‘Reforms in India’s healthcare cannot happen without reforms in medical education’

Urgent health reforms for the NDA government would be:

Commitment to halve the maternal and infant mortality within five years

As you are aware, our IMR and MMR figures are not significantly better than Sub-Saharan African countries. We cannot change the IMR and MMR data without reforms in medical education. We have 50,000 under-graduate seats in various medical colleges and only 12,500 post-graduate seats. US has 20,000 under graduate seats and 32,000 post-graduate seats. Most developed countries have double the number of post-graduation seats to address secondary and tertiary healthcare requirement. With less than 40,000 gynaecologists and 40,000 anaesthetists we can’t dream of reducing the MMR.

We can use technology to tag every pregnant lady and infant. With remote monitoring using GPs, PG students and ASHA workers we can monitor the progress of every pregnant lady and infant born in this country.

Reforms in medical education

If we add 100 new medical colleges every year for the next five years, we will have adequate number of doctors by year 2025. Medical colleges promoted by the private agencies are not going to address the needs of the country due to high cost. Government should convert every district headquarters hospital of North, Central and Eastern India into a medical college. Outstanding doctors across the world generally come from deprived backgrounds. We need to get them to join the medical college.

We would like to reiterate that reforms in healthcare in this country cannot happen without reforms in medical education. Courts and Medical Council do not allow a doctor without a post-graduation degree to anaesthetise a patient or perform a caesarean section. With the existing MCI norms, it is very much possible to equalise UG and PG seats in various medical colleges. If this is not addressed, we are not going to have adequate number of anaesthetists to anesthetise a pregnant lady, gynaecologists to do a caesarean section, radiologists to do ultrasound on a pregnant lady and paediatricians to look after the newborns.

CPS-training at all government district headquarters hospitals

College of Physicians and Surgeons (CPS), established 105 years ago by the British, offers two year diploma courses in Gynaecology, Anesthesia, Paediatrics and Radiology. Unfortunately, MCI derecognised their courses few years ago. Government health system can have adequate number of broad specialists in vital areas like Anaesthesia, Gynaecology, Paediatrics and Radiology in just two years without any investment by converting all district headquarters hospital as CPS training institutions.

Capping malpractice compensation

Medical negligence compensation of Rs 12 crores by the Supreme Court against a hospital in Kolkata drove many patients to consumer courts for a hefty compensation for medical negligence. We will land in a situation like in the US within the next one or two years where insurance companies will charge three months of doctor’s salary for covering the losses of malpractice compensation. In the US, to protect the medical profession, no doctor can be sued for more than Rs 1.25 crores. Capping medical negligence compensation is a norm even in many European countries.

84 per cent of Indian hospitals have less than 30 beds in small towns, where more than 50 per cent of our children are born. One stray incidence of medical compensation of Rs one crore will close most of these nursing homes, adding significant pressure on the government health system.

Hence, I recommend that we should ensure that medical negligence compensation is capped before legal community understands the financial gains out of medical litigation.

Rationalisation of payment for surgical procedures and treatment by government and private health insurance agencies

Today 20 per cent of our country’s population is getting covered under various health insurance schemes like CGHS, ECHS, ESI, various state schemes as well as the private health insurance programmes. Unfortunately, there is no scientific study performed to find out how much it costs to do these procedures in leading government hospitals as well as private hospitals. We request the government to get one of the reputed consultancy firms to conduct a study and do the costing of major procedures in prestigious government institutions like AIIMS and leading private hospitals which offers quality healthcare and come up with a rational pricing for the procedure. Today, these prices are determined arbitrarily and this is creating major problems across the country because of ill-conceived compensation package which will force the hospitals to cut corners or refuse surgery. A standard rate which gets revised on a yearly basis will be the guideline which will help Central Government as well as various state government schemes and the private insurance companies to work out their own pricing.

Promotion of nursing and paramedical education

The nursing profession is gradually dying in India with 50 per cent reduction in admissions, especially in Southern India. This is primarily because the nursing profession does not allow career progression. If that can be facilitated and nurses can become nurse practitioners or nurse intensivists like in the Western countries, then nurses’ work will add value to offer better healthcare services to the patients.

Today, there is no body at national level or at state level governing paramedical education. Behind every doctor, there are four technicians. Today their training programme is not governed by a respectable body. If you can create a State body in every State, it will be like a paramedical university which will set the norms and help in maintaining the standard. Today, most of these paramedical courses are conducted in medical universities dominated by the doctors who, to protect their own interest, do not allow nursing and paramedical professionals to be empowered.

Statutory recognition for National Board of Examination (NBE offering DNB)

Today, with over 6000 PG seats, DNB has emerged as an effective option for doctors aspiring to specialise but lack the needed funds. Unfortunately, since last ten years, DNB is under massive attack from MCI to reduce its importance in order to maintain the capitation fees valuation of MD and MS seats. Getting recognition for the National Board as an Act of Parliament will empower DNB to expand aggressively to meet the demand of over two lakh young doctors who are spending two to five years mugging MCQs in Kerala or Kota to get one of those scarce PGseats.

Mobile phone based health insurance

Ten years ago, Yeshaswini health scheme was launched in the state of Karnataka by collecting Rs 5/- from 17 lakh farmers. At the end of ten years, over 5.5 lakh farmers had varieties of surgeries and over 50,000 farmers had a heart operation done by paying just Rs 5/- per month. We have 850 million mobile phone subscribers who are spending Rs 150/- per month just to speak on the mobile phone. If we have a regulation asking them to pay Rs 20/- extra with each mobile phone subscription every month, we will be able to offer surgical treatment for 850 million people. China has implemented a similar programme to cover cancer care successfully.

– Dr Girdhar Gyani, Director, Association of Healthcare Providers of India