India's Hippocratic Growth
Roopen Roy (Views are personal)
It does not require great knowledge, intelligence or analysis to predict that we are heading towards a crisis in healthcare. Despite the many innovations in the fields of telemedicine and robotics, the requirement for human interaction remains. The demand for doctors, nurses and paramedics continue to surge. Part of the reason, of course, is the increase in life-expectancy and consequent greying of the world population. Even in “young” countries like India, the ageing population, in absolute numbers, is sizeable and rising.
By its very nature, health care delivery will remain intensely high touch , even while it embraces hi-tech. If a patient needs a cardiac bypass surgery, there is little likelihood that he or she will consent to a robot performing the operation.
Much has been written about the potential of India as a global hub of health tourism. It will be years before India becomes a magnet for Western patients. There are several reasons. The problem with the tourism industry in India is not the lack of beautiful locations. The hurdles are bad infrastructure and lack of trained manpower. The healthcare industry is not plagued by a lack of demand. The familiar challenges are poor infrastructure, inefficient hospital management and shortage of trained manpower which includes doctors and surgeons.
The healthcare industry on its own cannot solve India’s infrastructure problems. It will take time as we continue to invest. But we can make planned investments to scale up our trained manpower availability. Most countries with the will and access to capital can create first class infrastructure. But all countries cannot create a large pool of doctors, surgeons, nurses and paramedics. India can.
Few countries have India’s capability of scaling. The availability of trained manpower and the potential for good quality soft infrastructure will be the differentiator that will propel India ahead.
Unfortunately, we are under-investing in this critical area. Last year on a trip to Kunming in China, I sat next to a young Indian student from Bihar.He was studying medicine in China. He informed me that there are hundreds of Indian students like him studying in China. He added that the medical colleges in China do not fleece the students with “capitation fees” and other “under the table” charges that some private colleges in India are notorious for. He said many of the medical students, after qualifying as doctors find jobs in China and other countries. He was planning to marry his Chinese classmate and stay back.
On returning to India, I looked at the official website of the Medical Council of India (MCI). Their Notification reads as follows , “The Department of Education of Peoples Republic of China has institutionalized the enrolment plan for 2012-2013 which include 50 colleges/universities teaching in English medium. Further they have enclosed a list of 50 Colleges/Universities and other related information can be downloaded from their website i.e. www.studyinchina.edu.cn .”
Honestly I did not know that as many as 50 medical colleges are offering a total of 5030 MBBS seats in the English medium in China. China is not only making idols of Hindu gods and goddesses for sale in India, they are playing a big role in the medical college business.The MCI also recognizes 400 plus medical colleges in Armenia, Bangladesh, Belarus, Czech Republic, Iran, Kazakhstan, Nigeria, Pakistan, Philippines, Poland, Romania, Russia, UAE, Ukraine, Uzbekistan and Yemen.
Just for context, as of end of 2011, India had a total number of 335 medical colleges offering 40,335 seats. The largest number of seats are in Karnataka (5625), Andhra Pradesh (4850), Tamil Nadu (4815) and Maharashtra (4860). The “laggards” are Bihar, Assam, Orissa and Haryana with less than 1000 seats each.
In order to produce more doctors, some fundamental reforms are required. It is well-known that the Medical Council of India keeps an iron grip over medical education. There have been persistent and widespread allegations of corruption in allowing new medical colleges to open in the private sector and even for letting the existing ones continue in business. This licence-permit raj is coming in the way of quality medical education and expansion.
I would suggest four measures to accelerate the growth in the capacity of MBBS seats in India. First, the stranglehold of MCI has to be broken and an independent body with representation from the civil society, members of the retired judiciary, NGOs, eminent medical practitioners, insurance companies and government should regulate, but not control, the medical colleges based on transparent rules. Second, the geographic imbalance should be removed. Today there is one MBBS seat per 160,000 people in Bihar compared with 10,000 people in Karnataka! Those states which do not have teaching medical colleges should receive more investments from the central government and more incentives for the private sector to open new medical colleges. Third, India should open up to foreign investments in medical education. Is it not preferable to have a medical college in India in collaboration with Johns Hopkins than to send Indian students to study medicine in Chengdu College of Medicine in China or the Akmola Medical Institute in Kazakhstan? And lastly, there is a need to scale up the capacity quickly and the state must move in with fresh and substantial investments.
Without addressing the supply side of doctors, a universal health care strategy will fail. The World Health Organization (WHO) estimates a shortage of 4.3 million physicians, nurses and other health workers worldwide. India is in a great position to bridge a large part of this gap if it executes the right policies without delay.