In 2016, the World Health Organisation (WHO) reported that 57.3% of ‘allopathic doctors’ in India did not have the requisite medical qualifications, worse still 31.4% of these practitioners were educated only up to secondary school level. The report initially rubbished by the Government was only acknowledged in 2019, when the government cited the report to address the shortfall in the number of doctors by allowing Community Healthcare Professionals to practice medicine while passing the National Medical Commission Act in 2019.
While the Government has made attempts to revamp India’s healthcare sector to include legislative changes in addressing the shortfall in medical education and also launched the ambitious National Digital Health Mission, the success of different healthcare initiatives depends on experienced and qualified healthcare practitioners. Unfortunately, India continues to face an unprecedented shortage in the number of healthcare practitioners, paving the way for unlicensed quacks to operate. The WHO recommends one doctor for 1,000 people. The Indian Government has stated that the doctor patient ration in India is 1:1445 whereas a report by the Indian Journal of Public Health in 2017 reported that one government doctor attends to 11,082 patients. These staggering numbers not only leaves room for quacks to operate but also puts stress on an overwhelmed healthcare workforce and therefore requires healthcare practitioner centric reforms to address this shortfall.
1. Developing a Robust Verification and Licensing System
According to the Ministry of Health and Family Welfare Services, there are a total of 12,55,786 allopathic practitioners registered by the Medical Council of India and state medical councils. This would mean that the percentage of doctors within the population of 1.3 billion is just 0.12%. It is highly likely however, that there are less that 12.5 lakh doctors in India, this is because state medical councils rarely remove the names of doctors that have applied for licences in another state leaving room for duplication. Moreover, the MCI, which is now replaced by the National Medical Commission, did not take into account doctors that have migrated to other countries or more importantly it failed to cross verify databases with the state councils leaving room for errors in identifying the total number of practitioners in the country.
Identifying the total number of doctors, including specialists is crucial in developing and implementing the country’s health scheme. Inaccurate data about practitioners has also impacted the implementation of National Health Mission in different states, where shortage of medical officers and specialists have prevented the NHM from meeting its targets, leading to postponement of the mission and call for new human resource management policy to look into better sourcing doctors to meet the mission targets.
Addressing the shortage in doctors first requires ascertaining the exact number of doctors in the country. The NMC must refine the process of registering the data and ensure that state medical councils share its list of practitioners with the NMC and also waste no time in removing names of doctors who have moved to other states. This would call for more coordination between states and also involve the participation of technology platforms that are working in building a registry of healthcare workers.
2. Reforms focusing on the welfare of healthcare practitioners
The Covid19 pandemic has today brought to the fore numerous issues faced by the medical fraternity that only Government reforms can help alleviate. Some of this includes the treatment of practitioners in the country and the Government’s non-intervention in the past. In 2019, numerous healthcare bodies and the Indian Medical Association called for a central legislation to check violence against healthcare workers. Unfortunately, a draft bill proposed by the Ministry of Health and Family Welfare in December 2019 was opposed by the Ministry of Home Affairs, invariably leaving the medical fraternity short-changed.
Owing to the impending surge in Covid19 cases in the country and the need for full support from the medical fraternity to combat the pandemic, the Government in April 2020 introduced an ordinance to prevent violence against doctors. Yet despite these reforms and a few perks (insurance coverage) protecting doctors, India still faces a shortage of practitioners thereby highlighting that these reforms are reactionary and meet immediate needs rather than addressing the underlying long-term issues.
One overlooked factor that results in a shortage of doctors in India is the migration of India doctors abroad. While there is little information on the number of doctors leaving India, in 2017 researchers from the WHO stated that nearly 54% of AIIMS students who graduated between 1989–2000 now reside outside India. The Government recently introduced a slew of changes in counter this shortfall, it increased the maximum intake of students for MBBS courses from 150 to 250 and eased norms for establishing medical institutions. This move will result in more medical graduates but does not address emigration of Indian doctors, including specialists to the West, which is a consequence of numerous push and pull factors.
This is just the tip of the ice-berg and it is clear that the Government needs to focus attention on retaining doctors in addition to building capacity with respect to medical educational facilities. Reforms must be holistic and include enhancing coordination between center, state and private sector in assessing the number of doctors, and address the core grievances of the medical fraternity.