Result of medical education and health care being profit oriented
Lack of adequate number of trained doctors and nurses is proving to be one of the biggest handicaps in treating increasing number of Covid affected patients in the country. This is the result of failing to create the required number of medical colleges and nursing schools to train sufficient numbers of doctors and nurses required for a country of our size. The policy of privatisation of medical education that has been followed by successive governments over the last three decades has worsened the situation. The state’s refusal to spend on setting up more and more public hospitals and medical colleges is turning out to be a criminal neglect, leading to hundreds of avoidable deaths.
The severe paucity of doctors and nurses is illustrated by the example of a dedicated facility created last month near Mumbai. A thousand bed Covid treatment hospital was set up and inaugurated with a lot of publicity. However, even after a few of weeks of its inauguration, the hospital could use only 10 percent of beds as it did not have doctors and nurses for rest of the beds. Similar reports of shortage of doctors and nurses have come from all over the country. A 200 bed Covid hospital needs at least 50-75 specialist doctors and 500 nurses.
India has been acutely short of medical personnel for a long time. To meet WHO norms, the country needs 4 lakh more doctors and at least 10 lakh more nurses. At present India produces only around 50,000 doctors and 2 lakh nurse every year. It requires 6 to 8 years to train a graduate doctor and another 3-4 years to prepare a post-graduate doctor. The shortage is shocking when so many educated youth in the country are looking for suitable job opportunities. What is equally shocking is that there are vacancies in posts of doctors waiting to be filled up since 4-5 years. Such is the case, for example, in Delhi’s University College of Medical Sciences (UCMS) and Guru Tegh Bahadur (GTB). Unless immediate steps are taken by the State, the shortage will only get worse.
The shortage is much worse in rural India since over 60 percent of doctors and hospitals are in urban India where only 30 percent of population resides. Half the doctors of the country are concentrated in just five states – Maharashtra, Tamil Nadu, Karnataka, Andhra Pradesh and Uttar Pradesh. The states with the largest rural populations such as Bihar and Uttar Pradesh have the lowest per capita hospital bed or doctor availability.
The Indian state has refused to accept that it is its responsibility to ensure that all the people of our country have access to a modern universal health care system. Privatisation of medical education has been pushed along with that of healthcare. Today half the medical colleges in the country are private. The fees vary from college to college and are exorbitant. In many private colleges, students are paying Rs 25 lakh rupees per year. The fees for post-graduate medical education in private colleges can go up to 3 crore rupees! After spending such large amounts on their education, such students have to first worry about returning the loans taken for this purpose. As this is not possible in rural areas and small cities, majority of them are forced to carry out their profession in large cities and in private hospitals, leading to acute shortage of doctors in rural India and in public hospitals.
Private hospitals are not interested in investing in creation of the infrastructure which will make their hospitals suitable for medical education. Hardly any new state-owned hospitals are being set up in the country. In these circumstances, Niti Aayog is pushing for private medical colleges by proposing the scheme of setting up medical colleges in PPP mode with government district hospitals, thereby proposing privatisation of government district hospitals, too!
The current healthcare policy of private hospitals and medical education cannot solve the chronic shortage of health infrastructure and personnel in the country. The consequences of the historical neglect of the healthcare and its privatisation are most visible in the present time of a pandemic. We have to demand that the State must take the responsibility of the health of people, invest sufficient amount and not leave it to the profit driven private sector.