A few weeks ago, a tragic incident happened at an unregistered nursing facility in Uttar Pradesh. A 30-year-old quack, who was a class 8 dropout, conducted a C-section surgery on a pregnant woman using a razor blade. As a result, both the mother and her baby died. The accused was arrested after the victim’s husband lodged a complaint. There are several such cases reported on a daily basis in India which shows that a large population of the country is in the clutches of quacks.
According to Section 15 of the Indian Medical Council Act, 1956, a person other than a medical practitioner enrolled on a State Medical Register practising medicine is punishable with imprisonment and a fine.
The data released by the Union Health Ministry in 2019 said that 57.3% of personnel practising allopathic medicine in the country do not have a medical qualification putting patients at risk. Also, India’s doctor-population ratio is 1:1456 as compared with the World Health Organisation standards of 1:1000. “There are also 7.63 lakh Ayurveda, Unani and Homeopathy (AUH) doctors in the country. Assuming 80% availability, it is estimated that around 6.1 lakh AUH doctors may be actually available for service, and considered together with allopathic doctors, we have a doctor-population ratio of 1:884, which is still low,” the Ministry added. According to government records, a total of 11,46,044 allopathic doctors were registered with the State Medical Councils/ Medical Council of India as of December 31, 2018.
Skewed urban to rural doctor density ratio
A majority of the rural population in India is dependent on the quacks as there is a huge skew in the distribution of doctors working in the Urban and Rural areas with the urban to rural doctor density ratio being 3.8:1. The people in rural areas reach out to quacks as they are easily available for minor ailments and injuries.
Overburdened specialists and need for mid-level providers
The Health Ministry plans to bring in mid-level healthcare providers to relieve overburdened specialists. A large proportion of the patients visiting research institutions like AIIMS and PGI can be managed in tertiary care institutions like medical colleges if they are enabled to do so. Similarly, some proportion of patients visiting medical colleges can be managed in the District Hospitals, and people visiting district hospitals can be managed by Community Health Centres, Primary Health Centres and so on.
The ambitious Ayushman Bharat initiative announced by the Government of India in this year’s Budget Speech needs 1,50,000 mid-level providers within the next 3-5 years to provide comprehensive primary and preventive care. It will take 7-8 years to ramp up the supply of doctors, therefore, in the interim we have no option but to rely upon a cadre of specially trained mid-level providers who can lead the Health and Wellness Centres.
The Health Minister has earlier said, “Countries such as Thailand, United Kingdom, China and even [a city like] New York have permitted community health workers/ nurse practitioners into mainstream health services, with improved health outcomes. Since we have a shortage of doctors and specialists, this is vital.” Highlighting the importance and scope of community health workers, he further said that Chhattisgarh and Assam have experimented with community health workers and that according to independent evaluations carried out by the Harvard School of Public Health, they have performed very well.
Role of telemedicine in reducing quacks
Non-metros, including villages, registered 750% growth in telemedicine, according to a report compiled by healthcare app Practo and not-for-profit Telemedicine Society of India on the growth of telemedicine in India in 2020. The patients who had no option other than consulting the quacks took the help of technology and consulted registered/verified doctors through video/audio channels. “The prevalence of unqualified medical practitioners, especially in the rural setting, is very high and a digital healthcare policy has the potential to eradicate quackery and provide awareness and accessibility to qualified specialist doctors to rural Indians,” the report added.
Identifying registered/verified medical practitioners
Indian Medical register: Indian regulatory body National Medical Commission, which regulates medical education and medical professionals, has a database of all the Registered Doctors with the various State Medical Councils across India. The database can be accessed on its website. One can search the database for Registered Doctors by entering the Name, Qualification, Registration Year, Registration No and Registered Council. The NMC also has a list of blacklisted doctors, which can help people in identifying the registered and unregistered medical practitioners.
Social profiles and peer groups: In this era of social networking, social profiles play a vital role in segregating real from fake profiles. There are some open forums where people pen down their experiences and get quick responses from others who have had similar experiences. Similarly, peers of healthcare professionals can serve as a point of contact in cases where verification of profiles are vital.
Employers: The employers of healthcare care professionals including hospitals, nursing homes, clinics and labs, generally conduct KYC when they offer them work based on their qualification. The data collected by the employers can help in bringing transparency.
Startups having databases of verified doctors: There are some startups that are working to make the lives of patients, hospitals and telemedicine platforms easier. They deploy the latest technologies to verify doctors and make everything transparent. Bengaluru-based MedPiper Technologies, Inc, which has a professional network for pre-verified and peer-authenticated professionals and practitioners offers a solution in the sector. The platform uses blockchain technology to enable the verification of profile credentials by peers, educators and employers, and match those verified profiles to job requirements. The platform helps medical professionals like doctors and nurses explore the available opportunities and act as a bridge between them and hospitals or telemedicine platforms.
Several research studies have highlighted the acute shortage of the health workforce in India. States like Kerala and Tamil Nadu having high health workforce population ratio also have high population health outcomes. The country can meet its healthcare goals only if it has a high density of qualified active health workforce. The country has to invest big in the sector and create a conducive environment to encourage HCPs to form a workforce that is qualified enough to deliver the required healthcare services.