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The World Health Organisation defines a single framework for health system strengthening comprising six building blocks — service delivery, health workforce, medical products, vaccines and technologies, financing and leadership and governance (stewardship). Health workforce is one of the most important building blocks to strengthen the health system and achieve universal health coverage.
There is a dearth of specialist doctors in public health facilities, which is evident from a myriad of studies. Apathy of policy makers towards lack of human resources for health adds up to the gravity of the situation.
Other cost-effective methods are available to improve the dwindling human resources, but alienated approach towards the issue has led to abysmal health service delivery in public hospitals.
The Diplomate National Board (DNB) course is an effective way to tackle the dearth of human resources in public hospitals. India is the only country which is running two parallel doctoral courses — Doctor of Medicine (MD) and DNB. The rationale behind starting course, introduced in 1975 by National Board of Examination, was acute shortage of specialists in rural areas and skewed population and healthcare professional ratio.
There are several facilitating factors to promote implementation of DNB course at district hospitals, including huge footfall of patients for training and exposure of post-graduate students, good infrastructure and availability of experienced doctors.
In concurrence with MD courses, DNB, too, has a centralised entry exam, a three-year tenure period, academic, clinical and research exposure and an exit exam.
With the implementation of DNB course, round-the-clock faculty is available to provide healthcare services. It provides services for three years in post-degree courses and two years in post-diploma courses.
As a new entrant, students have a zeal to provide better services, despite the high footfall. Better services lead to increased patient flow, which prompts public health facilities to strive for better infrastructure and service provision.
Some key challenges that need to be taken care of are limited teaching support, frequent transfers of specialists and lack of ownership amongst government departments. The attitude of the Medical Council of India towards DNB trainees was slightly discriminatory; but with its dissolution and the formation of the National Medical Commission, we can expect some positive attitude towards them.
DNB is a cost-effective way of dealing with human resource crunch and to achieving universal health coverage without added financial burden of human resource on the state exchequer.
Neha Sharma, project officer-DNB, Public Health Foundation of India