Medical Superintendent & HOD, Hospital Administration, AIIMS, Dr Shakti Gupta’s vision is to establish a full-fledged Centre for Excellence in Hospital Administration at AIIMS, the first and the only ISO 9000:2001 certified department in the country. In an interaction with eHealth, he shared his perspective on the current medical education scenario in India scheme and threw light upon the challenges. Excerpts:
What is the present medical education scenario in India?
Medical education in India is in a state of metamorphosis wherein there is a paradigm shift from conventional rigid methodology to need based curriculum. Medical education presently is focusing on healthcare resources where primary stress is on super specialisation. This has to be changed and the old concept of family physicians be ushered in which will ease the load from the super specialists and healthcare can permeate to deep interiors of our society. While graduates generally posses reasonably sound knowledge of medical science, they are generally found deficient in performance of clinical skills, and problem solving, which forms the core of clinical competence. There is a growing trend of mistrust among the public for the medical profession as one hears of cases of negligence, misconduct and unethical practices leading to legal suits. There is a gross disconnect in realizing dream of producing doctors for the rural areas and strengthening the primary healthcare infrastructure in India.
What are the loopholes faced by the medical education system? How can they be removed?
The Government of India recognises Health for all as a national goal which should be guided by principles of equity, affordability, effectiveness, and accountability. However, there are many impediments on the path of achieving this goal because of inadequacy of healthcare education which cascades shortage of healthcare workers. There is lack of inter-speciality synchronisation and planning for academic curriculum.
What is your opinion about medical training in India? Why are we not able to retain talent?
India has about 20 health workers per 10,000 population; the total number of allopathic doctors, nurses and midwives in India stands at 11.9 per 10,000 population against WHO benchmark of 25.4 per 10,000. As I have mentioned earlier our mode of teaching needs to undergo sea change. Some important modalities like Problem based learning, on the job training, integrated learning modules (ILM); Learning from other countries-using modern tools and technologies, learning from private sector-synergy based approach can be incorporated into our system.
It is a happy development that the government has already approved the establishment of the National Institute of Paramedical Sciences (NIPS), Regional Institutes of Paramedical Sciences (RIPS) and a scheme to support the State Government Medical Colleges for conducting paramedical courses through a onetime grant.
We are unable to retain talent as there is no fertile ground for students excelling in research and academics can work further. The conditions of employment in rural areas are not very appealing to the young qualified healthcare personnel. To add to it the lure of dollars and scope for growth is what pushes our talent overseas.
Rural India, today, faces a serious lack of doctors and healthcare facilities. What needs to be done with medical education to bridge the rural-urban healthcare divide?
Human resource shortage, unequal distribution of healthcare workforce between urban and rural areas and inefficiencies in the medical education system are some of the challenges that must be overcome through concerted policy action and implementation. There is an urgent need to increase student capacity, both through revamping existing institutions and establishing new ones, reform curriculum to reflect national needs, encourage innovation and adopt global best practices in healthcare and education. Moreover there is a mismatch between rural and urban healthcare resources. “Doctors to population” ratio is lower by 6 times in rural areas as compared to urban areas.
The newer policy of Government to produce rural doctors out of the local populace is a welcome step. I think the private sector must also do its might in training the students from rural sector at an affordable cost. We have to incorporate IT into our lives and concept of tele-education and tele-consultation has to be embedded into the education system.
We need more than one lakh doctors per year. Or so to say, India can absorb one lakh doctors per year. And we only produce 30,000. What should be done to combat this challenge?
There is an urgent need to revisit the requirement of Healthcare personnel in our country. We produce approximately 34,000 doctors every year. The MCI has reviewed the existing manpower situation and medical college curriculum in the country and has estimated that the target for doctor population ratio should be 1 doctor for 1000 population by 2031. This implies that the current intake and critical mass of doctors needs to be doubled.
Common digital calendar can be made for participating educational institutions. We all must have a road map for achieving the goals and no mission will be successful and objectives will be attained unless things are monitored. There should be strict control measures, time bound goals, accountability at all levels and transparency in systems.
Health system can be generator of jobs but the need of healthcare personnel is so huge in the country and abroad that our output is much less than the desired numbers
We must encourage private sector to step into Medical education to bridge the existing gap and strict regulatory bodies must monitor this. Medical education should encompass infrastructure for training of Medical, Dental, Paramedical and Nursing students. These four pillars of Health education should grow simultaneously to provide effective human resources for health.
Health system can be such a huge generator of jobs, besides improving the quality of life of our people. And yet such undersupply is incomprehensible. So, how could we improve the situation?
Health system can be generator of jobs but the need of healthcare personnel is so huge in the country and abroad that our output is much less than the desired numbers. Moreover it is not as rewarding as other branches are and it calls for long hours of struggle and perseverance which is not found in this generation. However things can improve if we improve the working conditions and facilities for healthcare personnel. Management skills and communication should be augmented with resources for improved quality. IT skills and e-labs can be launched to reach out far and wide. Vision sharing by experts and Orientation to Nation’s health system & policy is the need of the hour.
Are you satisfied with this year’s budget for Health and Family Welfare?
The Union budget 2010-2011 increased the allocation for health care by ` 2, 700 crore increasing the allotment to ` 22, 300 crores. This budgetary allocation is only 2 per cent of the total budget, and is still very far from the target of three percent of GDP.
Through increased allocations in the flagship public health programme, NRHM (National Rural Health Mission), an overall directional continuity has been maintained. The budget aims at benefiting all sections of the society but lacks specific provisions to boost private investment in healthcare sector especially in rural areas. Considering that there is a severe shortage of health infrastructure and health human resources there remains a lot that can be achieved through PPP models, which are the need of the hour. However, the five percent reduction in tax while importing medical equipment will be beneficial. The expansion of the service tax net to include health check-ups undertaken by hospitals for employees of business entities, and for health services provided under health insurance schemes may prove to be a deterrent at a time when preventive healthcare has to be promoted. The proposal to extend Integrated Child Development Services (ICDS) to every child by March, 2012 is also a welcome step as it would ensure nutritional security to the children under the age of six years.
Inclusion of all BPL (Below Poverty Line) families under Rashtriya Swasthya Bima Yojana (RSBY) through increased budgetary allocations is a step in right direction.