World Health Day: Indian tale of unfulfilled goals

India short of five lakh doctors and the situation is worse than Vietnam

By Mehak Aggarwal
Published: Sunday 07 April 2019
File photo of a crowded outpatient department in Ram Manohar Lohia hospital in New Delhi. Photo: Meeta Ahlawat__

Year after year, World Health Day is celebrated on April 7 to mark the anniversary of the founding of World Health Organization (WHO) in 1948. Each year a different theme is selected that highlights a priority area of public health.

The goal of the 70th annual World Health Day is to further the fight for universal healthcare. According to WHO, half the world is lacking healthcare and the goal is a world where everyone has access to healthcare services without having to worry about going into debt paying for them.

But where does India stand?

India's Ministry of Health was established in 1947. The government has made health a priority in its series of five-year plans, each of which determines state spending priorities for the coming five years. The National Health Policy was endorsed by Parliament in 1983. The policy aimed at universal health care coverage with the motto ‘Health for all by 2000’.

Health here was defined as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. The goal of health for all meant ensuring availability of one doctor for every 1,000 patients by 2000. Even after a passage of 18 more years after the set date, India has approximately one doctor for every 2,000 patents. Respective governments have been ignoring this aspect and have not cared to bother for more qualified doctors and retaining the talent by creating good and safe conditions.

Instead of improving the public health sector, governments have been trying every now and then to put the responsibility of public health on the shoulders of doctors in the private sector. For these reasons exodus of doctors is further deepening the crisis. Illegal capitation fees in private medical colleges, a health services inequality between urban and rural India and a disconnect between public health and medical education systems were among the issues a committee investigated while probing the Medical Council of India, the 84-year-old organisation responsible for medical education standards.

Instead of improving the working of the council, the government has come up with a National Medical Commission which may further increase the cost of medical education and make it unaffordable for a common man. India is short of at least five lakh doctors and the gap may widen in days to come if the government doesn’t give health a priority.

Leaving aside human resources, healthcare in India is even starving of basic facilities. India is prone to a health management failure. The depth of this fact can be measured only if we go through with the following examples.

In Odisha, a man carried his wife’s body over his shoulder for 10 kilometres after being denied an ambulance. In Kanpur, a man’s sick son died on his shoulder after being denied admission to a hospital. Such cases become visible when they get social media and television attention, but millions cannot access India’s overburdened hospitals and inadequate medical facilities, a crisis illustrated by the fact that India is short of nearly 500,000 doctors compared to a WHO norm of 1:1,000 population, according to an analysis of government data.

The WHO’s 2000 World Health Report ranks India’s health care system at 112 out of 190 countries. A new initiative from the Indian government to open up All India Institutes of Medical Sciences (AIIMS) in every city would further potentiate the wide gap between rural and urban India. A staggering 70 per cent of the rural population has minimal access to health care services, which are miles away from their home town. For primary healthcare, the Indian government spends only about 30 per cent of the country’s total healthcare budget which seems to be a penny in comparison to health care delivery in the US and the UK.

AIIMS should be considered as a tertiary centre and more often it houses high profile individuals who feel they are safe under the hands of skilled clinicians. Primary health centres should emerge in every nook and corner of rural areas, well equipped financially with adequate infrastructure and dedicated doctors.

What can be done?

Instead of mere slogans, India needs a revamp of health planning. Instead of compromising on quality of healthcare by coming up with novel concepts of National Medical Commission, we need to add to infrastructure of our medical colleges to add more seats for MBBS and post-graduation. 

Low availability of government doctors in India is due to less recruitment drive in the public sector, lack of infrastructure, lack of availability of essential medical equipment and medicines, and low salary in government hospitals. There is also a shortage of patient beds, nurses and allied manpower in existing government hospitals. Government hospitals with a single working doctor are also found in rural areas. Because of low infrastructure and facility, government doctors frequently face the ire and anger of patients and patients’ relatives despite attempting their best. Until and unless good infrastructure and adequate facilities are available in government hospitals, the situation of scarcity of doctors is unlikely to improve.

The government, in addition to increasing the number of medical colleges and government hospitals across the country, should also notice the huge gap in numbers of available undergraduate and postgraduate seats in existing medical colleges. Lack of specialists should be specifically addressed. If all the above issues are adequately addressed, the ratio of government doctors and patients will surely get better.

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