The Future of Medical Education in India – The Way to Go

The Union Health Minister Ghulam Nabi Azad appears to be busy shooting the breeze by announcing vague policy changes involving setting up of Medical Colleges through private capital and in collaboration with government run district hospitals. The minister who is well known for putting his foot in the mouth, recently announced at a FICCI conference that the government is considering relaxing the norms for setting up medical colleges by the private sector. He also announced that these colleges can be affiliated with the government owned district hospitals, thus doing away with the requirement of a teaching hospital to be attached with the medical college.

The minister is seeking private equity participation in rural, backward and far-flung areas of the country. He believes that the private players can be attracted to set up medical colleges in these parts of the country by offering concessions such as access to district hospitals.

Doesn’t this sound completely hare brained?

Why would a private entity invest money in backward and far flung areas? The minister must know that what passes for District Hospitals is a sham. The hospitals are poorly equipped, have limited resources and are dens of corruption. Many are old and decrepit, some even falling apart with peeling plaster and leaking roofs. How will these private medical colleges attract students when they will be offering their students medical training in these hospitals? Will these students learn cutting edge medicine in hospitals, where high tech might mean an X-Ray machine? Why would they pay hefty fees to go to attend these medical colleges, knowing fully well what lies in store for them in the future? And if the students don’t find this proposition attractive, how will the medical colleges make money and generate a return for their investors?

India needs more doctors. According to the current planning commission estimates India needs 600000 doctors, a million nurses and more than 200000 dentists. The only way this shortage can be met is by investing in medical education. The government must find the resources to set up more medical colleges and teaching hospitals across the country. The bulk of the investment must come from the government. After all, this is an investment in the future of the health of the citizens.

The private sector can be roped in to partner in this effort, where in some of these colleges can be set up in collaboration with private players. The government can facilitate these investments by offering tax breaks, land at concessional rates, soft loans, duty concessions on buying high tech equipment, and by developing allied infrastructure like power, roads and telecom in these areas. The teaching hospitals established along with the medical school can than serve as regional/district level referral centres for far flung Primary Health Centres. The teaching hospitals can also run outreach programs, touching lives of people in remote areas through regular camps and mobile hospitals.

These state of the art medical colleges and teaching hospitals will than be able to attract bright students and dedicated faculty. Many of them will come hopefully, not from far off places but also from local areas and will be happy to serve their own communities. Thus, they will form the backbone of a medical network that will extend its reach into the farthest nooks and corners of our country, making it possible for our citizens to access high quality healthcare nearer to their homes.

The minister must find a way to make a clean break from the past, think afresh and find the resources to get this going. More importantly he needs clear thinking and resolute will to bring about the change in the way healthcare is delivered in our country.

Compulsory Rural Postings After MBBS

The Hindustan Times reported a few weeks ago that the Union Health Minister Dr. Anbumani Ramdoss has announced that young medical graduates, fresh out of medical schools will now have to mandatorily serve one year in rural and semi-urban centres in India.

Dr. Ramdoss believes that this will help in augmenting healthcare services in these parts of the country. It is well known that in the Indian hinterlands the availabilty of healthcare services is pathetic.  In villages, where more than 66% of India lives, it is rare to find a qualified doctor. In semi-urban centres too modern, good quality and reliable healthcare is largely unavailable.    

The government has set up a network of Primary Healthcare Centres in the rural areas. However, these centres are mostly crumbling buildings with poor or non existant medical infrastructure. The doctors posted in these back of the beyond places are mostly conspicuous by their absence. District Hospitals established in all district head quarters are also in a bad shape. The medical infrastructure is poor, doctors are poorly paid and are mostly buried under an avalanche of patients. 

While good quality healthcare remains out of the reach of most Indians living in rural and semi-urban India, their does seem to be a crying need for qualified doctors. However, I am not sure if a compulsory posting of young doctors is the solution.

The minister must recognise that young doctors passing out of India's medical colleges aspire to a career in medicine, which can afford them a modern and comfortable life. They see their peers passing out of fancy business schools choosing high profile careers in business . A doctor toils much harder-many years at the medical school to earn a grduate degree, followed by a gruelling post graduate course and than the struggle for a job in an intensely competitive medical world. Now to send them for one more year to the inhospitable Primary Healthcare Centres and District Hospitals appear to be cruel.

Moreover, one is not sure how competent fresh medical school graduates are and what quality of care will they be able to deliver in ill equipped and distant rural and semi urban medical centres, where they might have to work unsupervised. While, they may be much better than what we have today (assorted quacks), they will hardly be able to do justice to the demands of their profession.

While the minister might argue that since medical education in India is largely subsidised by the government and therefore it has a right to ask these young graduates to spend one year of their professional life working for the government in far flung inaccessible areas, this would hardly cut any ice. By the same logic shouldn't engineers, business and science graduates passing out of government owned colleges and Universities be also required to serve in remote areas. This can never work.

I do believe that there are no easy answers here. It will take many years for good quality healthcare services to 'trickle down' to these remote rural areas. For the moment, the government must provide roads and communication infrastructure, which allows patients to be quickly transported to urban centres, where relatively better healthcare is available. The government must offer incentives such as an option for subsidised post graduate education, health insurance and guaranteed employment for doctors, who choose to serve a year or more in rural hospitals. 

Last but not the least the government must improve its healthcare infrastructure. It must invest in better equipped facilities, ensure better hygiene and provide a better professional work environment. It can even experiment by involving private players in a model which guarantees minimum returns on private capital and the franchisee will guarantee far better and more efficient care.

At the end of the day, the government must try and attract young doctors rather than force them into rural postings.