Deadline: April 10th, Transforming Health Systems

Deadline: April 10th, Transforming Health Systems
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India's medical system in poor health

By Neeta Lal
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.