See this new WHO report on the health workforce in India.
Below are five of the key findings, highlighted in the Preface:
(i) At the national level the density of doctors of all types (allopathic, ayurvedic, unani and homeopathic) in 2001 was 80 doctors per 100,000 of the population and the density of nurses was 61 per 100,000. The comparable figures for China were 148 for doctors and 103 for nurses. In both countries the densities were higher in urban areas than rural areas, but in India the density in urban areas was 4 times the rural, whereas in China it was twice the rural density. What this showed was that in the matter of health personnel we were less well endowed than China, which is not entirely surprising considering that China had a much higher per capita GDP, but such resources as we had were more unequally distributed between urban and rural areas.
(ii) Many individuals claiming to be doctors in their occupation did not have the requisite professional qualifications. Almost one third of those calling themselves doctors were educated only up to secondary school. The lack of medical qualifications was particularly high in rural areas. Whereas 58% of the doctors in urban areas had a medical degree, only 19% of those in rural areas had such a qualification.
(iii) The lack of trained health professionals was obviously a major constraint on our ability to achieve health delivery in a short period. To reach the Chinese level of density of doctors we would need an additional 700,000 doctors but the capacity of our medical universities at the time was limited to producing only 30,000 doctors per year. It has increased since then, but hardly to the level which would allow early closing of the gap. I also pointed out that all doctors do not need to have an MBBS degree. In China, many doctors hold only three-year medical diplomas and much of our need could also be met through paramedicals. However, there was strong opposition from the medical profession to allow “unqualified persons” to practice as doctors in any public facility. There has been some change since then, with some states recognizing three-year licentiate diplomas and thus allowing these persons to serve in public clinics and hospitals.
(iv) There was enormous variation in density across states. The density of doctors in Chandigarh (a city which is a Union Territory) was ten times that in the worst state, Meghalaya. The doctor density in Punjab, one of the upper income states, was 2.6 times higher than in Bihar, which is one of the poorest states.
(v) One of the interesting findings in the study was that the percentage of female doctors who had medical degrees was much higher than male doctors. I took the liberty of drawing the Prime Minister’s attention to an interesting inference from this fact: viz. if one was somewhere in India with no personal knowledge of individuals but in need of a doctor, one would do better in a probabilistic sense by going to a woman doctor!
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