A doctor needs time to fully assess the condition of the patient, make the correct diagnosis, suggest a suitable treatment and follow up with the patient to assess improvements. However Indian doctors are not able to do so. Here are my observations on why that is the case.
Low Doctor Patient Ratio
The World Health Organization recommends that there be 1000 patients per doctor. India stands at 1700 patients per doctor (as per 2012).
India ranks 67th in the World in the Doctor-Patient Ratio, right behind Iraq and Pakistan. Here’s a Senior Political Commentator of Pakistan, sharing his views about this problem.[youtube https://www.youtube.com/watch?v=TPKA6Gi3D0M]
- India needs 2.4 million nurses.
- The current nurse-to-people ratio is one nurse for 1,100 people, while the World Health Organisation recommended ratio is one nurse per 500 people.
- While the international nurse to doctor ratio is 3:1, India’s nurse to doctor count stands at 1.5:1.
The Data Accuracy Problem
Around 27% of India’s registered doctors and almost 63% nurses aren’t active anymore. According to joint secretary in the ministry Dr Vishwas Mehta’s presentation, the Medical Council of India (MCI) has 7.5 lakh doctors registered under it.
However, Union health ministry’s scrutiny has found that two lakh of the registered doctors aren’t working anymore. Of the 10.7 lakh nurses registered, six lakh don’t exist.
The lack of updated quality Public Data, which helps to critique progress of health issues in India, is a serious problem.
Skewed distribution of medical colleges.
45% of medical colleges are located in South India (47% MBBS seats), North India has 17% of medical colleges (16% of the MBBS seats), Western India accounts for 21% of medical colleges (22% MBBS seats).
In comparison, central India has 5% of medical colleges (5% MBBS seats), East has 10% of colleges (9% MBBS seats). Northeastern states are most neglected. It has only 3% of medical colleges (3% MBBS seats).
To give you an overall perspective, as of 2014, India had 676 Administrative Districts, out of which only 193 have Medical Colleges.
Medical Seats v/s Required Doctors
India produces 30,000 doctors, 18,000 specialists, 30,000 AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000 pharmacists annually. However, there are only 52,300 MBBS Seats in Public and Private Colleges.
Clearly, India’s Doctor Patient deficit will not be met anytime soon. According to Union health ministry data, the target by 2025 is 0.8 per 1,000. After detailed inputs from various working groups, the MCI came to a consensus that the targeted doctor-population ratio of 1: 1000 would be achievable by the year 2031.
In the quest of matching doctor patient ratio, we should not compromise on the quality of education of the doctors, at any cost.
However, there is an opportunity here. Only 0.6% of the 6.3 Lakh students, who take the All India Pre-Medical Entrance Test, get to crack it. That’s an unbelievably high-stakes game, for a mind boggling 99.4% fail to crack the exam.
The students who have not been able to get through the exams, should be offered an opportunity to pursue a career in the Health Industry as technicians, research fellows, and academic scholars. There needs to be a middle ground developed in the currently “all or nothing” test system.
The ratio of postgraduate medical teacher to the student has been relaxed from 1:1 to 1:2 which will result in availability of more medical specialists.
Women Education & Care
The number of female allopathic doctors (medical graduates with a bachelor’s or postgraduate specialist diploma or degree registered with the Indian Medical Council) is abysmally low.
Only 17% of all allopathic doctors and 6% of allopathic doctors in rural areas are women. There is less than one female allopathic doctor per 10,000 population in rural areas (0.5), whereas it is 6.5 in urban areas. Now, nearly two-thirds or 66% of all health workers are men.
This affects the health of women in the country severely due to most women’s preference of a female Gynecologist.
India’s health is in ICU thanks to a massive gap in the availability of skilled health personnel. The lack of skilled service providers in India is the biggest constraint in providing universal health care.
However, this is not a problem only faced by India. Health workers are distributed unevenly across the globe. The African Region suffers more than 24% of the global burden of disease but has access to only 3% of health workers and less than 1% of the world’s financial resources.
In conclusion, I feel these 5 problems, if handled in a careful, quick and robust way can help doctors dedicate more time with a patient and provide a thoughtful treatment per patient – leading to better treatment, quick recovery, and a healthier nation.