recommended that they refer such cases to doctors and intervene ONLY if there is no other alternative, as in the case of emergencies. Even in such cases, the RMP/LMAFP should only administer first aid and then refer to the nearest doctor.

However, our conversations with RMP/LMAFPs revealed that their views were radically different. In their eyes, their training and certification abled them to completely handle a wide range of ailments-one RMP went as far as to confess, and quite proudly at that, that he was quite capable of delivering children and had considerable experience in dealing with physical injuries (fractures, deep cuts, moderate burns, etc.) When asked as to his motivation for obtaining an RMP degree, he blatantly acknowledged that the RMP certificate was his safety net- if things went south, his certificate would protect him from the public’s out lash.

Of the three out of the five training institutions that we visited, two were NGO-based. These NGOs, with the approval of the government, were offering training and certification to address the acute shortage of doctors in rural areas. Granted, it was not the best solution, but it was a workable one. However, lack of proper monitoring has allowed the system to get completely out of hand. In fact the issue of accountability and transparency is so neglected that till now, we are still unsure of the government body that is actually responsible for overseeing the quality of training and monitoring the activities of the degree holders.

The case of the paramedic however, is thankfully much less confounding. The paramedic is trained under the Bangladesh Technical Education Board, with half his scores presented by the training institution and the other half presented from the Board itself. The average paramedic is trained in the areas of clinical medicine, pediatrics, surgery, gynecology and obstetrics, eye and ENT related problems, and first aid and bandaging. In addition to his coursework, the paramedic is also provided with and marked on extensive field activities.

During our conversation, it was also revealed that a large number of paramedics also choose to set up shop in rural areas, underserved through formal health care systems. Unfortunately, we did not have the good fortune of coming across any such personnel. However, the mere existence of such a situation, where a large number of trained paramedics choose to reside in rural areas despite the opportunity to migrate to urban centers, is remarkably fortunate. The way we see it, it provides an existing platform of semi-formal healthcare delivery in rural areas. The remaining challenges are to link them to formal sector healthcare providers, develop an adequate monitoring system, and empower them through training and technology to provide high quality health services at affordable prices.

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Posted by Ahmed Abu Bakr

Comments
  • Nikunja sarkar 21.01.2017 21:48

    I want training.madecil training

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  • M V Rao 03.04.2017 16:40

    Dear sir
    I need Rural Medical Practitioner certificate GUIDE me reg… This
    Thanking you
    M V Rao

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    • Kiron chandra paramanya 06.05.2017 18:53

      Dear.sir
      I need Rural Medical practitioner certificate and register.

      Reply      Show answers (0)
  • Kiron chandra paramanya 06.05.2017 18:56

    Dear,sir
    I need Rural medical practitionar certificate and register.

    Reply      Show answers (0)
  • ripan sarkar 21.05.2017 17:13

    আমি আশা করমির কাছে নাম লেখানো সত‍্যেও আমার কাছে কোনো উওর পাইনী,।

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  • Yalamanda Rao 21.05.2017 23:16

    Traing and Certificate

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  • RAKIBUL ISLAM 02.06.2017 23:41

    Dear, Sir
    I need RMP certificate and also register
    ……Sir,,,,,,please immedately give me reply……

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  • Yatham raju 18.06.2017 13:19

    Sir…just I have completed my bpharm…so I want to ecom rmp in village….so what course will be helpful me ….pls explain in detail

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  • bhagyadhar 24.06.2017 21:39

    i want to do rmp for rural practice.

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  • Umar Yaseen Shah 02.07.2017 14:47

    Enter your message I need RMP certificate I am working since last five years in health care Dio center

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  • Lokesh githala 08.07.2017 22:39

    Rmp course certificate

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  • Ajay Choudhary 09.07.2017 21:09

    Dear sir I went the training RMP

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  • Eswar 10.07.2017 14:27

    How to apply medical couse

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  • vikas bakshi 13.07.2017 0:01

    Dear sir
    I need rural medical practioner certificate & diploma course

    Reply      Show answers (0)
  • Shajath quyoom mattoo 14.07.2017 15:31

    I want to r m p medical certifiCate and I am Pharmacist and Dentalpractice

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  • Sadrul Ahmed 30.07.2017 0:52

    আমি RMP কোর্স করবো।কোথায় , কিভাবে কোর্স করব, কত টাকা খরচ হবে…?দয়া করে জানাবেন।

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  • Rajeev Musalgaonkar 01.08.2017 8:36

    Dear sir,
    I have experience as RBM in pharmaceutical sales .I want to serve humanity now for that want to get registered .plz guide how I can procure the same .

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  • Hari Nath 17.08.2017 13:15

    I want RMP certification

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  • vinod singh 19.08.2017 16:24

    I have completed B. Pharma in the year 2006 & also got RMP certificates for the year 2016 after completing course in Doctor of medicine in alternative medicine from IBAM academy Kolcutta.
    I need some guidance from your site so that i am freely consult to patients.
    thanks for your corporation.

    Regards,
    Vinod singh

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  • ubaid khan 20.08.2017 19:01

    dear sir I need rural medical practioner certificate and diploma course. I am pharmacist please help me thank you.

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  • Ambika prasad 22.08.2017 12:52

    I want to registered as rural medical practitioner.
    What i have to do?

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  • Anand varma 31.08.2017 11:56

    Rpm certificate me like kitni qualification chahiye and sons Bihar ka address batlay

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  • Vijendra saini 03.09.2017 11:03

    Sir…just I have completed my d-pharm…so I want to ecom rmp in village….so what course will be helpful me ….pls explain in detail.

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  • Md sajjad alan 05.09.2017 18:35

    I am RMP course certificate

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  • MD.SYFUL ISLAM 07.09.2017 21:48

    I want to this course, but I don’t know address, please want me address.

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  • RAJANIKANT 08.09.2017 17:42

    DEAR SIR
    I WANT TO REGITERED AS RMP.

    Reply      Show answers (0)
  • Mukundhan 09.09.2017 17:41

    I completed nursing I want rural medical practitioner certificate please help me to suggest the best way

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