Doctors’ shortage is the big ailment afflicting India’s primary healthcare system
A shortage of medical practitioners puts a strain on our public health facilities, particularly in the villages. The answer perhaps lies in training informal healthcare workers and freeing up doctors of administrative responsibilities at the district leveleditorials Updated: Dec 01, 2017 12:09 IST
Last year, nine-year-old schoolboy Ansh died on his father’s shoulders when the emergency section of a Kanpur hospital denied him admission. A few days after that, when district hospital authorities in Odisha’s tribal Kalahandi district refused to arrange for a hearse, Dana Majhi was compelled to carry his wife’s body on his shoulders for 10 kilometres. These shameful incidents point to the gaps in our shambolic public healthcare system. We have just one government doctor for every 10,189 people, one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people. With a doctor-patient population ratio worse than Vietnam, Algeria and Pakistan, the shortage of doctors is one of the biggest ailments afflicting our health-management system, a parliamentary panel report on health and family welfare said in 2016. A 2017 study by the economics and business policy faculty at the FORE School of Management says India needs 2.07 million more doctors by 2030 to achieve a decent doctor-to-population ratio of 1:1,000.
A shortage of doctors puts a strain on our public health facilities, particularly in the villages. According to Indiaspend, public-health centres in our rural areas are short of more than 3,000 doctors. The shortfall has increased 200% over the last decade. Clearly there is a discrepancy between the State’s national healthcare plans and ground realities. The National Health Policy 2017 wants to raise India’s public health expenditure to 2.5% of the GDP from the current 1.4%. The Centre’s Rs 160,000 crore National Health Assurance Mission promises more than 50 free drugs, a dozen diagnostic tests and insurance cover to every citizen by 2019. As a part of the National Health Mission, among the ambitious goals set by the Centre is to reduce the infant mortality rate to 30 per 1,000 live births, from the current estimate of 40. This will involve setting up of medical and nursing resources within a three-kilometre radius of villages. Given the size of our population and the lack of even basic healthcare facilities, it is obvious that just a market-led mechanism can’t bridge the demand-supply gap. The Niti Aayog’s action agenda for 2020 admits as much.
Part of the shortfall in the supply of doctors can be attributed to the medical education system which is stretched for resources. India’s 462 medical colleges teach 56,748 doctors, but with our population increasing by 26 million every year, this is inadequate. Then there are the regional imbalances. Eight states, which make up 46% of the national population, have only 21% MBBS seats. Six other states with 31% of India’s population have only 21%. Even here, the poorer states are the biggest victims of this disparity. Jharkhand and Chhattisgarh, for instance, have the worst infrastructure for institutional health service delivery among states with a high percentage of undernourished children. Walking for more than 12 kilometres to access health centres and basic diagnostic services is common. With health being a state subject, the buck finally stops with the local government to bolster our ailing primary healthcare infrastructure. The workable remedy perhaps lies in quality training for informal healthcare workers and freeing up doctors from too many administrative responsibilities at the district level to help them focus on treating patients in the villages.