The challenge in Indian healthcare does not lie in finding good doctors but having them where they are needed the most - in remote locations. India, it is estimated produces close to 80,000 doctors per annum, but most of them only work in bigger metros and urban locations. The situation turns grim as you move to remote areas. Therefore, the government's announcement to set up 75 new government colleges, especially in underserved areas has been welcomed by many within the Indian healthcare sector. Experts say, it is important to keep track of how it is executed, who gets to choose where these are set up and with whom the ownership lies (the Centre or states). One should also look into the challenges of finding the right faculty.
The Cabinet Committee on Economic Affairs, chaired by Prime Minister Narendra Modi, has approved establishing 75 government medical colleges by 2021-22. These would be attached to existing district/ referral hospitals. The Cabinet has sanctioned Rs 24,375 crore during the 15th Finance Commission period i.e. up to 2021-22. The establishment of new medical colleges attached with existing district/referral hospitals, is expected to result in increased availability of qualified doctors and improve the tertiary care infrastructure in the country. Under this, the existing infrastructure of districts hospitals is to be utilised. But then, district hospitals are typically the domain of the state governments unless there is a scheme under which states are to be given funds to upgrade these hospitals to become teaching establishments. This poses another issue of converting a district hospital, whose primary job is treatment and care, into a teaching hospital. This is slightly different from the usual norm of having a hospital attached to a teaching college.
What stands out about the announcement is that the new medical colleges will be set up in underserved areas having no medical colleges with at least 200 bedded district hospitals. Preference will be given to aspirational districts and district hospitals having 300 beds. It will lead to an addition of at least 15,700 MBBS seats in the country. "This is great news for the future of the country," says Devi Prasad Shetty, the chairman and founder of Narayana Health and a leading cardiac surgeon of India. "Today, nearly 70 per cent of medical colleges in India are in the southern and western regions of the country. This hopefully will ensure that we get the doctors to regions in central, northern and eastern parts of India that suffers from shortage of doctors because of fewer medical colleges. But, the population that needs to be served is huge," he adds.
Government medical colleges in underserved regions will help young students aspiring to become doctors, who otherwise travel for long hours to study or practise medicine. "Even if 5-10 per cent of fresh graduates decide to stay back in underserved areas, it will be more than sufficient," Shetty points out.
The ministry of health would do well to answer some basic questions. Will the Centre or state governments run the medical colleges? The central government is unlikely to run these medical colleges. If it does - since it is taking credit for it - it will be quite unusual because Centre only runs institutions such as AIIMS and JIPMER. If ownership rests with state governments, nothing may be possible until the state cooperates.
Since there is a reference to the 15th finance commission, state governments have the responsibility to spend. It could then mean that states are being asked to pay for it from their finance commission allocation, then, one could ask, how the central government can take credit for the setting up of these institutions? Who chooses the districts, who is giving the land? How much money is the central government putting into it and how much is expected of the state governments? Answers to these will tell where the ownership lies.
Also, when working out on the distribution of the 75 colleges across states, there is need for more clarity on what would determine the selection of the locations/states.
One needs to understand the assessment of the government on the exact requirement of discipline-wise faculty since all faculty members need to have masters degree at least. There is clearly a shortage of well-trained doctors with MD or MS degrees, as most of them prefer lucrative specialisations such as radiology or gynecology over psychiatry, geriatric or palliative care. K Sujatha Rao, former union health secretary agrees that shortage of faculty has become a big concern. "Focus must be on finding good faculty that these institutions need," she says.
Another expert on Indian healthcare, on the condition of anonymity, says, "We need clarity on other important aspects that these institutions require, especially in district hospitals. For example, number of surgeons required against the number of anaesthetists needed and number of district hospitals with a viable, functioning, hygienic and well-operated blood bank. This is as important as knowing the plans on the basic numbers."
Indu Bhushan, the CEO of Ayushman Bharat, is upbeat about the announcement. "It is good that we get more supply of doctors along with tertiary care. While we have doctors, we need their better distribution."
The note further adds that the government had earlier "approved to establish 58 new Medical Colleges attached with existing district/referral hospitals under Phase-I and 24 under Phase-II. Of this, 39 medical colleges under Phase-I, have already started functioning, while the remaining 19 would be made functional by 2020-21. Under Phase-II, 18 new medical colleges have been approved".