Tuesday June 26, 2018

India short of 500,000 Doctors, the Doctor-Patient ratio of 1:1,700 is worse than Vietnam

India is short of nearly 500,000 doctors, based on the World Health Organization (WHO) norm of 1:1,000 population, according to an IndiaSpend analysis of Government data.

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New Delhi, September 1, 2016: Needless to say that, Health-Management failure is prone in India. The depth of this fact can be measured only if we go through with these examples.

In Odisha, a man slung his wife’s body over his shoulder and carried it 10 km after being denied an ambulance on August 24, 2016.

In Kanpur, a man’s sick son died on his shoulder after being denied admission to a hospital on August 29, 2016.

Such cases become visible when they get social media and television attention, but millions cannot access India’s overburdened hospitals and inadequate medical facilities, a crisis illustrated by the fact that India is short of nearly 500,000 doctors, based on the World Health Organization(WHO) norm of 1:1,000 population, according to an IndiaSpend analysis of government data.

With more than 740,000 active doctors at the end of 2014 — a claimed doctor-patient population ratio of 1:1,674, worse than Vietnam, Algeria and Pakistan — the doctor shortage was one of the health-management failures cited by the report of a parliamentary committee on health and family welfare, which presented its findings on March 8, 2016.

Illegal capitation fees in private medical colleges, a health-services inequality between urban and rural India and a disconnect between the public-health and medical-education systems were among the issues the committee investigated while probing the Medical Council of India, the 82-year-old organisation responsible for medical-education standards.

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Up to 55 percent of India’s 55,000 doctors graduate every year from private colleges, many of which charge illegal donations, or “capitation fees”; in Tamil Nadu, it now costs a medical student from such a college Rs 2 crore to get an MBBS degree, the Times Of India reported on August 26, 2016.

The imbalances begin with access to medical education.

States with nearly half the population have only a fifth of MBBS seats

“Six states, which represent 31 percent of India’s population, have 58 per cent MBBS seats; on the other hand, eight states, which comprise 46 percent of India’s population, have only 21 per cent MBBS seats,” said an unnamed expert who deposed before the parliamentary committee.

These medical-education imbalances reflect larger public-healthcare issues. In general, poverty is correlated with the lack of healthcare. For instance, among states with the highest proportion of undernourished children, Jharkhand and Chhattisgarh have the worst infrastructure for institutional deliveries.

India’s poorer states have health indicators that are worse than many nations poorer than them, and India’s healthcare spending is the lowest among BRICS (Brazil, Russia, India, China, South Africa) nations, as are its health indicators.

Every year, 55,000 doctors complete their MBBS and 25,000 post-graduation nationwide, said another unnamed expert. At this rate of growth, he told the committee, India should have a doctor (allopathic) for every 1,250 people for a population of 1.3 billion by 2020, and one for every 1,075 by 2022 (population: 1.36 billion).

“However, the committee has been informed? that doctors cannot be produced overnight, and if we add 100 medical colleges every year for the next five years, only by the year 2029 will the country have an adequate number of doctors,” the second expert said.

The shortage of doctors, the report said, is despite the increase in medical colleges, from 23 in 1947 to 398 at the end of 2014. India, the report noted, has more medical colleges than any country, and 49,930 admissions were available in 2014.

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“An expert who appeared before the committee submitted that India was very very short of doctors and to meet this shortfall, India needs to have not four hundred, but one thousand medical colleges,” the report said.

The central government has approved 22 medical colleges with 1,765 seats in the last two years, according to an e-book published by the Ministry of Health and Family Welfare.

The NITI Aayog, the government’s think-tank, has prepared the draft National Education Commission Bill, 2016, to reassess India’s healthcare and medical-education infrastructure.

While 11 new All IndiaInstitutes of Medical Sciences (AIIMS) have been added with 1,100 seats, the government has proposed an additional 4,700 MBBS seats.

As many as 5,540 MBBS seats and 1,004 PG seats have been added in the last two academic sessions, the e-book said.

Medical-education shortages manifest themselves in under-staffed public-health services nationwide: There is an 83 percent shortage of specialist medical professionals in community health centres (CHCs), as IndiaSpend reported in September 2015.

Public-health centres across India’s rural areas — 25,308 in 29 states and seven union territories — are short of more than 3,000 doctors, the scarcity rising 200 per cent (or tripling) over 10 years, IndiaSpend reported in February 2016.

The committee was, thus, sceptical of the government’s claims of the doctor-population ratio.

“Given the fact that the Indian Medical Register is not a live database and contains names of doctors who may have passed away or retired from active practice, by now, as well as those with a permanent address outside India and that there is no mechanism in place for filtering out such cases, the Committee is highly sceptical of the ministry’s claim of having one doctor per 1,674 population,” the parliamentary report said. “In view of the above, the Committee feels that the total universe of doctors in India is much smaller than the official figure, and we may have one doctor per 2,000 population, if not more.” (IANS)

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  • Kabir Chaudhary

    There are more than enough doctors graduating from medical schools in the country but they seem to run to other countries to earn cash, rather than saving and treating patients in their own country.

    • steve webster

      That is because in Canada they can often go back to school one year plus take up junior position under a doctor here in a rural area for 2 more years . After the first year they are often sending $3,000 to $4,000 per month back to their family in India to cover debt to cover education . After being in Canada 3 years they can make many times what they would in India, It very frustrating to be in country short of ambulances and supplies for the bottom third.

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  • Kabir Chaudhary

    There are more than enough doctors graduating from medical schools in the country but they seem to run to other countries to earn cash, rather than saving and treating patients in their own country.

    • steve webster

      That is because in Canada they can often go back to school one year plus take up junior position under a doctor here in a rural area for 2 more years . After the first year they are often sending $3,000 to $4,000 per month back to their family in India to cover debt to cover education . After being in Canada 3 years they can make many times what they would in India, It very frustrating to be in country short of ambulances and supplies for the bottom third.

Next Story

Across Asia’s Borders, Survivors Of Human Trafficking, Dial in for Justice

The trial has been ongoing since 2013

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Tara Khokon Miya is seen in her village home in Shipur, Bangladesh, Feb. 26, 2018. She is helping to prepare her 27-year-old daughter to testify via videoconferencing technology against the men who trafficked her to India.
Tara Khokon Miya is seen in her village home in Shipur, Bangladesh, Feb. 26, 2018. She is helping to prepare her 27-year-old daughter to testify via videoconferencing technology against the men who trafficked her to India. VOA

When Neha Maldar testified against the traffickers who enslaved her as a sex worker in India, she spoke from the safety of her own country, Bangladesh, via videoconferencing, a technology that could revolutionize the pursuit of justice in such cases.

The men in the western city of Mumbai appeared via video link more than 2,000 km (1,243 miles) west of Maldar as she sat in a government office in Jessore, a major regional hub for sex trafficking, 50 km from Bangladesh’s border with India.

“I saw the people who had trafficked me on the screen and I wasn’t scared to identify them,” Maldar, who now runs a beauty parlor from her home near Jessore, told Reuters. “I was determined to see them behind bars.”

“I told them how I was beaten for refusing to work in the brothel in the beginning and how the money I made was taken away,” she said, adding that she had lied to Indian authorities about her situation after being rescued, out of fear.

Thousands of people from Bangladesh and Nepal — mainly poor, rural women

and children — are lured to India each year by traffickers who promise good jobs but sell them into prostitution or domestic servitude, anti-slavery activists say.

Activists hope the safe, convenient technology could boost convictions. A Bangladeshi sex trafficker was jailed for the first time in 2016 on the strength of a victim’s testimony to a court in Mumbai via video link from Dhaka, Bangladesh’s capital.

Convictions for cross-border trafficking in the region are rare as most victims choose not to pursue cases that have traditionally required them to testify in Indian courts, which meant staying in a shelter for the duration of the trial.

“They have always wanted to go back home, to their families,” said Shiny Padiyara, a legal counsel at the Indian charity Rescue Foundation that has facilitated videoconferencing cases and runs shelters for trafficking victims. “And most never return to testify.”

But videoconferencing is making it easier to pursue justice. Survivors have given statements, identified their traffickers, and been cross examined in at least 10 other ongoing international cases in Bangladesh, advocates said.

“Enabling victims to testify via video conference will lead to a possible decrease in acquittal rates for want of prime witnesses,” said Adrian Phillips of Justice and Care, a charity that supports the use of video testimony to help secure justice.

Even then, it is tough. During Maldar’s three-hour deposition, she withstood a tough cross-examination, showed identity documents to prove her age and countered allegations by the defense lawyer that she was lying about her identity.

Students Combat Human Trafficking
Students Combat Human Trafficking, flickr

‘Unpardonable’

Tara Khokon Miya is preparing her 27-year-old daughter to testify against the men who trafficked her to India from Dhaka, where she had been working in a garment factory.

“I almost lost my daughter forever,” she said, sitting in her home in Magura, less than 50 km from Jessore, describing how she disappeared after work and was taken to a brothel in India, and raped and beaten for almost a year before being rescued.

“What the traffickers did to my daughter was unpardonable,” Miya said, wiping her tears. “We seek justice. I nurtured her in my womb and can’t describe what it felt like to not know about her whereabouts.”

The trial has been ongoing since 2013 when the young woman, who declined to be named, was repatriated. The charity Rights Jessore is helping the family through the process, by providing counseling and rehearsing cross-examination.

“The best thing is her father will be by her side when she talks in court,” Miya said, finally breaking into a smile.

India signed a bilateral agreement with Bangladesh in 2015 to ensure faster trafficking investigations and prosecutions, and with Nepal in 2017, and laid down basic procedures to encourage the use of videoconferencing in court proceedings.

“The procedure is very transparent,” said judge K M Mamun Uzzaman at Jessore courthouse, which often converts its conference hall into a courtroom for videoconferencing cases to protect survivors’ privacy.

“I’m usually present and victims are able to testify confidently … it is easy and cost effective for us,” he said. “But the biggest beneficiaries are the survivors.”

Silencing Victims
Silencing Victims, pixabay

The future

Videoconferencing in Bangladesh has been plagued by technical glitches such as power cuts and poor connections.

“Sometimes the internet connection is weak or it gets disconnected during the testimony,” said Binoy Krishna Mallick head of Rights Jessore, a pioneer in using this technology to encourage trafficking survivors to pursue justice. “But these are just teething troubles.”

The bigger challenge, activists say, is to ensure survivors remain committed to the trial despite delays caused by a backlog of cases and witnesses’ failure to appear to testify.

Swati Chauhan, one of the first judges to experiment with video testimony in 2010, is convinced that technology can eliminate many of these hurdles.

Also read: Imagining Panun Kashmir: Dissent And Detente in South Asia

“Victims go through a lot of trauma, so it is natural that they don’t want to confront their trafficker in a court — but that doesn’t mean they don’t want the trafficker to be punished,” she said. “A videoconference requires meticulous planning and it is not easy coordinating between departments and countries. But it is the future for many seeking justice.” (VOA)