Prime responsibility for healthcare

Arun Mitra

India produces nearly 50,000 MBBS doctors every year in its 479 medical colleges. There are about 9.3 lakh doctors registered with the Medical Council of India. Out of this, doctors engaged in active professional work are presumed to be numbering about 8 lakh only. With this number we are not able to meet the challenge of doctor patient ratio, which is much less than what is required as per WHO guidelines. WHO recommends one doctor per 1,000 persons whereas we have one doctor for 1,650 persons. Considering the population distribution in the country, we find that there is huge urban rural gap in this ratio as the number of doctors serving in rural areas is much less proportionately. So we need more doctors. It is in this context that we must review the scenario of medical education in or country.
Medical education is not only tough but versatile because the students are prepared to treat the sick and more so to prevent disease. The subject of preventive and social medicine is taught for the longest period in the medical curriculum. In fact, a mindset is developed in the students that their primary duty is to prevent disease from occurring and cure only if needed. Students are also trained to have sympathy and empathy towards the sick, irrespective of their economic status, caste, creed, religion, beliefs or gender. Medical students are thus trained to fully integrate in the society and to assimilate in the existing socio-economic structure. But this in itself requires the type of environment and system in the system so that when the young doctors come in the field they have the type of attitude they are expected to behold by the society, which has much expectations from them. But ironically, the situation has deteriorated continuously and we find lack of such atmosphere in the educational institutions. The medical colleges, which should have been only the centre of knowledge, have now become centres of business.
Before Independence there were only 20 medical colleges in India, 19 in the government sector and only one in the private sector. After Independence, the scenario started changing and 7 more colleges were opened in the state sector by the end of 1950. For nearly three decades to come, more colleges opened in the government sector only. By the end of 1980, our country had only 13 medical colleges in the non-government sector, while there were 99 colleges in the government sector. After 1980 we see a shift in the situation: that is, more colleges started coming up in the private sector. In the last two decades, from 2000 till now, there have opened only 96 colleges in the government sector while the number in private sector is 182; that is almost double of the state sector. In the last three years of the present government, 58 colleges have come up in the non-government sector with only 36 in the government sector. (Source: MCI website)
These private colleges charge exorbitant tuition fees. Till two years ago, there has been open trading of seats in these colleges, with underhand money transactions putting seats on sale. This prevented meritorious students from getting into medical colleges. After NEET, since it became difficult to get underhand money, these colleges further increased tuition fees. So opening a medical college has become a lucrative business. That is why many corporates have joined powerful politicians and are openly flouting the rules for running these colleges.
A large number of these colleges do not fulfill norms laid down by the Medical Council of India. It is a common practice in these colleges to hire dummy patients at the time of inspection by the MCI. Though sometimes the MCI conducts surprise inspections, these colleges have their own resources to get prior information even about the secret inspections. They also manage dummy faculty -- ghost faculty -- who get salaries but hardly come for teaching. Concerned about the low standards of education in many medical colleges, the government, instead of improving them, has opted to hold exit exams for the students thus putting more burden on them, which is no answer to the problem. Ironically, when the Punjab Medical Council took certain decisions to check the practice of ghost faculty, it was met with strong resistance from none other than the Medical Education Minister of the state to scuttle the process.
This paradigm shift took place since 1980s and the process became fast after changes in the economic policies, where the government decided to be facilitator and not provider of education and health. This needs to be reversed and the government must become a provider if there has to be inclusive healthcare for all citizens. It would be naïve to expect from a student who has spent crores in getting medical education to have a service attitude in providing healthcare. (IPA)

Tuesday, 5 December, 2017