However, Union health ministry’s scrutiny has found that two lakh of the registered doctors aren’t working anymore. Of the 10. lakh nurses registered, six lakh don’t exist. At present, there is only one doctor for every 2,000 population. The target is to have one doctor for every 1,000 population. While the international nurse to doctor ratio is 3:1, India’s count stands at 1. 5:1. Besides, the number of female allopathic doctors (medical graduates with a bachelor’s or postgraduate specialist diploma or degree registered with the Indian Medical Council) is abysmally low. Only 17% of all allopathic doctors and 6% of allopathic doctors in rural areas are women.
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There is less than one female allopathic doctor per 10,000 population in rural areas (0. 5), whereas it is 6. 5 in urban areas. Union health minister Ghulam Nabi Azad informed the Committee that the ministry is giving a special push to nursing education. “During the last two years, the ministry has sanctioned 132 Auxillary Nurse Midwives (ANM) and 137 General Nursing Midwifery (GNM) schools all over the country. These 269 schools will produce an additional 20,000 nurses every year. Six nursing colleges are also being established at the new AIIMS eing set up under the Pradhan Mantri Swasthya Surakhsha Yojana and these will be functional by next year,” Azad said. A skewed distribution of medical colleges is another big problem.
The ministry’s presentation said 45% of medical colleges are located south India, with 47% of the MBBS seats. North India is home to 17% of the medical colleges, with 16% of the MBBS seats. Western India accounts for 21% of colleges and 22% of the MBBS seats. In comparison, central India has 5% of medical colleges and 5% of MBBS seats, east has 10% of colleges and only 9% MBBS seats.
Northeastern states are most neglected. It has only 3% of medical colleges and 3% MBBS seats. The Planning Commission recently said geographic and rural-urban imbalance exists in training and availability of human resource. Medical colleges are unevenly spread across the states with wide disparities in the quality of education. Of the 640 districts, only 193 have a medical college. Azad, however, said that in last three years alone the number of post-graduate seats to produce super specialty doctors has increased by more than 9,100.
The number of PG seats available in this academic year is 22,194 as against 13,043 in the year 2008-09. During 2009-12, 46 new medical colleges have been set up,” the minister added. Under-representation of women in healthcare workforce is seriously affecting women’s access to health care. Now, nearly two-thirds or 66% of all health workers are men. According to the paper “Human Resources for Health in India” published in the British Medical Journal The Lancet recently, one in five dentists are women, while there is one woman in 10 pharmacists.
Against a World Health Organization recommended norm of 23/25 health workers (doctors, nurses, midwives) per 10,000 population, India has 19 health workers per 10,000 (doctors – 6, nurses and midwives – 13). India has 270 medical schools, from which 28,158 doctors graduate every year. The southwestern states of Andhra Pradesh, Maharashtra, Karnataka, Kerala, and Tamil Nadu, which together account for 31% of India’s population, account for 58% of all medical colleges – both public and private – in the country.
While India faces an acute shortage of trained medical manpower, as many as 1,333 doctors migrated to foreign shores over the last one year. During the same period, the previous year – from April 1, 2010 to March 31, 2011 – 1,157 doctors had migrated in search of employment, and between 2009 and 2010, 1,458 doctors went abroad. This latest revelation by Union health minister Ghulam Nabi Azad on Friday comes just days after he had said that doctors going to the US for higher medical studies will now have to sign a bond with the ministry before leaving and honour the document by returning home after finishing the study period. Now, if a student does not come back from the US, he won’t be allowed to practice there,” Azad had said.
The US has insisted on a government No objection Certificate (NoC) from this academic session from every student enrolling with an American institute. Azad said, “These are all doctors who asked the Medical Council of India (MCI) to issue them Good Standing Certificates (GSC) – a mandatory requirement for doctors going to work in hospitals abroad. GSCs give us a rough estimate of the doctors migrating to other countries. However, it does not reflect the absolute number.
No centralized data is maintained for doctors and nurses migrating to other countries. ” Azad said over 3,000 doctors went abroad for studies and did not return in the last three years. He added on Monday, “Those who apply to go to the US for studies from 2012 will have to give us a bond saying they would come back after finishing the studies. If they don’t fulfill the bond obligation, we can write to the US to deny the student permission to practice. ” The minister’s proposal, however, has found resistance from former members of the governing body of MCI. The bond can’t work till the government can guarantee the students a good job worth their skills, once they return to India,” said a former member of the MCI’s governing body. Almost 70% of health workers in India are presently employed in the private sector.
Almost 18% of primary health centres in the public sector are without a doctor, 38% are without a laboratory technician and 16% are without a pharmacist. Immigration is a big threat to India. Indian doctors emigrating to the West constitute the largest number of foreign trained physicians in the USA (4·9%) and the UK (10. %), the second largest in Australia (4%) and third largest in Canada (2. 1%). About 100,000 Indian doctors work in the US and the UK ministry officials say at the time of Independence, India had 19 medical schools, from which 1,200 doctors graduated every year. Now, India has 270 medical schools, from which 28,158 doctors graduate annually. The southwestern states of Andhra Pradesh, Maharashtra, Karnataka, Kerala, and Tamil Nadu (which together account for 31% of the country’s population) account for 58% of all medical colleges (public and private) in India.
According to the ministry, doctors going abroad to work doesn’t augur well for the country. The nation has just one doctor for every 1,700 people. In comparison, the doctor-population ratio globally is 1. 5:1,000. Somalia has one doctor for 10,000 population. China’s doctor population ratio stands at 1:1063, Korea (1:951), Brazil (1:844), Singapore (1:714), Japan (1:606), Thailand (1:500), the UK (1:469), the US (1:350) and Germany 1:296. MCI intends to reduce the gap to one doctor for 1,000 population by 2031.
According to the Planning Commission, India is short of six lakh doctors, 10 lakh nurses and two lakh dental surgeons. It estimates that Indian doctors who have migrated to developed countries form nearly 5% of their medical workforce. Almost 60,000 Indian physicians are estimated to be working in countries like the US, the UK, Canada and Australia alone. A recent paper in the Lancet had said India had eight healthcare workers, 3. 8 allopathic doctors and 2. 4 nurses per 10,000 population. When compared to other countries, this is about half the WHO benchmark of 25. 4 workers per 10,000 people.
