How many doctors it takes to fix India's healthcare glitches?

The 2006 WHO World Report, which focussed on the state of the health workforce, noted that to achieve the standard 80 per cent healthcare coverage, a country must have no less than 2.5 health workers for every 1,000 people. India currently has about 0.57 physicians and 0.6 nurses for every 1,000 persons.

This constitutes a critical shortage of human resources for health, and is significantly below the WHO standard.

India’s mandate for Universal Health depends, to a great extent, on adequate and effective Human Resources for Health (HRH) providing care at primary, secondary and tertiary levels in both the public and private sectors.

India’s current health scenario faces challenges posed by demographic and epidemiological transitions, evolving socio-cultural contexts, overlapping behavioural risks and new infections compounded with the threat of antibiotic resistance. States are presently struggling with the complexities of escalating human resource costs, additional demands on the available health work force compounded by chronic HRH shortages, uneven distribution, skill-mix imbalances etc.

So, is the addition of 10,000 MBBS seats a good decision? No points for guessing the answer to that question. However, in addition to the worry is that it is only a drop in the ocean of medical provider capacity that India needs, it is only one aspect of the many systemic changes that need to be put in place to ensure equitable, affordable, accessible healthcare.

But the doctor alone is not enough….and cannot and should not be expected to be the panacea for all ills. Effective delivery of healthcare services depends largely on the nature of education, training and appropriate orientation towards community health of all categories of medical and health personnel, and their capacity to function as integrated teams.

 For instance in the UK, more than 84,000 allied health professionals (AHPs) with a range of skills and expertise, play key roles within the national health service, working autonomously, in multi-professional teams in various settings.

Though some of them may have a PhD and use the title ‘Dr’ (for example, psychologists), they are not medically qualified. All of them are first-contact practitioners and work across a wide range of locations and sectors within acute, primary and community care.
Australia’s health system is managed not just by their doctors and nurses, but also by the 90,000 university-trained, autonomous AHPs vital to the system.

Similarly, while the addition of 58 new medical colleges is again a very welcome step towards medical capacity building, it is imperative to evaluate the distribution of healthcare institutions; providers and hospitals across India with particular focus on those districts that do not have any medical colleges in order to appropriately address issues of equity, accessibility and affordability.

We not only need a quantitative increase in trained manpower but also improved effectiveness of existing methods in training. The availability of educational resources such as libraries, simulation centres and modern information technology tools at various centres is also variable across the country and needs to be evaluated. While established centres managed by large medical institutions offer a reasonable level of facilities, the educational resources are abysmal in stand-alone centres or smaller set-ups. 

Thus, the consideration and allocation of adequate and commensurate resource allocation for existing medical and other healthcare institutions is paramount.

No matter what type of healthcare providers are being trained, centres of excellence and globally recognised institutions should be identified along with hospitals with known good practices, which may become possible training sites. Those institutions willing to conduct courses or to become training sites should be incentivised by the government. Private partners can play a key role in capacity building and training through PPP modes to better utilise the infrastructure of government hospitals.  The government can encourage private sector interest through initiatives such as provision of tax incentives, and permits to corporates to undertake healthcare for optimised use of resources.

All bottlenecks that may be related to regulatory or financial issues that prevent institutions and hospitals from serving as clinical sites for training should be identified and efforts should be made to minimise them.  Solutions should be found for interactions between educationists and potential employers to assess the availability of clinical sites.
It will take more than 10,000 MBBS doctors to change our healthcare light bulbs.

It will take active steps to correct the current situation where lesser trained health workers severely outnumber mid- to higher-level skilled health providers in both rural and urban areas, compromising the integrity of the overall quality of services provided. It will require us to take an honest analytical view of the insufficient investment in pre-service training, work overload, undefined roles, inadequate growth opportunities and limited human resources to provide advanced training opportunities. It will require us to prioritise health manpower issues before we run off inaugurating the next new building or institution.But, there has been no better time to do all of this than now. Welcome doctors of 2019!

(The writer is Head for Hospital Services at the Public health Foundation of India)

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