Medical Education

The recent COVID-19 epidemic has put a lot of strain on the already tottering healthcare system in India. This, along with other challenges in achieving Sustainable Development Goals (SDGs), need the healthcare systems to be strengthened.

Healthcare workforce

One of the critical building blocks of the health system is human resources. Health workers are critical not just for the functioning of health systems but also for the preparedness of health systems in preventing, detecting and responding to threats posed by diseases and epidemics such as COVID-19.

A 2019 report by US based Center for Disease Dynamics, Economics & Policy (CDDEP) found out that

• India has a shortage of an estimated 600,000 doctors and 2 million nurses. There is one government doctor for every 10,189 people (the World Health Organisation (WHO) recommends a ratio of 1:1,000).

The workforce crisis has been aggravated by the imbalances within the country.

• Spatial Imbalances- the doctor-population ratio in northern States is far short of the required norm, while the southern States, barring Telangana, have enough doctors in possession.
• Rural-Urban Divide– across the nation there is a general lack of adequate staffing in rural areas.

To plug in this gap, certain proposals like the recent one such as the NITI Aayog’s proposal of allowing private entities to take over district hospitals for converting them into teaching hospitals with at least 150 MBBS seats might look promising in the short term but there are shortcomings with it as well.

Is the Market oriented approach towards medical education suitable to solve the workforce crisis?

In order to meet the significant shortfall of qualified doctors in northern States, scaling up of medical education is warranted.

However, solely relying on the private sector to fill in the critical workforce gap will not only aid to corporatize healthcare but also undermine the established public healthcare system.

• District hospitals are considered as the last resort for the poor. However corporatization will make the health services very costly and exclude them from getting care.
• Even from the perspective of producing more doctors to meet the shortages in under-served areas, this is unlikely to yield the desired result. Private players treat medical education as a business. Thus, it would shut the door on a large number of medical aspirants who would otherwise have a strong motivation to work in rural areas but do not have the means to finance themselves.
• Additionally, the medical graduates trained in such private sector ‘managed’ medical colleges will prefer to find employment in corporate hospitals and not in rural areas to regain their investment.
• Further, this approach is not aligned with India’s national health policy goals like achieving universal health care and health equity. Instead, it will widen health inequalities further.

Therefore an unfettered market approach or a regulated market with medical colleges that are publicly funded but privately operated, providing competition for traditional government medical colleges, is not the answer to the healthcare workforce crisis.

Way Forward

• Medical education is a public good as its purpose is to improve the population health and decrease disease burden.
• There should be a substantial increase in public investment in medical education.
• By establishing new medical colleges, the government can increase student intake as well as enhance equitable access to medical education.
• Also there must be allocation of adequate financial resources to strengthen the overall capacity of existing medical colleges to enrich student learning and improve output.

Dialing Mains:

Question: Healthcare workforce shortage can be fulfilled by maintaining a fine balance between private and public medical education. Comment . (120 words, 8 marks)