Country faces dearth of quality docs, MCI at fault

The 92nd report of the Parliamentary Standing Committee on Health and Family Welfare is an unusual one.

The 30-odd lawmakers from different political parties did not scrutinise a proposed law or review new policies of the NDA government. They decided suo motu to examine the functioning of the Medical Council of India (MCI), which controls the cash-rich medical education sector, despite being accused of corruption several times in the past.

The previous UPA government made an effort to clean up the Augean Stables, but another set of parliamentarians representing the same panel, had outrightly rejected the government’s proposal to replace the MCI with another body – National Council for Human Resources on Health (NCHRH).

Why is the regulator at fault? The Council was set up in 1934 with 2 broad objectives – to keep high standards of undergraduate and post-graduate medical education, which would lead to production of a large number of top quality doctors, and maintaining a national register of doctors. After almost 90 years, it is clear the MCI failed on both the fronts.

Despite having the most number of medical colleges in the world, and about 9.29 lakh doctors enrolled in the Indian Medical Register, India is much behind in achieving the targeted doctor-population ratio of 1:1000 as per WHO norms. The quality of a large number of doctors is also a suspect.

Assuming 80% availability of the doctors listed in the register, it is estimated that around 7.4 lakh doctors may be actually available for service, leading to a doctor-population ratio of 1:1,674. This data, however, is questionable as the IMR is not a live register and there is no way to find out if everyone on the list is available. The actual doctor-population ratio is suspected to be well above 1:2,000 mark.

Every year around 55,000 MBBS and 25,000 MD doctors graduate from various colleges. At this rate of growth, India should have a doctor-population ratio of 1:1,250 for a population of 133 crore by 2020 and 1:1,075 by 2022 (population: 136 core). The numbers, however, don’t suggest anything on the quality of the MBBS graduates.

Deposing before lawmakers, several experts noted that many MBBS doctors are of such poor quality that they can't even do basic things like plastering bones or suturing a wound. Many opt for MD/MCH for acquiring the skill, but since only 50% undergraduate students can go for post-graduation in India, a large number of MBBS graduates pass out as poorly qualified doctors. Many of them are not even confident to start their profession as doctors.

“Since the quality of education imparted at many institutions is questionable, one foreign expert publicly asked the authorities in the US, UK, Australia and Canada to debar Indian medical doctors from being employed in their countries,” commented former health secretary Sujatha Rao, in her letter to Prime Minister Narendra Modi. Several other former health secretaries and prominent doctors too signed the letter urging the prime minister to take immediate corrective steps to improve the standard of medical education. A high-powered committee has been set up to chalk out the roadmap.

Besides MBBS doctors, there is acute shortage of the number of specialists and super-specialists. Official data demonstrates that as on March 2015, out of the sanctioned posts of government doctors, 74.6% posts of surgeons; 65.4% posts of obstetricians and gynaecologists; 68.1% posts of physicians and 62.8% posts of paediatricians were vacant.

Overall, 67.6% of the sanctioned posts of specialists at the community health centres were vacant, compelling the common man to seek care from more expensive private healthcare sector. As many as 63 million people are faced with poverty every year due to healthcare costs alone, an indication that healthcare is moving away from the reach of the people in general and the poor in particular.

Life expectancy

The disease burden has not reduced though there are improvements on life expectancy and communicable and infectious diseases. While communicable diseases like TB and malaria have not been eliminated, there is an increasing burden of non-communicable diseases like cancer, cardiovascular disease, stroke and diabetes.

As per the Report of the Working Group on Tertiary Care Institutions for the 12th Five Year Plan, the rates of infant and maternal deaths still remain high. According to the report, nearly 1 million Indians die every year due to inadequate healthcare facilities, 700 million people have no access to specialist care and 80% of specialists are working in urban areas.

An estimate presented before the MPs suggests that if 100 medical colleges are added every year for the next 5 years, then by 2029, India will have adequate number of doctors. But not only is the distribution of medical colleges disproportional, the terms and conditions to set up new medical colleges are unrealistic.

The uneven distribution of medical colleges is evident from the fact that 6 states representing 31% of India’s population have 58% of the MBBS seats; while 8 states which comprise 46% of India’s population have 21% of MBBS seats. The House committee also blamed the government for overlooking the problem.

With most of the graduates failing to go back to their home district or state, mere increase in the number of MBBS seats would not address the skew. It requires out of the box thinking on part of the government and the MCI to increase the number of medical colleges, arrange for the faculty and maintain the quality.

Probably, the biggest gain for the health ministry is restoration of lawmakers’ faith. Last time, when the NCHRH bill was debated, MPs made it clear that the ministry had no business in the MCI.

Four years down the line, the opinion has changed – MPs now say the government is the most important player in the healthcare sector and it can interfere in policy matter. It remains to be seen if the government can now justify that faith.