According to the official statistics available with the health ministry, the total number of registered allopathic doctors in the country is 5.5 lakh. The doctor-population ratio works out to 1:2000 approximately. There are around 3.72 lakh nurses in the country and the nurses-population ratio comes to 1:2950. All of this has to be studied in the context of the fact that till a few decades ago, till few years ago healthcare delivery was sole responsibility of private practitioners and doctor-owned-and-run hospitals. And almost all the large hospitals were either government or charitable hospitals.
Apollo Hospital started the trend of corporate hospital, others followed. There has been a large gap after first corporate hospital and the trend of corporatisation in healthcare delivery in India.
Today, the industry is moving rapidly towards organized sector and more so towards corporatisation of healthcare delivery. So in metro cities, there is a glut of doctors, hospitals and clinical labs while in vast swathes of rural India, there are none. If I were to be asked if the situation is likely to improve any time, in the foreseeable future, the answer has to be no.
The reason lies in the domain of medical education. In the past several decades, there has been an incredible increase in the privatization of medical education with rapid expansion in the number of private medical schools. This trend has had widespread implications globally and influenced medical educational policies all over the world. There has been a worldwide boom in private medical education. India tops the list with the largest numbers of medical schools within one country (271). Out of these about 137 are privately owned institutions. Private medical schools can be totally autonomous or partially autonomous (controlled at various levels and in various degrees by government). They can be profit-generating institutions (revenues which enrich one individual or a consortium) or non-profit institutions which are more society centered.
Although notionally, the institutions might be non-profit, the fact that they do not receive any government aid and have to be self-financing and maintain their extensive and expensive facilities through the revenue generated through fees etc. means that that the cost of education is extremely high and either unaffordable for many or financed through high interest bearing bank loans. After spending such a high amount of money on education and possibly with loans to repay, who on earth will take up poorly paying government jobs in remote areas with little infra-structure? No one. So unless, we think differently, the situation can only deteriorate.
A solution that could potentially be tried is the use of alternate systems of medicine – clubbed together as AYUSH by the government authorities. Comprising of Ayurveda, Unani, Homeopathy and Yoga, the disciplines largely languish. Ayurveda has recently received a new lease of life through the New Age spas, but the other disciplines languish, largely because they are seen as the poor man’s choice of treatment and the government has done nothing to popularize them by ensuring that all flagship government health programmers like the National Rural Health Mission (and now the Urban Health Mission too), gravitate around Allopathic treatment and the AYUSH remains an ungainly step child. Till the time this anomaly is corrected, the situation is unlikely to change.
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