Medico Friend Circle (MFC) is a nation-wide group of individuals involved in the health sector.

Working for the people, and especially for the poor, the MFC has been extremely critical of the health care system in the country and realizes the massive impact of Indias dissatisfactory health services on society. They believe that the existing system of health care is geared towards the need of the rich, and not the majority (poor). The primary objective of MFC thus is to evolve an appropriate approach towards health care which is humane and patterned to meet the requirements and demands of the vast majority of people (with plethoric differences) in our country. The MFC accepts that post-independence, there has been rapid growth in health care services, and while the public sector has grown, it has unfortunately given way to the private sector as the key player in the health care sector. Many would argue that the private sector, as the major provider of medical care would be able to better meet the needs of the people, and while some proof of this may be found in the urban scenario, the rural scenario faces massive burdens due to this. Jeffrey Hammer, Yamini Aiyar, and Salimah Samji, in their paper, Understanding Government Failure in Public Health Services argue that public health care services in India are characterized by a set of problems: high absenteeism, low quality in clinical care, low satisfaction with care, and the practice that invades most of our public services: corruption. A result of this mistrust vis--vis the system, people turn to the private sector thus bringing forth another set of problems: high out of pocket expenditures ( leading to loans and sale of assets for the poor), and quality of care that at times can be even worse than what is offered by public care facilities. An overwhelming 85% including the poor place their trust in the private sector and opt for their services. The private sector follows the idea of the commercial, and medical professionals are increasingly driven by profit rather than by concern for wellbeing of people. Commercial competition and personal interests of doctors lead to several kinds of malpractice. In alliance with profit oriented drug companies, there are many cases of patients using medicines when they are not required. Doctors often prescribe medicines for which cheaper alternatives are available. MFC believes that medical and health care must be available to everyone irrespective of her/his ability to pay. This requires strengthening of public services. Also that medical intervention and health care be strictly guided by the needs of our people and not by commercial interests.

The main problem with health care in India lies in the massive difference that lies in the quality of health care between the rural scenario and the urban scenario. The obvious greater purchasing power of the urban and many times, doctors own desires, and upper class and caste background, means an often claustrophobic number of doctors in prospering areas and a complete scarcity of doctors in the rural scenario. The poor thus languish forced to seek alternatives to the public health sectors offering. MFC is strongly critical of the training that doctors receive. They argue that the hospital based training model is directly lifted from the industrialized west. It does not take into account Indias rural scenario and caters only to the requirements of the urban. They argue that even after prolonged expensive training in medical colleges, graduates are incapable of dealing with health problems in rural areas. We, therefore, attempt to work towards a pattern of medical and health care adequately geared to the predominantly rural health concerns of our country and a medical curriculum and training tailored to the needs of the vast majority of the people in our country. MFC also propagates the idea of community based health workers. They f eel that even with limited good quality training, such a system if supported by referral services of doctors is more app more so far a developing country like India as it would help demystify medical knowledge. We, therefore, work towards popularisation and demystification of medical science and the establishment of an appropriate health care system in which different categories of health professional are regarded as equal members of a democratically functioning team. Ivan Illich presents an interesting argument in his paper. He says that the current trend can be seen as one in which industrialized societies provide package deals to developing countries, and the latter, by adopting them, is seen as embarking upon the path to success. Unfortunately, these package deals have a set of problems. One, they are not context specific, and two; they are inherently biased and cater to the needs of the urban sector. Illich points at two flaws that are relevant to the health sector. The first is in reference to the continued technological refinement of products which are already established. He argues that the motive behind this is to ensure greater profits for the producer, and not the wellbeing of the consumer. Do we not see private practitioners prescribe medicines for which solutions far

cheaper are available? Second, and more importantly, he argues that the health sector is particularly organized in a way which offers invasive methods as the solution to all problems? In health, and especially in a country like India, does it not make sense to focus more on safe drinking water, sanitation, and awareness? The MFC feels the same way about the situation. They argue that doctors focus far more on the curative rather than the preventive. This thought process requires an urgent overhaul. We believe in giving due importance to curative technology in saving a person's life, alleviating suffering or preventing disability, even while we stress the primary role of preventive and social measures to solve health problems on a societal level. MFC has always felt that the health care system can be overhauled only when the total system is overhauled. Women suffer massively as they are seen only as child bearers and health-programmes for women are geared only towards maternity and contraception. We therefore demand a sensitive and comprehensive public health system which caters to all health-needs of the people, and for mechanisms of active participation by the community in planning and carrying out preventive and promotive measures. The MFC strongly believes that the present health care system undermines the role of nonallopathic therapy despite poof of their success. It is unfortunate that doctors resist knowledge pertaining to traditional and often effective systems of medical care. Prejudice, ignorance and self-interest have prevailed over open-minded scientificity in this important area of medical care. We insist that research on non-allopathic therapies be encouraged by allotting more funds and other resources and that such therapies get their proper place in our health-care system. MFC thus tries to foster among health workers a current that upholds human values and aims at restructuring the health care system. It believes in deep and inclusive debate and discussion and offers a forum for dialogue/debate and sharing of experiences with the aim of realizing the goals outlined above and for taking up issues of common concern for action.

MFC works with two viewpoints in mind. One, it believes that there is a need to evolve a pattern of medical education and methodology of health care relevant to Indian needs and conditions. MFC realises the divergences present in India and realises that an import of ideas from the industrialized west, for example, is not the solution. The requirement is that of an indigenous solution. Two, positive efforts need to be made to improve the non medical aspects of society to ensure better life more humane and just in its content and purpose. The MFC believes that the health care system is only as good as the total system. The problem has to be looked at from a holistic perspective, and the only way to better the situation is to ensure a total social transformation in the country. Since the MFC is a nationwide body, it was decided that it would not be constituted as a rigid organization but one that would remain loosely knit and disjoined. The purpose of the MFC is only to serve as a platform for medicos who share a common belief and work for a similar goal. As a corollary, any person involved in health and health related activities can become a member. Members however are expected to form groups and circles wherever possible. The MFC functions mainly through members and groups formed in various parts of the country that coordinate via the central cell. The cell performs a set of functions. First, it encourages coordination through the publication of a monthly bulletin which contains diverse thought provoking articles, activity reports, papers members find useful, books that aid the goal of MFC and questions and discussions which members of the MFC may find interesting. Second, the cell maintains a fact bank (via generous member contributions) which stores information, data, facts and a list of problems which may interest its members. Third, and rather crucially, it maintains data of all members and persons with a view to help and encouraging contact building and communication. Fourth, it arranges medico camps, seminars, and conferences with a special focus on rural health projects. Fifth, it manages finances. It is pivotal to note here that the MFC is based on the idea of member contribution, and while the membership fee has been fixed at a measly Rs. 20/annum, MFC expects members to contribute depending on capability. Programmes and Ideals Each member of the MFC, as part of a group, or as an individual should select a topic as a problem, study it thoroughly, critique it, make necessary suggestions, and then circulate the knowledge to others. The idea of the study is that members pick up issues that pertain to

health and health related activities and look at them via a social needs and perspectives lens, E.g. poverty, malnutrition.

Apart from the study, members are expected to follow certain guidelines and ideals in practice, and otherwise. i. ii. Learn about alternative forms of medicine and imbibe this learning into their practice. Emphasise on preventive and total medicine rather than disease specific interventionary medicine. iii. iv. v. Try to curtail the unnecessary use of drugs, and use minimum amount of drugs. Emphasise more on health education, prevention of diseases during their practice. Critically realise the need to study sociology, economics, political science and other similar social sciences. A doctor is not merely a physician of individual patients but also a social being and so he should understand society, its working and its problems. vi. Discuss various socio-medical problems with others and try to create awareness among them; try to develop a group of medicos with similar interests at various places. vii. viii. ix. Learn clinical medicine perfectly, relying less on costly investigations. Learn nursing procedures and undertake basic investigations. Not accept physicians samples from the medical representatives as it is a form of subtle corruption. x. xi. xii. xiii. xiv. Oppose ragging in Medical Colleges at individual and group levels. Improve relations among the different categories of health workers. Try to learn more about the health team. Help blood donation activity. Visit rural health projects during vacation so as to get a first-hand experience of rural life, its problems and their solutions. xv. Develop medical services in rural areas and devote at least one year to develop a new pattern of medical care suitable to rural India. Some of the members of MFC are already working on rural projects in different part of the country. More are needed for similar action

Essentially, groups of medicos who find themselves drawn to similar problems should attempt solutions that would normally go beyond the scope of doctors work. For example, if a group decides to embark on collective social work like surveying a village community,

the right approach would be to select and adapt a village or a community and study not just their health problems, but their origin, the extent and nature, and if possible, solutions. This provides an opportunity for medicos to understand health problems in conjunction with the socio economic context and thus helps in developing social relationships. Medicos should also engage in dialogues with general practitioners (especially at the rural level) and provide medical assistance, both theoretical, and practical. Finally, medicos should try to expose, wherever possible, faults in the present health care system and make attempts to modify in line with MFCs vision.

Bibliography 1. Development as planned poverty Ivan Illich (TPD) 2. Hammer J, Y Aiyar and S Samji 2007: Understanding Government Failure in Public Health Services, Economic and Political Weekly, Vol. 42, No. 40, pp. 4049-4057. 3. http://www.mfcindia.org/