Healthcare is a major challenge

Nantoo Banerjee
India is facing a gigantic task of producing over 2.07 million medical doctors in the next 12 years if the country has to achieve a modest doctor-to-population ratio of 1:1,000 by 2030. Though, according to the World Health Organisation (WHO) and the union health ministry, India has currently around seven doctors per 10,000 people, the actual number of practising doctors may be far less. A recent study published in the Indian Journal of Public Health suggested that there could be only 4.8 practising doctors available per 10,000 people in India in 2014. No one seems to be really sure about how many practising doctors are actually available in the country. The task of producing such a large number of doctors in such a short period is not easy. The duration of an M.B.B.S. course extends over a period of 4.5 academic years which are divided into nine semesters. Each semester is of six months’ duration. Students are required to complete a year of compulsory rotating internship, taking the total period to 5.5 years before they are fully eligible to enter the profession. The country would need at least 600 more medical colleges to come up quickly to meet the additional demand for doctors in the next 10 to 12 years. The earlier the Government formulates a  realistic medical education policy, better it is for the country and its burgeoning population. By 2030, India’s population is expected to reach 1.476 billion, if not more.
Healthcare is a major challenge for the Government. It is a highly sensitive area as well, socially and politically. In a poor country such as India, it would be wrong to leave this area largely with the profit-oriented, often unscrupulous, private sector. Unfortunately, the Government is practising the same since the 1991 economic reform, promoting poor quality private medical colleges and professionally incompetent, money-shark private hospitals and clinics, to address the complicated issue of healthcare, especially for the poor and middle-class. This is increasingly provoking distrust and anger among the common man against the system. Only last month, the parents of a dengue fever-hit seven-year-old boy were billed over Rs.16 lakh for treatment at a well-known private hospital in Gurgaon, that failed to save his life. The Haryana Government has ordered a probe into the case. In India where the demand for health infrastructure far outstrips the supply, one may say that a compromise with commercialisation may be unavoidable. But, not certainly at the current scale. The Central and State Governments must play their respective roles to ensure not only a healthier doctor-to-population ratio, but also a government-to-private healthcare outlet ratio to win the trust of its people in the system. The affordability of healthcare is fast becoming a matter of life and death for the citizens. Sadly, the Government is not spending enough on good medical education and healthcare services, leaving the fields open for exploitation by private medical colleges, hospitals, nursing homes and clinics.
There are about 460 medical colleges as recognised by the Medical Council of India with a combined capacity of around 64,000 seats. Nearly, 50 per cent of these medical colleges are in the private sector which are attached with the so-called multi-speciality hospitals. Almost half of the medical seats are in private colleges and most of them collect capitation fees in some form or the other. Few have ever filed a formal complaint about the system. If 24,000 seats are allotted for a Rs 50 lakh capitation each, they total Rs.12,000 crore a year in shady fees. Across zones, South India offers the largest number medical colleges and medical seats. The Eastern India has the lowest number of medical colleges and seats. Most medical colleges are located in highly urban areas. Not many of India’s 700-plus districts boast a medical college. Depending upon the size and population of districts, there should be more than one medical college per district.
The FORE School of Management study on ‘aggregate availability of doctors in India: 2014-2030’, conducted by its economics and business faculty, said: “as per the availability of practising doctors in India for 2014, the latest year for which data are available, there were 600,031 doctors available for practice in India in 2014 to serve its 1.239-billion population with a doctor-population ratio of just 4.84 per 10,000 people in contrast to the Government data.” According to Basant Pantnuru, an associate professor of the school deeply connected with the study, “the current availability of doctors data in India is based on the registration stock of doctors accumulated since the early 20th century. This has not been adjusted to attrition of the strength occurring due to retirement, emigration, etc. Rest of the registered doctors have either retired or emigrated from the country to practice abroad. It is estimated that the country would be able to achieve a ratio of about 6.9 practising doctors per 10,000 people only by 2030.”
Due to lack of reliable data, the leakage of doctors for reasons such as those who discontinued medical practice due to advanced age, change in profession, ill health, death or for any other reason during 1979-2014 (35-year period) is assumed to be zero. In fact, there is little time to be wasted by the authorities to address the grave situation. It is time to identify the number of doctors who are no longer in practice. The Government must try to improve the doctor-population ratio and set up new medical colleges and hospitals in districts. The private sector health education and healthcare services are welcome only in a more competitive environment with the Government-run medical colleges and hospitals operating as a pivot in the system. (IPA)

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