India is one of many countries facing severe shortages of trained medical professionals – including nurses, dentists, and administrators – but especially doctors. These shortages have wide ranging effects on both the local and the global level, and this issue has the potential to create a plethora of secondary problems for the affected nation. In India, the shortage of doctors has led to a crisis in the educational system.
In order to give a sense of scale to the issue, one could compare availability of medical care in India to that in the United States. By the most recent data, the United States has 2.672 doctors per 1,000 people, and 3.1 hospital beds per 1,000 people. India, on the other hand, has a mere 0.599 doctors and 0.9 hospital beds per 1,000 people.1 Judging from those numbers, India would need almost 2.4 million new doctors and over 2 million more hospital beds to reach the same proportions as the United States.
This shortage stems from a lack medical infrastructure and difficulty in accessing available resources, and is especially felt in rural India. In a 2008 study focusing on the Ujjain district, researchers found that about 61% (almost 1.1 million people) of that district’s population lives in what is considered rural areas, served by only 39 professionally qualified doctors. As a result, those in rural areas turn to unqualified providers that the researchers refer to as “quacks”. Due to the shortage of professionally qualified doctors, the need for any form of medical care is extremely high. This results in the presence of 1,666 of these “quacks” in the Ujjain district. The unqualified providers often seek to meet the simplest needs of the patients who come to them, which is most often alleviating symptoms enough for patients to return to work. However, these types of treatments most often either leave the problem unsolved or require further treatment at a later date. Therefore, the care delivered in rural areas is frequently either insufficient or even deleterious for the patient. This, in turn, frequently produces a skewed view of standard of medical care.2
India has recognized that the shortage stems from an insufficient medical education system. India responded by creating a sprawling system of medical education that produces 31,000 doctors each year. Even at this prodigious rate, it would take several decades to close the gap between the need and the current supply of doctors.3 However, what normally happens is that the brightest new doctors get recruited to overseas positions, most frequently in the United Kingdom. This is known as brain drain, and besides losing promising doctors, many researchers go overseas, as India has an unproductive research network which has not yet yielded a single Nobel laureate in medicine.4
India has been seeking to deal with the shortage for years by increasing the number of medical schools. Since its independence, India’s medical schools have consistently increased in number, with 86 schools in 1965 swelling to 143 schools in 1990. Between 1990 and 2009, 128 more medical schools opened, bringing the total number of schools to 271 in 2009.5This drastic increase has overwhelmed both the available teachers and the educational and medical infrastructure, creating schools that are both underequipped and understaffed. Many lack dormitories and cafeterias for students, and some lack labs for complex procedures.
These schools are supposed to be overseen by the Medical Counsel of India (MCI), which is responsible for ensuring the quality of both the infrastructure and the professors at India’s medical institutes. However, many institutions do not meet the standards enumerated by the counsel, and therefore have developed a process of window dressing, where schools share equipment or professors during inspections in order to give the impression of compliance. There have been accounts of prestigious colleges adding names of non-existent professors to their lists. The scramble for all these medical schools to meet MCI requirements, and to even keep these schools running, creates a gargantuan demand for competent professors.5 Since demand is high, it is difficult for schools to retain faculty over the long term, which creates a lack of continuity in both the school’s practices and its policy.
The plethora of new and underequipped medical schools will create more doctors and healthcare professionals on paper, but will lower the quality of the doctors produced, further exacerbating the preexisting shortage. So, while attempting to alleviate a shortage of doctors, India has managed to create a completely new crisis on top of the preexisting one. In this case, the response could alleviate the symptoms but is creating a whole new set of additional problems.
- “CIA World Factbook,” Central Intelligence Agency, Accessed 1/25/2012
- Katrak, Homi. “Measuring the shortage of medical practitioners in rural and urban areas in developing countries: a simple framework and simulation exercises with data from India,” The International Journal of Health Planning and Management, No. 23 (2008): 93-105.
- Yathish, TR. “How to Strengthen and Reform Indian Medical Education System: Is Nationalization the Only Answer?” Online J Health Allied Scs. 2009;8(4):1 http://www.ojhas.org/issue32/2009-4-1.htm
- Tulenko, Kate. “Countries Without Doctors?” Foreign Policy, June 2010. http://www.foreignpolicy.com/articles/2010/06/11/countries_without_doctors
- Deshpande Srinivas Ramachandra & Deshpande-Naik Gayathree Srinivas. Crass commercialization and corruption of the Indian medical education system and the resultant decay of the Indian Health Education in the last two decades. A case for urgent international review and monitoring.” Electronic Pysicician 2009, 1:9-16, http://www.ephysician.ir/2009/9-16.pdf
- Image: Witlin, Ray. “World Bank: Medical Checkup.” Flickr, last modified January 7, 2008, http://www.flickr.com/photos/worldbank/2182854821/
Ted Gannett is a first-year student at the University of Chicago majoring in Chemistry and minoring in East Asian Languages and Civilizations. He also volunteers with Health Leads Chicago, a volunteer organization that works in several Chicago hospitals. Follow The Triple Helix Online on Twitter and join us on Facebook.