India aspires to be a superpower by 2030. However, the 1.2 billion-strong population, its biggest strength and one of the key parameters of development, can well become the Achilles’ heel. Lack of quality healthcare services is a key concern for a majority of Indians, triggered by insufficient number of doctors catering to public health needs and poor state of healthcare education in the country.
Healthcare education can particularly be a driving force in making people aware and provide them with relevant information and enabling them to make the best health choices.
What is healthcare education? Simply speaking, healthcare education encompasses the formal training received by the medical and allied healthcare staff in medical colleges. However, we often stop at that. Healthcare education in India is largely synonymous to medical training and educating the people to help them take informed decision often slips away: Making the people aware of their health needs and risks, payment options to reduce their out-of-pocket medical expense, etc. are some of the aspects on which even a well-educated, city-bred person may need some help. India must utilise the access its community health workers (Anganwadi and Accredited Social Health Activist (ASHA) workers) enjoy to inform and assure people of the options they have, failing which even the best technology and most efficient staff will fall short of making an impact.
Need a multipronged approach towards training medical corps For the medical training providers, the most important criterion to adhere to is the quality of education. However, cost is a bigger factor for the aspirants. India has 492 medical colleges, out of which 233 are government-owned and produce around 62,960 MBBS doctors. While aspirants hoard at the government medical colleges offering subsidised education, the lack of infrastructural upgrade is a major concern. Private medical colleges have better infrastructure but charge a higher fee. But no institution can teach an aspiring doctor to be empathetic towards the need of people. As a result, the mandatory rural posting is often considered as a compulsory dose of quinine rather than an opportunity to gather first hand information for a better service.
Earlier this year, the government launched Ayushman Bharat, an ambitious healthcare protection scheme that will cover 10 lakh families below the poverty level. The scheme may face severe challenges in delivering comprehensive primary health care to communities due to a wide gap of trained medical staff. According to a study published in the Indian Journal of Public Health, India would need 2.07 million registered doctors to achieve the World Health Organization-directed doctor-population ratio of 1:1,000 by 2030. Effectively, this would thrust a growth of 151 per cent between 2010 and 2030 against a growth rate of 14.41 per cent until 2014. Moreover, the Indian Medical Council Act only allows doctors trained in allopathy to treat using allopathic drugs scheduled under the Drugs Act 1940.
The looming crisis can be addressed by roping in licentiate medical practitioners (LMP) primary care physicians selected locally, trained under short-term courses, enrolled and then licensed — who can facilitate the supply of trained healthcare providers in villages. Not only will they weed out quacks, deputing LMPs in rural healthcare centers will alleviate the suspicion of being treated as a second-class citizen among village dwellers.
Shortage of allied healthcare professionals will impair medical services The focus on doctors as the mainstay of public health system is doing more harm than good. Doctors need ample support from the allied healthcare professionals (AHP) — nurses, midwives, anesthetists, etc. — in order to make it work. However, the current education scenario supplies about 3 lakh against an imminent requirement of nearly 65 lakh healthcare professionals. There is an urgent need of more nursing colleges, trained midwives and nurses who play a crucial role. The government’s recent proposal to authorise nurses to treat illnesses and making a legal amendment in the National Medical Commission Bill in this effect will help ease the burden of doctors; it can be a game-changer in the future.
The prevalent practice of equating a doctor only with an MBBS degree holder is also impeding the expansion of healthcare education. India has around 7 lakh AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) doctors and 1.92 lakh Bachelor of Dental Surgery (BDS) degree holders who are barely counted as a part of the formal healthcare system. By drawing them into the system, we will not only adopt a more holistic approach but also free MBBS doctors to take care of ailments that are more serious. Unfortunately, they are the lesser cousins of the MBBS degree and in most cases these courses are opted as a second choice.
Efforts must be channelised to change attitudes
If there is one thing that needs change, it is our attitude. India is a hub of medical tourism and yet about 7,000 students every year travel abroad, mostly Russia and China, to study medicine. We should ask why. Is it because these countries offer a better infrastructure and environment than India? Are these degrees as valuable as they look to be? Probably not, for when they come back to practice in India, they have to qualify Foreign Medical Graduates Exam (FMGE) as per the norms laid down by the Medical Council of India (MCI). Bringing in these students back to the Indian healthcare education system will definitely provide an impetus to improve.
The specialised courses for medical professionals show how we focus at providing curative care at the cost of preventive care. Hence, the distribution usually tilts towards ‘lucrative’ options such as radiology, orthopaedics and gynaecology over family medicine, geriatric care, and psychiatry.
We talk more about cancer and obesity whereas diseases like diarrhea and anemia affect more people in India. As one of the largest countries in the tropical region, India clearly has an opportunity to develop itself as a hub of research and development center for tropical diseases. This will make several neglected diseases a part of the medical discourse and provide a clear roadmap to the experienced professionals for continuing medical education (CME).
(The writer is MD, Paras Healthcare)