Taking a cue from the Ukraine crisis, Bharat Dogra offers some suggestions for correcting the mismatch between medical needs of the Indian populace and the readiness of people who can cater to these needs
As thousands of medical students from India faced extreme difficulties and risks in Ukraine, the anomaly of large numbers of Indians going abroad to study medicine in difficult conditions when there is a big need for more doctors right here, has attracted attention. And the need for adequate opportunities for medical education in India has been brought home.
The fact is that while some 16 lakh students take the NEET examination, and around 8 lakh qualify, there are only about 90000 seats available.In addition, a recent finding by a study group led by Anup Karan of the Indian Institute of Public Health is that the density of doctors and nurses/ midwives (in India) is estimated at 6.1 and 10.6, respectively. The numbers drop to 5.0 and 6.0, respectively, after accounting for adequate qualification. The estimates are well below the WHO threshold of 44.5 doctors, nurses and midwives per 10000 population.
Clearly, the needs of people and the willingness of those who can provide these needs have not been aligned. Much can be done by government to resolve the issue, which pertains not just to the medical profession but to several other important services as well. There is a clear need for strengthening the government health system at the decentralised level – specifically at the district and village levels. Primary and community health centres and district hospitals need significant improvement in order to meet around 90 per cent of the healthcare needs of the poorest of the people entirely free of cost, with only highly complicated cases having to be referred to higher levels of government or private care.
To achieve this, the budget needs to be increased several times, the management system improved, adequate supply of low-cost generic medicines ensured, supportive activities like preventive measures boosted, and corrupt practices curbed. Such steps will increase the need for doctors and all other medical personnel within the government healthcare system in all districts, and the need should be met by holding local exams for various categories of medical personnel.
Selected candidates should be given low cost, good quality medical education (entirely free for the poorest among those who qualify), linked not just to district hospitals but even to primary and community health centres. This is important for learning the basics of rural medicare too. Those who avail of this low-cost education should be required to commit to serving the district for at least a decade, and assured of well-paid jobs and housing and other essential facilities by the government. Those who refuse to make such a commitment should have the option of accessing the education at a high fee, and be free to choose their options of practice after they qualify.
Medical journals in English and local languages can be started at district levels to document such efforts and the learnings from them. A system of reward and honour for those who serve well in rural areas and slum communities can be established. Such steps will ensure a match between need and aspiration, and give youth options for well-paid, stable, longterm livelihoods close to home. Sectors other than healthcare can also follow similar patterns.
(The writer is a senior freelance journalist and author who has been associated with several social movements and initiatives. He lives in Delhi.)
April – June 2022