India needs the political will to make medical education affordable and accessible to all sections of society

By Dhirendra Pratap Singh, Elets News Network (ENN)

The health crisis in India has been exacerbated by the shortage of doctors and also by the fact that majority of specialists are based in urban areas.  An abysmally low government spending on health is also the reason behind poor state of healthcare in India. Seventy four percent of the Indian population lives in the villages, thus the delivery of health services to rural masses holds the key and forms an integral part of their socio-economic development.

Reforms in Medical Education

Reform in medical education is urgently needed. The field of medical education in India is not sufficiently advanced.  Government as well as private sector should provide further impetus to medical education. There is no dearth of students who want to be doctors and at times they are unable to fulfil the ambition as there is lack of quality institutes for medicines. There is also the need to review the current fee structure in government medical colleges. A monthly fee of around `200 seems too less, particularly when many students come from better off families and are clearly in a position to pay a realistic fees.

There is acute shortage of doctors in India. India needs more than one lakh doctors per year. And we only produce 35,000. We must scale up our medical infrastructure five times. Shortage of doctors affects the poor, who do not have easy access to healthcare services. Policy pronouncements and intentions to provide universal healthcare can be just wishful thinking unless backed by a political will to make education affordable and accessible to all.

Medical Education in the Digital Era

What happened in the USA a decade ago in terms of creating robust medical education technology systems and services to manage the same, is just about beginning in India.  While many are keen to adopt scalable technology, the lack of quality service providers is rare and there is no precedent in the market. The second issue is not just getting the right technology in place, but supporting it with the right content that is pedagogically sound for a fulfilling distance learning experience.

In diverse medical education contexts, e-Learning appears to be at least as effective as traditional instructor-led methods such as lectures.

Prof TK Jena, Director, School of Health Sciences, IGNOU is of the view that the doctor of future is going to be an engineer. Fifty years ago, it was Doctor who mattered. Today its the radiologist or other specialists, who matter. He further says, Already people are working towards developing virtual classrooms in the field of medical education. ICT can play an important role in health education.

If Indias GDP continues to grow at 7 percent a year, in 2020 the number of citizens in the high-income segment will rise to 52 million and in the middle-income segment to 372 million. The number of households in the low-income group will drop to 933 million. As a result, India has the potential to add around 4 million citizens every year to the high-income segment and 26 million citizens ever year to the middle-income segment up to 2020. ICT-enabled solutions in healthcare, education, financial services and public services can drive socio-economic inclusion of 30 million citizens each year, faster, cheaper and more effectively than traditional models.

Says Dr Dheeraj Mehrotra, Deputy General Manager, Schand  Harcourt, The tilt from Web 1.0 to 2.0 and now to 3.0 offers new opportunities to our students. It is up to the teachers to guide their students through the maze of the digital world. Teachers need to develop a balanced approach in developing new policies and practices that can guide the students in regards to usage of the Internet.
A large part of the ICT agenda in medical education is being driven by the technology companies rather than education companies. Mostly the conversations are about hardware or software without any focus on adequate quality of content or providing support to the teachers. Experts believe that it is all about the teachers.

Says Kartikay Saini, Chairman, Scottish High International School, Until teachers become the facilitators of digital education, all the interactive whiteboards, smart tools, cloud computing and educational software will not be of much use. The best practise in education is one that leads to inquiry based learning, research based learning. As we can see around us, the learners profile is changing.

The integration of e-Learning into medical education can catalyse the shift toward applying adult learning theory, where educators will no longer serve mainly as the distributors of content, but will become more involved as facilitators of learning and assessors of competency.

Rural-urban Healthcare Divide

Sending doctors to remote villages where there are no basic facilities is a challenge. There should be basic facilities for the doctors, who are being sent to rural areas. The Government is really serious about improving rural health. Government has already allocated huge funds to improve rural healthcare sector. National Rural Health Mission is a very good step in this direction. There is a ray of hope and things will improve.  Government alone cant do everything. It also needs public support.

Key areas that require attention
  • Establishing the NCHRH
  • Instituting a nation-wide examination to determine college admissions
  • Earmarking medical and nursing education for public investment
  • Making private capital an exception
  • Increasing the remuneration of teaching faculty and expanding their gross availability by inviting foreign faculty alongside increased use of technology;
  • Working out a fair fee structure for private medical education
  • Creating new cadres of health professionals who are trained to address the needs of the rural population
  • Health Ministry announced the target to achieve 80,000 MBBS seats and 45,000 PG (MD/MS/Diploma) seats by 2021
  • GoI is targeting additional 38,431 seats in the MBBS and 22,806 seats in the PG streams by 2021
  • This ambitious plan will need about 20 medical colleges to open each year with an intake of 200 students

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 nations health system and policy is the need of the hour. Professional skills, Ethics and human values should be preached and stress management be incorporated at all levels.

Public hospitals are spurred on by the growing need to really understand the cost of health consum-ables and avoid waste. Private hospitals, in order to stay in business and function effectively, need to find ways of saving money and re-establishing a profit margin in an environment where revenue is stagnant and costs are increasing. The health funds are also searching for ways to reduce operating costs and look to e-commerce, using industry standards, as a better way of dealing with claims.

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