2. NOT AUGMENTING THE MEDICAL WORKFORCE
A DIRE SHORTAGE OF HEALTH PROFESSIONALS HAS CRIPPLED INDIA’S FIGHT AGAINST COVID. THERE IS NEED FOR RADICAL SOLUTIONS
47 PER CENT No. of Indian districts that do not have even a single medical college
THE DISTRICT HOSPITAL IN Bihar’s Gopalganj district received three ventilators from the Centre in September last year. These were among the 60,000-odd ventilators the government had procured, for nearly Rs 2,000 crore, in response to the Covid pandemic; roughly 17,000 of them were dispatched to the states. But this April, when some patients at the Gopalganj district hospital needed to be put on ventilator, the life-saving devices could not be used due to a manpower crisis—the support of an anaesthetist was not available.
The unfortunate incident highlights the ill-preparedness of the nation’s medical infrastructure at the time of a raging pandemic. Indeed, there is a massive shortage of beds, ICUs, ventilators, oxygen and life-saving drugs. But as renowned cardiologist Dr Devi Prasad Shetty, chairman and executive director of Narayana Health, says, beds don’t treat patients—doctors do.
India’s response to Covid has been crippled by an acute shortage of medical staff—doctors, nurses, paramedics, technicians. For the record, the country has 37.6 health workers for every 10,000 people. The WHO (World Health Organization) benchmark is a minimum 44.5.
At 562, India has the highest number of medical colleges in the world. Not surprisingly then, we have the second highest number of doctors globally. But given our 1.3 billion population, the doctor-patient ratio is abysmal—nine doctors per 10,000 people, as against 42 in Germany, 28 in the UK and 26 in the US. Comparisons with China are starker. For its 1.4 billion people, China has 3.61 million doctors, nearly thrice that of India. Similarly, though India has around 3.2 million nurses and produces 335,000 nursing professionals every year through 5,085 institutes, there are only 15 nurses for every 10,000 individuals. The UK has 150, Germany 132, the US 85 and China 23.
The Centre, since 2014, has been pursuing an ambitious plan to set up 157 medical colleges in three phases at an estimated Rs 24,735 crore and raise 15,700 additional medical graduates every year. Work is also on to establish 22 institutes on the lines of AIIMS (All India Institute of Medical Sciences). But mega infrastructure takes time to build—only 46 of the 157 medical colleges and six of the 22 AIIMS are operational. Other central measures to beef up the medical workforce included increasing the number of MBBS seats from an average 150 to 250 per institute, relaxing the teacher-student ratio norms and age limit for appointing teachers, and making it mandatory for medical colleges to start postgraduate courses within three years of recognition.
TO FIGHT COVID, the government claims to have appointed nearly 265,000 health professionals on contractual basis in the states, including 11,921 general physicians, 3,789 specialists, 73,619 nurses, 81,978 auxiliary nurse midwives and 44,314 paramedics. Defence minister Rajnath Singh has asked governors to work with chief ministers to devise plans to rope in doctors and nurses who retired from the armed forces for
the fight against Covid. State governments launched recruitment drives, but with limited success. Bihar advertised for 9,000 nurses but could fill only around 5,000 posts. The Delhi government asked fourth- and fifthyear MBBS students, interns and BDS doctors to join Covid duty on a daily honorarium of Rs 1,000-Rs 2,000.
Experts say the prevailing health emergency demands radical steps and urgent hiring of medical staff by cutting down on red tape. A paper published in March by Anup Karan, additional professor at the New Delhi-based Indian Institute of Public Health, says incentives should be offered to encourage the estimated 30 per cent doctors, who are no longer a part of the workforce, to return to duty. Recruitments to public health services should be fast-tracked by relaxing norms. National-level live registers of health professionals should be main