Too few doctors

Too few doctors

India must pace up supply of medical practitioners, both by traditional and innovative means.

The 2018 National Health Profile highlights major troubles dogging the sector, like low public expenditure on health and poor government doctor-patient ratio in India. The first dovetails into the second. Public spending on health is only a little over 1% of GDP, which translates into inadequate infrastructure including medical education. A government allopathic doctor therefore ends up serving an average population of 11,082, 11 times the WHO recommended 1:1,000 doctor-population ratio. The situation is worse in poorer states like Bihar where one doctor has to suffice for as many as 28,391 people.

Against nearly 1.2 lakh government allopaths, Medical Council of India has over 10.2 lakh registered practitioners on its rolls. Last year, government informed Parliament that India’s doctor-population ratio could be 1:1,612 assuming there were 8.18 lakh active allopathic doctors, across the private and public sectors. This still translates into a whopping shortage of nearly five lakh doctors to meet WHO norms, not to mention that this shortfall grows every year with growing population. Of course 70% of India still lives in rural areas and these aggregate numbers can disguise the reality of a severe urban-rural imbalance in supply of doctors.

A fallout of this shortage is that quacks step in to fill the breach. A 2016 WHO report found that nearly one-third of those found practicising as allopaths did not have medical degrees. It’s true that of the 67,000 odd MBBS seats in India, nearly 13,000 have been added since 2014. But this increased intake is not adequate. Supply needs to be paced up. On the upside there have been some important public health gains, such as a 22% reduction in maternal mortality rates since 2013 and the steady expansion of the “universal” screening programme for non-communicable diseases like diabetes, hypertension and common cancers.

The Ayushman Bharat scheme, offering free secondary and tertiary care, may prove to be a gamechanger – but here too many poor and rural patients will miss out on its benefits unless the “last-mile” shortage of doctors is fixed. Out of the box suggestions like converting district hospitals into medical nursing and paramedical schools merit consideration. The expansion of India’s training and licensing architecture could also include new career progression paths for nurses, whereby they could shoulder some of the healthcare delivery that is currently the exclusive domain of doctors.