eHEALTH-July-2011-[8-10]-Reaching Masses

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Reaching masses

The only way to make healthcare affordable is to create a massive education network, and this should encompass infrastructure for training of Medical, Dental, Paramedical and Nursing students

By Dhirendra Pratap Singh

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ndia is scaling up economic activity, both on the demand and the supply side and a massive boom in healthcare services has changed the nation’s health delivery landscape beyond recognition in the last decade. Indian hospitals with the mantra of star facilities and bleeding-edge technology are writing a new chapter in India’s healthcare services. Despite this, India has 94 beds per lakh population compared to the WHO norm of 333.

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The density of doctors is also dismally low; there are only 43 doctors per 10,000 population compared to 249 doctors for every 10,000 people in Australia, 209 in Canada, 166 in the UK and 548 in the US. Estimates of doctor shortage is around 6, 00,000. This translates into an enormous opportunity to transform the medical education system, which should be opened up for private participation and companies should be allowed to establish medical and dental colleges.

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All India Institute of Medical Sciences (AIIMS) has been at the forefront of providing medical education in the government sector. At AIIMS, everything is kingsize,from the awe-inspiring campus with nearly 18 lakh patient footfalls a year, an array of 50 disciplines, 25 clinical departments and six super speciality centres managing every type of disease, to more than 54,000 wannabes who compete fiercely for one of its 77 MBBS seats. Research is what sets the

cover story AIIMS apart. AIIMS, which brings out more than 50 per cent of all the medical research from India, published over 1,500 original works in high-impact journals this year.

Rural-urban divide India has a health crisis exacerbated by the shortage of doctors and a mismatch between the need for basic medical services in rural areas and the congregation of specialists in urban centres. An abysmally low government spending on health—at US $ 32 per capita--, characterises the poor state of healthcare in India which is facing a ‘double burden’ of diseases afflicting both the poor and rich classes, recently published WHO report says.

While per capita health expenditure is about US $32 in poor countries, including India, it is around US $4590 in rich countries (more than 140 times). The high income countries consequently have 10 times more doctors, 12 times more nurses and midwifes and 30 times more dentists, the report said. With steep income disparities, India is also struggling to tackle a ‘doubleburden’ of diseases, which include infectious diseases affecting the poor on the one hand and chronic lifestyle ailments typical of fast urbanisation on the other.

In 2005, the National Rural Health Mission was launched to provide accessible, affordable and accountable quality health services to the poor in the remotest of regions. In order to attract more doctors to the peripheral areas, incentives in terms of salaries and reservation in post graduate seats are on offer.

But there is a major roadblock, which most aspirants have to deal with—the lack of postgraduate seats. According to the official estimates one in two graduates gets to do a postgraduate in medicine.

medical college has become a lucrative business opportunity, resulting in several players with political clout entering the area.

The Government is coming with six AIIMS-like institutes and upgradation of 13 existing Government Medical Colleges. The new AIIMS-like institutes will be completed by the end of 2012 at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh. The upgradation components in Phase-I include government medical colleges at Trivandrum, Salem, Bangalore, Kolkata, Jammu and Srinagar, NIMS Hyderabad and B J Medical College, Ahmedabad.

The idea is to make affordable and reliable healthcare services available to the rural populace though these. Each hospital will have 960 beds and will provide undergraduate medical education to 100 students per year. Post-graduate and post-doctoral courses will also be offered.

The Pradhan Mantri Swasthya Suraksha Yojana PMSSY was initially started in March, 2006, with the object of correcting regional imbalances in availability of affordable or reliable tertiary health care services and also to augment facilities for quality medical education in the country.

While per capita health expenditure is about US $32 in poor countries, including India, it is around US $4590 in rich countries (more than 140 times). The high income countries consequently have 10 times more doctors, 12 times more nurses and midwifes and 30 times more dentists, recently published WHO report says

Research Focus and Challenges India lacks a comprehensive policy to address the acute shortage of human resources in healthcare, which is a key driver of health costs and a huge constraint on scaling up public-health programmes. There is flawed

Post Liberalisation Era In the 1990s, medical education was opened up to private investment without putting in place appropriate systems and institutional mechanisms for enforcing quality and standards. During 1995-2006, of the 106 medical colleges established, 84 were private. Today, there are 313 medical colleges, of which 163 are in the private sector and 31 are deemed universities. Considering the high premium on medical degrees in India, establishing a

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Do You Know?

• As many as 12,263 specialists are needed in community health centres (CHCs) and 3,789 doctors in primary health centres (PHCs).

• While per capita health expenditure is about USD 32 in poor countries, including in India, it is around USD 4590 in rich countries (more than 140 times).

• The Indian healthcare market is on an unprecedented high at 16 per cent year on year. From ` 1, 02,600 crore in 2005, it now clocks ` 2, 00,000 crore and is projected to reach ` 3, 00,000 crore by 2012.

• The average life expectancy of a male in India is now 63, while a female lives 66 years, in India, • China, on the other hand, has improved the same to 74 years during the last 10 years.

• The healthcare industry employs over four million people, making it one of the largest service industries in the economy.

• Indians with foreign MBBS must clear MCI’s test in order to practice.

New watchdog in medical education

% of Doctors 0

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Algeria

Bahrain

Canada

Denmark

Countries

public policy. Also, poor governance, with the result that there is no standardisation of health-care providers in a manner that is relevant to the country’s needs. Lastly, corruption, an outcome of unregulated privatisation of medical education that has severely compromised its quality.

Faculty development is another important component in medical education. It is necessary to organise faculty development in a systematic manner. Steps are necessary at various levels, as the stakeholders are many, viz., the policy makers, the Government of India, Medical Council of India, teachers, students and private and government college managements.

Ethiopia

France

Ghana

Union Health Ministry has decided to seek Cabinet clearance for the proposed National Commission for Human Resources for Health (NCHRH) Bill, 2011. The Bill aims at creating a super medical authority by scrapping all other regulatory bodies. The proposed Bill aims to consolidate the law and promote human resources in the health sector.

The Bill aims to merge existing regulatory bodies such as the Medical Council of India, Dental Council of India, Pharmacy Council of India, Nursing Council of India and councils under the Department of AYUSH into a single body. The Bill also talks about constituting a separate board — the National Board for Health Education — to assist the commission to oversee health education. The board will facilitate and promote academic studies and research in emerging areas with focus on professional health education and ensure uniform augmentation of trained specialists and super specialists to achieve excellence in these connected areas.

Reforms needed Honduras

India

Jamaica This table is showing number of doctors in countries according to their population.

Source: OECD Health Data

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Reform in medical education is urgently needed. There is acute shortage of doctors in India. India needs more than one lakh doctors per year. Or so to say, India can absorb one lakh doctors per year. And we only produce 30,000. So what we need to do is to scale up our medical infrastructure three times. Shortage of doctors affects the poor, who do not have easy access to healthcare services. Private sector must be stepped into medical education to bridge the existing gap