India's medical system in poor
health By Neeta Lal
NEW
DELHI - The irony couldn't have been starker. Just
as India was cementing its position as a
world-class medical tourism destination - with
revenues from foreign patients set to touch a
whopping US$2 billion by 2012, according to a
Confederation of Indian Industries-McKinsey report
- comes a government survey which states that the
country's public healthcare system is headed for a
crisis due to an acute medical manpower crunch.
According to the recently released
Planning Commission report, India is short of a
phenomenal 600,000 doctors, 1 million nurses and
200,000 dental surgeons. With positions for
300,000 dental surgeons, only 73,000 are currently
full. Meanwhile, 1.1 million nurses are filling up
vacancies for 2.1 million, a shortfall of nearly
50%. To make matters worse, there is also a huge
paucity of
paramedical staff including
radiographers, X-ray technicians,
physiotherapists, laboratory technicians, dental
hygienist, orthopedists and opticians.
The
report also highlights a skewed statewide
distribution of doctors with states like Karnataka
and union territories such as Delhi and Goa having
a passable ratio while others, like Haryana, Bihar
and Uttar Pradesh, are being under-served. The
availability of specialist manpower in local
Community Health Centers, compared to the number
of sanctioned posts, is also disquieting.
About 59.4% surgeons, 45% obstetricians
and gynecologists, 61% physicians and 53%
pediatricians were not in position at the time of
the survey. The number of doctors registered by
different state councils during 2006 led to a
doctor-to-population ratio of 60:100,000.
Nationally, this glaring inequity
manifests itself in an abysmal patient-doctor
ratio. In other words, for every 10,000 Indians,
there is barely one doctor available. These
figures compare dismally with countries like
Australia which provides 249 doctors for every
10,000 people, Canada which offers 209, Britain
166 and the United States 548.
The medical
manpower shortfall is all the more ironic because,
as the report states, India ranks at the top of
nations whose well-qualified healthcare
professionals, particularly doctors, radiologists,
laboratory technicians, dental hygienists,
physiotherapists and medical rehabilitation
workers, are working in major developed countries.
"The current situation in the public
healthcare sector is scary," said Dr Aveek Parekh,
a senior oncologist at a New Delhi government
hospital. "The government needs to urgently
re-assess the country's healthcare needs and
address the shortfall if it is to avert an
imminent national crisis. It needs to probe the
various factors impacting the performances of the
health services sector and suggest short and long
term policies to enhance and sustain its
competitiveness in the future."
Experts
reiterate that the medical staff crisis is partly
triggered by the continuous exodus of Indian
doctors to foreign shores in search of better
growth opportunities and work environment.
According to the Planning Commission, Indian docs
who have migrated to developed countries, form
nearly five per cent of their medical workforce
with nearly 60,000 Indian physicians working in
the US, Britain, Canada and Australia alone.
"For several decades, Indian medical
professionals have been serving not only in the
Middle East but also in developed countries,
including the US and the UK," said Anwarul Hoda, a
member of the Planning Commission who headed the
group that drafted the report. "The overriding
requirement in India, therefore, is to increase
the supply of human resources at all levels from
specialists to paramedical personnel and improve
their quality."
This is easier said than
done considering the medical profession in India
has itself lost much of its old charm. In fact the
number of Indian youth who are now opting for
medicine as a career choice has whittled down
remarkably.
For instance, this year,
according to the Central Board of Secondary
Education (CBSE), only 1.6 million candidates took
the medical entrance exam, a 25% plummet since
last year. This is in stark contrast to the over
800,000 candidates who registered for the AIEE,
the engineering entrance test conducted by CBSE,
and another 300,500 who took the JEE exam for
entrance into the blue-chip Indian Institute of
Technology.
Overall, Indian medical
colleges currently churn out about 30,000 doctors
a year, apart from 20,000 dentists and 45,000
nurses. About 3,181 undergraduate degrees are
awarded annually, while 1,316 postgraduate
diplomas are given in the country each year.
Experts point out that the need for medical staff
is at least double these numbers.
Undoubtedly, the massive paucity of
medical staff in India underscores an overall
disenchantment with the profession. The current
crop of Indian youth are rejecting the white coat
in favor of more lucrative and less time- and
labor-intensive professions like business, law or
engineering.
"As a profession, medicine is
an extremely demanding one," says Aditi Pai, 28,
who opted out of a premier Indian medical college
to pursue an MBA. "Eighteen-hour workdays, seven
days a week are quite the norm while the pay
scales don't quite match up."
And they
don't. In fact, even senior government doctors -
after putting in 20-25 years - rarely take home
salaries in excess of 50,000 rupees (about
US$1,200). Poor pay, ill-equipped hospitals and
lack of support staff have driven even the most
idealistic doctors to explore greener pastures.
Worsening the current scenario is a
Medical Council of India stipulation that
undergraduate and postgraduate qualifications of
foreign institutions, which do not grant
recognition to Indian degrees, are currently not
recognized. Consequently, hospitals and other
clinical establishments cannot tap the pool of
non-resident Indian medical professionals who may
be willing to work in India. If this bottleneck is
removed, say experts, it would augment the supply
of quality medical personnel to Indian service
providers as well as in the areas of medical
tourism, telemedicine and clinical research.
To prevent the situation from
deteriorating further, the Planning Commission
suggests that the medical education sector be
opened up completely for private sector
participation to help it establish medical, dental
and nursing colleges. In addition, it also advises
the government to fill vacant posts of teachers in
government medical colleges to help them provide
good education at subsidized rates to meritorious
students.
Towards this end, Indian Health
Minister Ambumani Ramadoss stated last week that
India will soon be setting up new medical colleges
and recognize the medical degrees issued by five
English-speaking countries, including the US,
Britain and Australia. The 11th five-year plan,
stated the minister, envisages setting up of six
All-India Institute of Medical Sciences-like
institutions and upgrading 13 existing medical
institutes. It is also planning to establish 60
new medical colleges and 225 new nursing colleges
based on the template of the private ones.
These steps will be crucial in
resuscitating India's ailing healthcare system
back to health. Apart from addressing the
immediate healthcare needs of a billion-plus
population, they will also help the country build
on its growing status as a world-class medical
tourism hub which is growing at a robust clip of
25% per year.
New Delhi-based
independent journalist Neeta Lal
has had her work published in over 70 publications
across 20 countries .
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