Reforming medical education

NEWS An unfettered market approach is not the answer to the health workforce crisis.

India’s health systems have been confronting numerous challenges, but of all, shortage of human resources is a major one.
Human resources is the set of people who make up the workforce of an organization, business sector, industry, or economy. Hence it is the critical building blocks of any institution.
Despite being one of the critical building blocks of the health system, Indian health system faces a serious shortage of human resources, especially doctors.

AGGRAVATION OF THE CRISIS

Further the workforce crisis has been aggravated by the imbalances within the country.
For instance, the doctor-population ratio in northern States is far short of the required norm, while the southern States, barring Telangana, have enough doctors in possession.
Also, there is a general lack of adequate staffing in rural areas.
Hence, if the urgent action is not taken, the shortage will amplify and health systems will get further weakened.

SIGNIFICANCE OF HEALTH WORKERS

Health workers are critical not just for the functioning of health systems but also for the preparedness of health systems in preventing, detecting and responding to threats posed by diseases such as COVID-19.

PROPOSAL TO ADDRESS THE PROBLEM

In order to effectively address these challenges, our health systems must be strengthened.
In order to meet the significant shortfall of qualified doctors in northern States, scaling up of medical education is warranted.
These health system challenges will remain largely unaddressed with the government’s market-oriented approach towards medical education.
Therefore, NITI Aayog has proposed allowing private entities to take over district hospitals and convert them into teaching hospitals with at least 150 MBBS seats.

Though the proposal of NITI Aayog may sound attractive but there are reasons to be deeply concerned. As through the implementation of such a policy:

The private sector in medical education will be encouraged.
Also, it will directly aid the corporatisation processes of healthcare provisioning, while the under-resourced public health system will be a collateral damage.
Implementation of the proposal will change the consideration that- district hospitals as the last resort for the poor.
The corporatisation will make the services very costly and exclude poor from getting care.
Private players treat medical education as a business. Thus, it would shut the door on a large number of medical aspirants who would otherwise have a strong motivation to work in rural areas but do not have the means to finance themselves.
Additionally, the medical graduates trained in such private sector ‘managed’ medical colleges will prefer to find employment in corporate hospitals and not in rural areas to regain their investment.
Further, this proposal is not aligned with India’s national health policy goals like achieving universal health care and health equity. Instead, it will widen health inequalities further.
Thus, despite producing more doctors to meet the shortages in under-served areas, the proposal is unlikely to yield the desired healthcare results.

The government should learn from previous cases of public-private partnerships (PPPs):

In the past, contrary to the expectation that markets would help increase access to primary and tertiary care for the poor through private players, the evidence supporting their effectiveness is very limited.
In fact, many PPPs had to be suspended owing to the non-compliance of the agreement conditions by the private sector under which they were also supposed to cater to the non-paying patients.

There is need to make medical education a public good once again:

- An unrestrained market approach or a regulated market with medical colleges that are publicly funded but privately operated, providing competition for traditional government medical colleges, is not the answer to the health workforce crisis.

Medical education is a public good as its purpose is to improve the population health and decrease disease burden.

Instead here should be a substantial step-up in public investment in medical education.
By establishing new medical colleges, the government can increase student intake as well as enhance equitable access to medical education.
Besides, it must allocate adequate financial resources to strengthen the overall capacity of existing medical colleges to enrich student learning and improve output.

Hence, Solving doctor shortage, needs long-term thinking and commitment from the political leadership.

https://www.thehindu.com/opinion/op-ed/reforming-medical-education/article34552237.ece

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