Reforming medical education

Context:

• India’s health systems have been confronting numerous challenges. In order to effectively address these challenges, our health systems must be strengthened.
• NITI Aayog’s recently put across a proposal for allowing private entities to take over district hospitals for converting them into teaching hospitals with at least 150 seats. 

Relevance:

GS-II: Social Justice (Social Sector & Social Services, Education and Health related Issues)

Mains Questions:

1. How severe is the lack of sufficient workforce in healthcare sector in India? To what extent will NITI Aayog’s proposal of private involvement in taking over of hospitals to form teaching hospitals address the issue? (10 marks)
2. How has the Covid-19 pandemic affected the adequacy of healthcare workers in India? How can the issue be addressed? (10 marks)

Dimensions of the Article:

1. Current situation of inadequacy in Healthcare workforce
2. Similar Shortage of Engineers and the reform in 2000s
3. NITI Aayog’s proposal and issues with it
4. Way Forward

Current situation of inadequacy in Healthcare workforce

• India’s availability of doctors per thousand population does come close to the World Health Organisation’s prescribed doctor-patient ratio of 1:1000 if we include all the registered allopathic, homeopathic, ayurvedic and unani doctors. But the number of doctors who practise is much lower.
• It is also far lower than many countries including Russia, the USA, and all the European Union countries where the ratio is above 3 doctors per one thousand population. Unless we increase the ratio to the level of better performing countries on the health front, poor people in India will continue to suffer.
• As a major impediment for achieving the health-related Sustainable Development Goals (SDG) there is a serious shortage of health workers, especially doctors, in some northern States.
• Health workers are critical not just for the functioning of health systems but also for the preparedness of health systems in preventing, detecting and responding to threats posed by diseases such as COVID-19.
• The doctor-population ratio in northern States is far short of the required norm, while the southern States, barring Telangana, have enough doctors in possession- hence, the healthcare workforce crisis has been aggravated by the imbalances within the country.
• The problem of shortage of doctors and other support staff has been allowed to linger for the past several decades due to short-sighted policies of the institutions such as Medical Council of India

Medical Education as the building block of Health system

• Medical education is the bedrock on which the needs of ‘human resources for health’, one of the major building blocks of any health system, are met.
• Today’s health professionals are required to have knowledge, skills, and professionalism to provide safe, effective, efficient, timely, and affordable care to people.

Similar Shortage of Engineers and the reform in 2000s

• India faced a similar shortage of engineers through the 1990s when there were only 1,30,000 engineering seats on offer. But in 2000, the government dismantled the stranglehold of the engineering education regulatory body, AICTE, and reworked the regulatory framework that governed opening of engineering colleges. This resulted in an increase in the intake in engineering colleges by four times in just five years.
• Unfortunately, this kind of reform is yet to take place in medical education. As a result, shortages in medical seats still exist and students are, according to one estimate, collectively made to pay nearly 15,000 crores in capitation fee. Thousands of others line up to seek admission in countries such as China, Russia, Australia and many others, paying millions of dollars.

NITI Aayog’s proposal and issues with it

• NITI Aayog’s proposal for the taking over of district hospitals for converting them into teaching hospitals by private entities has reasons to be deeply concerned.
• The most important concern is that the private sector in medical education will be encouraged by the implementation of such a policy. Private players treat medical education as a business.
• It will also directly aid the corporatisation processes of healthcare provisioning while the under-resourced public health system will be a collateral damage.
• District hospitals are considered as the last resort for the poor.
• The corporatisation will make the services very costly and exclude them from getting care.
• Even from the perspective of producing more doctors to meet the shortages in under-served areas, this is unlikely to yield the desired result.
• Additionally, the medical graduates trained in such private sector ‘managed’ medical colleges will prefer to find employment in corporate hospitals and not in rural areas to regain their investment.
• Further, this proposal is not aligned with India’s national health policy goals like achieving universal health care and health equity. Instead, it will widen health inequalities further.

Way Forward

• The 500+ medical colleges in India have only over 75,000 seats for the MBBS course and only half these seats are in state-run medical colleges. If India has to achieve the doctor-patient ratio of 1:1,000, we need nearly 20 lakh more doctors by the year 2030.
• Time has come that we reform the medical education system, end the pervasive corruption in these regulatory institutions and ensure that we carry out the expansion in such a way that we produce the required number of doctors to look after our population.
• Today’s medical education should be able to groom such professionals to face medicine of the 21st century. The Lancet report, ‘Health Professionals for a new century: transforming health education to strengthen health systems in an interdependent world’ (2010) outlines key recommendations, to transform health professional education, needs to be looked upon.
• Extending teaching privileges to practising physicians and allowing e-learning tools will address the shortage of quality teachers across the system. Together, these reforms could double the existing medical seats without compromising on the quality of teaching.
• There should be a substantial step-up in public investment in medical education.
• By establishing new medical colleges, the government can increase student intake as well as enhance equitable access to medical education.
• Besides, it must allocate adequate financial resources to strengthen the overall capacity of existing medical colleges to enrich student learning and improve output.

-Source: The Hindu