Wednesday, August 25, 2010

The need for qualified doctors - Chap 5 from Dr Nadkarni's book

When we plan to improve our present health-care-system, we will have to look at each and every aspect of this system and think of improvement in every one of them. The discussion about how to improve the system becomes all the more important because our political leadership is far too ignorant about the administrative or organizational aspects involved in improving the present system. They work as if they are feudal lords and offer special benefits to those who approach them with their grievance-right or wrong. They are, in general, incapable of looking at the problems of the people as system failure. Yet I would like to remain optimistic and try to suggest long term remedies in the coming chapters that may go a long way to improve the health–care-system in the country.

So let us look at each fact of the health–care system in details. First let us give a thought to medical education. At the time of independence we had about 105 medical colleges churning out about 10,000 doctors every year. The need for the Health Care Professionals and the required organizational set up for the country was discussed in great detail by Bhore committee and Mudliar Committee. In fact, the pattern of primary health centre is based on the recommendations of the above committees. The committees recommended that there should be at least one doctor per 3000 population. This proportion was too low and it is now believed that the country needs one doctor per 1000 population. In bigger cities and wherever the specialization has advanced very much, the proportion of the doctors should be even higher-may be about 1 per 500 population But considering the need of one doctor per 1000 population India with population of 100 crores will need 10 lacs doctors. A doctor is supposed to practise for 35 to 40 years from the age of 25 to 60/65 which means 25000 to 30,000 doctors must come out every year from the various medical colleges. As there was such a great need, the number of medical colleges increased very rapidly. Whereas earlier all medical colleges were in the public sector – owned by government or municipality-now the private medical colleges owned by private trust sprang up in much greater numbers basically because the government could not afford to create so many new colleges and the private enterprises found this a very lucrative business. There was nothing wrong in medical education being taken up by private medical colleges, except for the fact that the private entrepreneurs thought of medical colleges only as a profitable business. The main aim of maintaining and improving the medical standards was completely sidelined. Thus the standard of medical education has suffered a lot. The ambition of the parents to send their children to the medical profession was so great that the fees for the medical colleges rose exorbitantly and the government had to step in to control the fees to some extent. Today there are 273 medical colleges turning out about 31,000 graduates in allopathy alone. The number of medical colleges of Homeopathy, Ayurvedic and Unani Medical colleges is167 Homeopathy, 169 Ayurvedic and 9 Unani respectively. It goes to prove that there is no real shortage of doctors in the country. There is a gross maldistribution.

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