Governance

INDIA NEEDS MORE DOCTORS

17 Oct 2023 7 mins Download PDF

Demand-supply gap in medical field:

There are gaps in doctor availability to patient ratio in India which can be partly attributed to
1. The demand for doctors exceeds supply in large parts of India.
2. The demand for medical education also exceeds the number (supply) of seats.
3. The expansion of supply side has been inadequate:
  1. Between 2010-11 to 2023, UG seats have nearly tripled, PG seats have almost quadrupled, while medical colleges have doubled.
  2. Despite the expansion, the number of medical graduates per lakh population in 2021, was 4.1, well below
    1. 6.2 in China (2018)
    2. 6.9 in Israel (2020)
    3. 8.5 in US (2021)
    4. 13.1 in UK (2021).
4. Medical education faces challenges of capacity, quality and regulatory bottlenecks. The number of seats in government medical colleges is low. The number and size of medical colleges have contributed to the increase in medical graduates, where size of medical colleges remains a critical barrier to increasing the supply of doctors.
  1. The average number of UG seats per college is 153 in India
  2. This is in stark contrast to 220 in Eastern Europe and 930 in China.
  3. The difference is due to regulatory and financial constraints in medical colleges.
5. Scaling up for private medical colleges shall require:
  1. Investments in physical infrastructure
  2. Hiring teaching faculty and other staff raise feasibility questions when seats remain vacant and costs are not recovered
  3. Can lead to price distortions with high capitation fees.
  4. Addressing teaching faculty shortages
Though India has competency-based curriculum similar to the one implemented in the US.
1. However, US has innovated in resource utilisation to scale the production of doctors.
2. It has focused on mainstreaming technology and providing better financial incentives to teachers.
3. Integrating interprofessional education (IPE) into the curriculum, where doctors, nurses and pharmacists are taught together.
Moreover, healthcare spend is also low in India, affecting supply. India spends only 1.3% of GDP on healthcare, among the lowest globally. The Budget Estimate 2022-23 has allocated Rs 86,606 crore to the health sector, which is a “negligible” increase as compared to the Revised Estimate of Rs 85,915 crore for FY 2021-22. Prioritisation of health is missing in this year’s budget despite the country facing the third wave of the pandemic, say public health experts.

Key Takeaways

India has a severe shortage of doctors, with just one government doctor for every 10,189 people (WHO norm is 1:1000).
Similarly, there is a shortage of nurses and paramedics as well. India has around 1.7 nurses per 1,000 people, far below the WHO standard of 3 nurses per 1,000.
This human resource crunch leads to the doctor-to-patient ratio in India being abysmal, sometimes 1:20,000 in rural areas. Patients often do not get enough time or attention.
The gap seems to be widening as demand is increasing rapidly with lifestyle diseases, rising incomes, better awareness and insurance. But supply is not keeping up.
Medical infrastructure in rural areas is inadequate - PHCs, CHCs lack staff and facilities leading to poor healthcare access. Urban hospitals are overloaded.
Medical education faces challenges of capacity, quality and regulatory bottlenecks. The number of seats in government medical colleges is low.
Moreover, healthcare spend is also low in India, affecting supply. India spends only 1.3% of GDP on healthcare, among the lowest globally.
The capacity for disease surveillance and database management is poor, leading to blindspots in medical planning.
The Covid-19 pandemic exposed and exacerbated these gaps in the healthcare system drastically.
Experts argue the gaps can only be reduced by significantly increasing government healthcare spend and boosting recruitment, infrastructure and accountability. The private sector needs better integration. Telemedicine holds promise for rural reach. But progress is bound to be slow.