As per the report by the Centre for Disease Dynamics, Economics and Policy (CDDEP), India is lagging by 2 million nurses and 6,00,000 doctors to treat its patients. According to the norms set by World Health Organisation (WHO), India must have one government doctor for every 1,000 people but in reality, for every 10,189 people there is one government doctor, whereas the nurse: patient ratio is 1:483, making a shortage of two million nurses. [i] India has been experiencing this shortage of medical personnel for decades. While the nation had only 5.5 doctors per 10,000 people in 1999-2000, the USA and China had 25 and 20 doctors respectively. [ii]
The Ground Reality
According to the reports by the Medical Council of India, only 1,14.969 (11%) are government doctors out of a total of 10,41,395 allopathic doctors registered as on September 30, 2017 under varied state medical councils. [iii] Each government doctor is catering to as many as 11,082 people. Over 60% of registered doctors are catering to the middle class and upper-middle-class population in urban areas even though nearly 70% of the population in India is residing in rural areas. As per health information, only 16% hospital beds and 31.5% of hospitals are located in rural areas. [iv] This is resulting in an increased disparity between healthcare facilities available for the urban and rural population.
Another area of concern regarding the healthcare sector of India is its Public Health Centres (PHCs). Over half of the PHCs in Chattisgarh function without a doctor. Other states facing a shortfall of skilled medical practitioners in PHCs include Gujarat (65), Assam (500), Madhya Pradesh (614), Punjab (45), Orissa (413) and Uttar Pradesh (1689). [v]
A weekend journal released by Lancet in 2015 mentioned that India was home to 17.5% of Earth’s population and yet accounted for 20% of the global burden of disease, 21% of all younger than five years child deaths and 27% of all neonatal deaths. [vi]
Low Spend On Healthcare
The percentage of total national budget spend on healthcare facilities in India remains at 1.5% of Gross Domestic Product (GDP). To compare, Nepal spends 2.3% of its GDP on healthcare, whereas Sri Lanka, United Kingdom and the USA spend 2%, 9.6% and 18% of its GDP respectively. As far as health insurance is concerned, India spends 32% on health insurance as per the Insurance Regulatory Authority of India (IRDA). The United Kingdom contributes 83.5% to health insurance. [vii]
To compensate for the low healthcare expenditure, the government through various policy interventions pushes medical device makers, pharmaceutical companies and even hospitals to cut prices. 2017 witnessed one of the biggest cuts in the price of knee implants and stents by more than 70% in addition to the regular revision of the Drugs and Cosmetics Act. [viii]
Attempts of Fixing Shortages with Unusual Schemes
The government is trying to fix the staff shortages in hospitals and public healthcare centres with AYUSH doctors. It is in favour of allowing dentists to practice modern medicine by doing a bridge course so the shortage of doctors in rural areas can be managed. The Indian Medical Association (IMA) has opposed the move strictly which received the nod from the Prime Minister to scale up the medical education in India.
Unaffordable Health Spending
As per a report by the Public Health Foundation of India, around 55 million people were pushed into poverty in a single year because of out-of-pocket health expenditure. Out of these, 38 million fell below the poverty line because of having to bear expensive medicinal costs alone. [ix] A 2017 report by the World Health Organisation shows 67.78% of total health expenditure in India was paid out of pocket, while the global average is only 18.2%. [x]According to the Indian Journal of Public Health, India requires 2.07 million additional doctors by the year 2030 to reach the prescribed doctor: population ratio of 1:1000. For that, the government would have to increase the percentage spending of its GDP on healthcare to cater to the increased spending requirements and ensure basic access to healthcare facilities for everyone.
Unregulated Private Sector
According to the National Sample Survey Office (NSSO), over the past two decades, there has been a decline in the number of people using public hospitals. Compared to 43% in 1995-1996, only 32% of urban Indians used it by 2015. Besides, a significant portion of these private medical professionals are under-qualified or may not be qualified. For example, according to a study in rural Madhya Pradesh, only 53% of the sampled healthcare providers had completed high school whereas only 11% had a medical degree. [xi]