India's health systems is on ventilator, and the country struggles to fix it. It's medical education is one of crumbling infrastructure, out-dated laboratories, acute shortage of doctors and sham medical colleges. As a result, India is unfortunately positioned for the world to consider a case study of all the things gone wrong in the system of healthcare delivery and the culture of preparing doctors for the future.
The Bhore Committee, tasked with assessing the country's health system, first published a report to pursue a robust primary health care system back in 1946. This was further strengthened by the Alma-Ata Declaration in 1978. In 2017 we neither have a robust primary health care system like Cuba nor do we have a medical education system that empowers doctors-in-training to rise up to newer heights. As of October 2016, India had 422 medical colleges and around 57000 medical seats. Private medical colleges outnumbered government medical colleges with a 224: 198 number respectively. According to the World Bank, Indians spend 89.2% of health expenses out-of-pocket which adds sufficient burden to the socio-economic situation of average middle-class Indians.
India has 1.2 billion citizens, but has merely 930,000 doctors to help with India’s ailing health concerns. As per the National Health Profile Report 2015, the total number of government doctors are about 106,000, and one government doctor caters to as many as 11,528 people in certain areas.
Community Health Centres (CHC’s) one might assume could boost the health indicators in every district, but the situation is far worse. There is a shortfall of 74.6% of the surgeons, 65.4% Obstetricians and Gynecologists, 68.1% physicians and 62.8% paediatricians, in CHC’s across the country. CHC’s are supposed to be superior to Primary Health Centres (PHC’s) as a pillar of our health structure, but solutions are far from being achieved.
In short, health care in India today still remains the privileged domain of a few. Recently, the Union Health Ministry unveiled the draft Indian Medical Council Bill 2016 (Amendment) in which medical graduates will have to clear the National Exit Test (NEXT) after they finish their program. The justification of the bill is to create a level playing ground for quality control due to the privatization of medical education. The irony is that the Medical Council of India (MCI) does not believe in the institutions it recognizes. Simple logic is at play here. There is a checklist and a regulatory framework, and only if the institute fulfills these parameters does the MCI recognize it and it is cleared to admit medical students. So if the candidates-in-training study from MCI recognized institutes, why question the calibre of those candidates at the end of 5.5 years by making them take the NEXT?
India faces an acute shortage of medical professionals. On one hand, the government is permitting Ayurveda doctors to prescribe drugs of modern medicine. On the other, it is punishing young medical students by NEXT in a system which has flourished because of their own wrong doings.
As per an RTI on August 2016, there were only 845 community medicine post-graduates in the country out of which 1/4th will pass out every year. India’s vast public health burden cannot be met with such numbers.
The number of post graduate seats in India is half the number of undergraduate seats, creating a disproportionate divide among the requirement of doctors the country needs and among the number of doctors that emerge out on a regular basis. Equalising under-graduate and post-graduate medical seats would be a wise move given the present shortage of doctors India faces. This song was sung long time ago by Dr. Devi Shetty, Chairman of Narayana Health Group, Bengaluru who repeatedly advocated for equalizing the ratio of medical seats in India. Given the small number of existing seats, the already low number of medical doctors in India, and privileged doctors leaving the country for greener pastures, India’s health systems is ailing, weak, and in need of resurrection.
I believe this attitude of experimentation with medical education must stop. The focus must be to create world class institutes. We often observe Indian students wanting to go abroad for higher education and fellowships, but how many foreigners have we seen want to come to India for higher education in healthcare? The budgetary allocation for health care is pro-poor and protects our systems poverty.
Not so far away in other countries, enlightened universities and institutes are abolishing biometrics as a means to check attendance, so that more trust is in-built among the professionals and a sense of duty grows. Meanwhile, MCI takes us back to the dark ages with compulsory biometrics. Scott Carney, a journalist who report from Chennai, has openly spoken about kidney rackets, the blood business and bone mafias through his book, ‘The Red Market”. Kamal Mahawar wrote in detail in “ The Ethical Doctor” and described the outdated and obsolete code of ethics in India
Much remains to be changed as the fault lines widen, perhaps first a change in leadership is necessary.