Highlighting that in a country of 1.47 billion people, where roughly 922 to 930 million reside in rural areas, it is in the national interest that qualified professionals are enumerated by the health department, the Gauhati High Court recently directed the Assam government to establish a permanent service cadre for those medical professionals who trained as Rural Health Practitioners.

Justice Soumitra Saikia was dealing with a plea of 609 medical professionals who successfully completed a Diploma course in Medicine and Rural Health Care under the 2004 Act, which was later declared unconstitutional in 2014 by the high court. Following this, the Assam legislature enacted the Assam Community Health Officer (CHO) and categorised them as paramedicine personnel, which petitioners argued “downgraded” their position.

“In a country of 1.47 billion people, of which about 62.5 per cent to 63 per cent reside in rural areas, bringing the rural population to roughly 922 to 930 million people, it is paramount in the national interest that qualified professionals who are capable of rendering essential health services in terms of the standards specified and/or enumerated by the health department,” the court said on May 29.

The order added that while it is true that the rural population must be given the best and the highest medical facilities to the extent available, it is equally important to involve local population who may be willing to undergo such training and attain such qualification as laid down by the State and render such services to the rural population as involvement of members of the local rural community will subserve the interest of better health care to such rural communities which are particularly not having access to specialised or higher medical institutions or facilities.

The case originated from a 2004 state initiative designed to address the shortage of doctors in rural areas. Under the Assam Rural Health Regulatory Authority (ARHRA) Act, students were enrolled in a three-and-a-half-year Diploma course in Medicine and Rural Health Care (DMRHC) at the Medical Institute in Jorhat.

These practitioners were authorised to treat common diseases, prescribe specific drugs, and perform minor surgeries within rural jurisdictions. However, the Indian Medical Association (IMA) challenged the Act, leading the high court to strike it down as unconstitutional in 2014.

The court found the Act in conflict with the Indian Medical Council Act, 1956, as the state had not obtained central permission to start the new medical course. In response to the 2014 ruling, the Assam legislature enacted the Assam Community Health Officer (CHO) and categorised them as paramedicine personnel.

The 609 petitioners moved to the high court, arguing that this re-designation downgraded their status from practitioners to paramedics and restricted their ability to practice medicine as they had been trained to do.

Appearing for the petitioners, Senior Advocate Harin P Raval submitted that there can never be any deprivation of the qualifications which the petitioners earned lawfully during the operation of the ARHRA Act of 2004.

It was submitted that no relief was either paid for or granted against the petitioners. The petitioners were never arrayed as parties in the proceedings before the High Court.