India’s healthcare system is not just broken, it has a hard-to-fix open compound fracture. Repeatedly rocked by medical malpractice – kidney donation rackets, sterilisation deaths and blindings in cataract camps to name a few – the system is severely compromised by the abysmal number of qualified doctors, nurses and other health practitioners.
Data from India’s census in 2001 has been sliced and diced many times over in the analysis of the country’s healthcare workforce. The World Health Organisation’s recent report that is yet another analysis of this data reiterates that we have just too few doctors for our ever-growing population and less than half have the right qualifications to treat patients.
The World Health Organisation recommends that there should be at least one doctor for every 1,000 people, that’s at least 100 doctors for every one lakh of population. India falls far short of that requirement having only about 60 allopathic doctors for every set of one lakh people.
With only one allopathic doctor in a rural area for every four practicing in an urban centre, the number of doctors for every lakh of population in rural areas falls to just 33. These numbers hold true even for nurses and midwives practicing in rural regions. To meet global healthcare standards, the number of ratio of nurses to doctors should be at least 2:1. The ideal for cost-effective quality healthcare is to have four nurses for every practicing doctor.
A previous analysis of India’s health workforce conducted in 2013 for the WHO revealed that between 2000 and 2009, the numbers of doctors and nurses and midwives inched marginally higher.
The new report also shows that a majority – a whopping 57% - of allopathic doctors does not have requisite medical qualification. Even among practitioners of alternative medicine, less than half have medical degrees.
Among allopathic doctors serving rural India, only about 19% have medical degrees.
Could things have improved in the last 15 years since this data was collected? The one big change in India’s medical system is the growth of educational institutions in the country, particularly private medical and nursing colleges.
The 2013 study finds that between 1991 and 2013, the number of admissions to medical colleges more than doubled from 22 438 to 49 508 and rose 668% from 3100 to 23 800.
The number of general nursing and midwifery institutes increased from 659 in 1997 to 2,487 in 2012. From 485 in 1997, auxiliary nurse midwifery institutes grew to 1,307 in 2012. There were nine times as many recognized nursing institutes offering the bachelors degrees in nursing in 2012 as there were in 2004.
But the quality of medical education at many of these institutions is highly questionable. A Reuters investigation into medical schools in June this year revealed all sorts of unethical practices, from hiring fake patients to fill hospital beds to paying private doctors to pose as full-time faculty members at the time of inpection of government authorities. According to the report, since 2010 at least 69 medical colleges have been hauled up for wrongdoings including rigging entrance examinations and accepting bribes for admissions.
Even with it’s own healthcare crisis, India continues to be one of the main contributors to the global healthcare workforce sending the most number of doctors and nurses abroad.