India faces an acute shortage of doctors and needs to desperately ramp up the output from medical colleges. The shortage is more acute for doctors willing to work in the rural areas where almost 70% of Indians live, or one who will work in government hospitals.Will more doctors mean better healthcare for India’s 1.3 billion? A closer look at the facts raises serious doubts.
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| Context: | India faces an acute shortage of doctors and needs to desperately ramp up the output from medical colleges. The shortage is more acute for doctors willing to work in the rural areas where almost 70% of Indians live, or one who will work in government hospitals.Will more doctors mean better healthcare for India’s 1.3 billion? A closer look at the facts raises serious doubts. |
| What is the current scenario of Doctors? | a. Composition:
1. Population: 1 028 610 328 in 2001 2. Health workers: 2 069 540 3. Doctor: 819 475 (or 39.6%) 4. Nurses and midwives: 630 406 (or 30.5%) 5. Dentists: 24 403 (or 1.2%) b. Of all doctors: 1. Allopathic: 77.2% and Ayurvedic, homeopathic or Unani: 22.8% 2. Other Heath Workers – 28.8 % were Pharmacists ancillary health professionals traditional and faith healers c. Density: 1. Density of all doctors — allopathic, ayurvedic, homoeopathic and unani — at the national level was 80 doctors per lakh population compared to 130 in China. 2. Density Nurses and midwives: India had 61 workers per lakh population compared to 96 in China. The number reduced tenfold to 6 per lakh population, if only those with a medical qualification were considered. d. Qualification: 1. More than half of them don’t have any medical qualification, and in rural areas, just 18.8 per cent of allopathic doctors are qualified. 2. Allopathic doctors : Almost one-third (31 per cent) of those who claimed to be allopathic doctors in 2001 were educated only up to the secondary school level and 57 per cent did not have any medical qualification. 3. The lack of medical qualifications was particularly high in rural areas. Whereas 58% of the doctors in urban areas had a medical degree, only 19% of those in rural areas had such a qualification. |
| What are the reasons for poor state of Health workforce? | 1. As often happens with government programmes, much of the focus was on how to provide the additional financial resources needed, since it was well known that India was not spending enough public money on health. Available data showed that the total expenditure on health (public and private expenditure combined) was about 4% of GDP which was comparable to that in other countries at a similar level of development. However, in India the share of public sector expenditure was only 25 percent of the total whereas in other countries it was 50 percent.
2. The production of human resource in health is a time consuming process, taking as long as nine years for a specialist, to eighteen months for an ANM. 3. Presence of quacks in the system. |
| Is increasing seats in medical colleges a solution? | More than a quarter of CGHS posts of general duty medical officers (381 out of 1,383), all in urban areas, were lying vacant. Hundreds of posts are lying vacant in top government hospitals including AIIMS.If the huge surplus of doctors in urban areas does not result in filling up these posts even in the Capital, obviously, adding to this surplus through rise in medical seats is not the solution.
The reasons for these vacancies listed by health minister included low rates of joining of those recruited and non-availability of eligible SC/ST candidates for reserved posts. The low rate of joining could be due to poor working conditions or inadequate professional incentives. The non-availability of SC/ST candidates certainly can’t be ameliorated by more private colleges with no caste reservation. If anything, it could exacerbate the problem. To meet the WHO norm, rural India needs 6 lakh more doctors. More than half of all MBBS seats are now in private colleges. It’s irrational to expect that more such colleges will bridge this gap. |
| Conclusion | There’s a lot more to tackling India’s biggest health issues than simply increasing the output of doctors. The experience of Sri Lanka, Thailand and Iran also shows that much better health outcomes are possible even in developing countries with less than one doctor for every 1,000 people. |