Saturday, November 22, 2008

India's healthcare conundrum

Anbumani Ramdoss, India’s Health Minister recently had occasion to highlight the vast gap in the medical workforce in the country. According to him, while the country had around 700,000 doctors, it needed 800,000 more to meet the standards of the World Health Organisation. He added that the country needed 1.5 million more nurses to achieve, as the Indian Planning Commission has indicated, the nurse-patient ratio of 1:500.

In order to overcome the huge deficit, conditions for establishing medical colleges have been relaxed. Sensing an opportunity for making a killing, poliiticians, their financiers and other influential and powerful business interests have got into the act. Colleges have been and are being opened any and everywhere regardless of the availalability or otherwise of the necessary faculty, equipment, patients and/or hospital-beds. Faculty members of distant institution are hired for few days to meet the needs of inspections, which, too, are rigged. Even fake patients are sometimes made to occupy, on payment, beds lying vacant in the attached hospitals.

A member of the Medical Council of India recently lamented the absence of accredition of medical education in India, the efforts being concentrated more towards securing recognition. The main reason for this aberration, he said, was the “absence of sincerity and moral values in the society”. While the Delhi High Court recently ordered closer scrutiny of Indian medical students graduating from abroad, it is almost time for such a scrutiny even of those who graduate from the mushrooming medical colleges in the country. Being products of an ongoing con-game, they mostly emerge as quacks armed with medical degrees. Instead of providing health care they are more likely to effectively deal with the acute population problem of the country!

Training and education of nurses is no different. Because of shortage of a million nurses, to achieve the ratio of a nurse for every 500 patients colleges have been allowed to be opened with scant facilities of teaching and learning. Producing nurses possessing, at best, rudimentary theoretical awareness with little knowledge or training in clinical applications, such institutions are only fattening their promoters doing nothing for the country or for the noble profession. Only the institutions of excellence that the government proposes to open may redeem to a limited extent the ongoing compromise in the quality of nursing.

The proliferating diagnostic labs are also an area of huge concern. According to the Quality Council of India, although 70% of the modern medical care is based on diagnostic lab tests, 90% of medical laboratories have remained unregulated by any standard. Most of the pathological laboratories do not follow any quality benchmark for want of stringent requirements. Here again, accredition (by government or other recognised agencies) is virtually absent and, hence, quality control is non-existent. Leave alone hygiene or sanitation, even sensitivity towards the need for a sterile ambience is absent. Qualified pathologists or radiologists are frequently unavailable. Inspections are unheard of and the entire system is governed by the hardly relevant Shops and Establishments Act. If this is what happens in urban areas one shudders to imagine the plight of the people in the country’s rural recesses. It is nothing but mockery of healthcare.

Instead of tackling these vital issues, Ramdoss got into avoidable controversies. His personal feud with the former Director of the prestigious institution of All India Institute of Medical Sciences, a cardiac surgeon of great repute, ended up with egg on his face and that of his government. Besides, to benefit a party apparatchik he banned production of vaccines by public sector labs, causing their widespread shortage that continues till date.

He, however, successfully imposed a ban on smoking in public places. He is now poised to move into the areas of drugs and alcoholism. Ramdoss’s strategy of mounting attacks on the lifestyle or habits or substances the pursuit and/or use of which cause deadly diseases necessitating heavy public investments for their treatment cannot but be appreciated. He however seems to be oblivious of the problem of food adulteration and use of toxic chemicals to ripen fruits and vegetables and to impart to them farm-fresh appearance. Health problems caused by water and air pollution are also nowhere on his horizon as yet.

India’s healthcare is a conundrum that would need much more than mere tinkering. To take care of health of a billion people, mostly poor, the immediate need would seem to be ruthless governance and rooting out of the prevailing rampant corruption in the health sector. And, the country is now at such a stage when penalisation of the states, the main instruments of healthcare delivery, for non-performance by blocking off their funding seems to have become necessary.