we have an "inverted pyramid" structure of availability
of health care professionals. As Dr Arole's Comprehensive
Health Care Project, in Jamkhed, Maharashtra proved, fully
80% of cases can be competently handled by a well-trained
paramedical professional and only 20% need the attention
of a medical doctor. While the country requires more well-trained
nurses, paramedical professionals, general practitioners
and public health experts, we remain deficient in all those
areas. Instead, we have umpteen numbers of super specialists
who are needed by only a small percentage of the population.
In fact, you have to search really hard to find a decent
family physician, while super specialists in every conceivable
category can be found at practically every street corner.
Hyderabad boasts of more MRIs, CT scans and other fancy
high tech medical equipment than the city of London! And
yet at the same time, the majority of the poor don't even
have access to basic health care.
the quality of training for our health care professionals
has deteriorated tremendously over the past 20-25 years.
Medicine, is a demanding profession and it calls for a higher
degree of professionalism, competence, dedication and discipline
than most other walks of life. In most parts of the world,
one can get into a medical school only after the completion
of a basic four-year degree. In countries like United States,
one has to go through rigorous training ranging from 4-7
years after medical school before you are allowed to practice.
In India, we allow 16 year olds to get into medical school,
even before they fully understand what they would like to
do. And the quality of training that is imparted is woefully
inadequate. Most medical colleges in the country don't have
competent faculty to teach. There were instances of some
colleges hiring local doctors for a fee, to pose as faculty
members during Medical Council inspections!
60 % of the resource allocation in the health sector goes
for curative services, which, largely favour the rich. Rs
3 is spent on the richest quintile for every Rs 1 spent
on the poorest 20 percent! This figure has to be viewed
in the light of the fact that hardly 0.9 % of the GDP is
spent on public health, which is one of the lowest in the
world. Hospitalized Indians spend more than half (58%) of
their total annual expenditure on health care and 25 - 30
% of them end up below the poverty line as a result. There
cannot be anything more disgraceful in a modern democracy.
policy makers should wake up and realize that what we need
are more nurses and paramedics; we need more general physicians
than super specialists; and more resource allocation towards
preventive than curative services. A fundamental rethinking
in health care delivery is vital to serve the needs of our