In 1909 the United States constituted a council to look after the health of medical education in America. The Carnegie Foundation (KF) was given the task. Carnegie appointed a school teacher and an educationist called Abraham Plexner to conduct the survey.
Plexner had an appraisal of all the 150 medical colleges and submitted his report. Keeping in mind the infrastructure needs for a medical college, what Plexner recommended was ‘slashing’ the number of medical colleges to just 31 from five times that number. After this eye-opening report was implemented, medical education in America transformed itself beyond imagination and hasn’t looked back since then.
Today, India needs that kind of a transformation. What it essentially means is that there should be a check on the mindless expansion of medical colleges in the country and only the qualitative ones should be recognized by the government.
The reality today is kids from only affluent families take admission in private medical colleges. Very few from the rural background are able to get into private medical colleges. There is a misconception that doctors hail from rich families, have cars and live in palatial residences. And, all this is achievable if you are a doctor in big cities. For the reason that the rural population doesn’t have money to spend on doctors, sumptuous life is impossible in village postings. So, doctors who serve in rural areas gradually develop a dislike and ultimately move to cities.
True, when a student takes admission in a medical college, his frame of mind invariably possesses an element of ‘community service.’ But, as he inches towards acquiring his MBBS degree after five years of rigorous learning, his thought-process undergoes a metamorphic change and he finds a new liking for city life.
Today, health education and health care has become more city-oriented. India’s medical education, unfortunately, is limited to the four walls of ‘doctors and investigations.’ Patients and their general well being are alien to the sanctified service of a physician. Those who are coming out of medical colleges have only one thing in mind: to work in cities and earn money.
Why doctors don’t want to honor their rural postings is not something unfamiliar: low pay, no reward and incentive for good work, faulty transfer rules, absence of a fool-proof promotional policy, lack of future prospects and absence of overall support to the profession. These problems are so deep – rooted that they need immediate reversal, although they seem unattainable.
Health care has today assumed horrifying proportions. Thousands of health centers in the country cry for just the presence of doctors and health attendants leaving alone the quality ones. The dichotomy is more glaring if one compares the quality of treatment in cities vis-à-vis villages. Yet another infirmity of India’s medical tutoring is the tendency to prescribe expensive medicines and needless tests thereby putting a heavy financial burden on patients.
Following the 1946 Bhore Committee report, post-independent India began a three-tier health care structure – primary, secondary and the apex level. But, this configuration needs enough trained personnel; and we are miserably placed.
There has been a silver lining too. Take infant mortality. We have been able to bring it down to 70 (from 120) and maternal mortality to 407 (from 840). While states like Kerala and Tamil Nadu have fared extremely well (IMR: 17), laggards have been Uttar Pradesh, Bihar and Madhya Pradesh (IMR: 100). This dissimilarity is due to the excellence of work of individuals and communities; the system being the same everywhere!
Nursing education too suffers from insufficiency- both quantitatively and qualitatively. In developed countries the doctor nurse proportion is 1:3 whereas in India it is 1:1. The Population doctor ratio is still more hopeless. It is 1:1722. When it comes to investment, government spending is hugely skewed. Facility and equipment wise private hospitals are better than government hospitals.What’s More, medical colleges are heavily concentrated in only six states – Maharashtra, Karnataka, Andhra Pradesh, Tamil Nadu, Kerala and Gujarat.These six states account for 63% of colleges and 67% of seats.
One more trouble area is the divergent position of the medical councils. MCI (for allopathic cure) and CCIM (for Indian system of medicine) often work at cross purposes and there is no unison between them. As for reforms in health, more money is spent for modern methods of treatment while traditional cure is overlooked. This, notwithstanding the fact that AYUSH doctors constitute the majority in the countryside.
In this state of affairs, what’s needed is a holistic approach to India’s medical education and health care. It needs the right direction, control and regulation. The strength of doctors, nursing and para-medical staff needs to be augmented, keeping in view the rural areas which cry for health personnel. Medical education also needs qualitative and ethical supervision. Unless steps are taken at the appropriate time; health care will be degenerated into money-making sans a ‘humane’ approach.
(The author Bhaskar Parichha is a Bhubaneswar based senior journalist and columnist. Views are personal)
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