Health Check
Healthcare Labor
force Economics
Providing accessibility, affordability and assurance in healthcare By: Dr.Mahboob Khan Phd
An adequate manpower
supply is important for the effective and
efficient delivery of health care
services and, therefore, for
Indian population health and the
cost and quality of health care.
There are various groups,
industry and regulatory bodies
that have been putting up the estimates of the supply and
demand and the gaps for
healthcare workforce in India
and that for doctors, nurses,
paramedics, etc and we can
keep arguing as to which one is
right and which one is wrong. At
a broad level, lets look at it from what we have relative to
the world, rather than
benchmark with developed
healthcare systems or emerging
healthcare systems of the world
as India is unique in the way it
is innovating healthcare delivery
and it would be wrong to make
comparisons on
doctors/nurses/paramedics per
1000 population, etc. As the
graph depicts, India has 18 per
cent of world’s population
(fairly young) with 20 per cent
of world’s disease burden. Producing over
50,000 doctors and nurses a
year, the supply of healthcare
manpower is woefully
inadequate, although India has
the largest number of medical
and nursing colleges in the
world! For the last 10 years or
more, the industry has been
crying out loud for a major
reform of the way medical
education and supply side
constraints of talent in India
has been governed. The
major constraints in the implementation of
government’s health
programmes and schemes have
been in the realm of physical
infrastructure, manpower and
other support facilities for an
effective healthcare delivery
system. Infrastructure where
available had not been fully
operational due to critical gaps
in availability of healthcare
manpower. Hence the
importance of developing a
skilled, motivated and supported
health manpower is now largely
realised to achieve the national
health goals. Indian Government
Policy Interventions Assessments of the adequacy
of healthcare supply often
focus on three dimensions of
the healthcare worker
population: its size; its
composition (e.g., the mix
56 India January 2016
between primary care and
secondary and tertiary care); and
its geographic distribution. For
the first-time in India, a
national-level healthcare skill
survey is being undertaken by
National Skill Development
Council (NSDC) that will
inform us on some of the three
dimensions mentioned. Last week, the Cabinet
Committee on Economic
Affairs (CCEA) on cleared a
Ministry of Health and Family
Welfare’s proposal to add
10,000 seats in state and central
government medical colleges
for the undergraduate (MBBS) level in a move
aimed at reducing the nation’s
disease burden. The decision
comes a week after CCEA
cleared a proposal to set up 58 government medical
colleges with 100 seats each.
While as doctors provide
health care services that, with
some exceptions, cannot be
provided by non-doctors, the
size, composition and
geographic distribution of the
doctors in India affects the
amount and type of health care
services available. I am a bit surprised at the nature and
the timing of all this. There is also a question on whether
we are taking the right policy
decisions in addressing India’s
health manpower economics
through various medical and
nursing Councils that exists
today in India and work in
tandem. Opportunity Lost for
Affordability,
Acessability and
Assurance in Healthcare Affordability: The Cost and
Benefits of Developing Careers
in Healthcare in India It costs approximately `2 crores
per seat to set up a medical
college for 100 seats in India.
While this may be economical,
investments in medical colleges and
doctor training is a lengthy
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What is the future of Medical Education? As per the Milbanks Report
on the Future of Academic
Medicine 2025, there are 3 key trends that are
impacting medical education
1. Digitalisation of
Healhcare • New science and
technology, particularly
genetics and IT
• Speed of internet and
digitalisation • 24/7 society • Lack of agreement on
where healthcare
begins and ends
2. Personalisation
of Healthcare
• Rich and poor gap • Seeking “wellness”
and rise of self-care
& sophistication • Increasing anxiety about
security and ethical issues
• Emergent diseases
3. Globalisation
of Healthcare • Gap between what can
be done and what can be
afforded • Increasing accountability
of all institutions
• Loss of respect for
experts •Economic and political
rise of India and China
India January 2016 57
Health Check
(in `) value within the healthcare manpower spectrum, when compared with other sectors, their respective attractiveness is low, resulting in relative enrolments in medical schools and also para medical schools remaining low and in some cases even the seats not being filled in.
Accessibility: Providing trained staff in different parts of India Due to overpopulation and a tremendous disease burden, along with inadequate resources and policies, there process; therefore, changes creating a revolving door has been a perpetual demand- implemented to alter supply phenomena. supply gap of medical do not have immediate effects To better understand the professionals as well as health on the supply of trained attractiveness of medicine as care resources in most parts healthcare professionals. a career in India, a couple of of the country, especially in Hence the proposed years ago, we had carried rural India, with demand investments made by the out an interesting exercise in always exceeding supply. The Government in medical college trying to compare different majority of medical school will require a couple of years careers in healthcare in India and residency training occurs for the impact to be visible in and their life time value to in hospital settings, where the healthcare system. While compare them on a common there are fewer primary care new medical colleges are being parameter in rupee terms. The role models and a greater planned, investors in existing chart below vividly compares orientation toward specialty medical colleges are looking them. care. Role models and at exits as they expectation It is interesting to note exposure are important factors on their investment is not that although surgeons and in specialty choice; therefore, attractive due to the size of medical adminstrators in India hospital-based training may quota seats and capitation, command a higher life-time influence medical students
It is important to
better understand
the attractiveness
of medicine as a
career in India
58 India January 2016
toward specialties. Hence
there is pent up demand and
premium for specialty MD
seats in India with some
specialties such as radiology
commanding a premium of
over crores of rupees. A recent estimate reveals
that as many as 40 per cent
of rural posting by trained
medical graduates and post
graduates in different states
in India are not fulfilled. There is a huge shortage of
gynaecologists, cardiologists
and child specialists in rural
hospitals in the government
sectors. Hence the government
announcement to increase the
supply of medical graduates
may still not address the
accessibility issue.
Assurance: Training to medical
professionals meets global
standards to perform in any
healthcare system Medicine in globally is
complex, and there is significant
variability in training programs
in India and elsewhere. Much of
how medical care is provided in
any part of the world is rooted
in local and regional cultural
standards, and mastering these
standards can be achieved only
by total immersion in that
system of medical care over
time and under strict
supervision. Medical education
are supposed to be overseen by
the different Councils of India,
which is responsible for
ensuring the quality of both
the infrastructure and the
professors at India’s medical
institutes and also provide
assurance that they meet the
global standards. Since
demand is high, it is difficult for schools to retain faculty
over the long term, which
creates a lack of continuity
in both the school’s practices
and its policy. The plethora of
new and underequipped
medical schools will create
more doctors and healthcare
professionals on paper, but will
lower the quality of the doctors
produced, further exacerbating
the preexisting shortage. So,
while attempting to alleviate a
shortage of doctors, India has
managed to create a completely
new crisis on top of the
preexisting one - the shortage
of teaching professionals in
these medical collages. Various
estimates put this somewhere
between 75,000 to 100,000
trained teachers and
professions currently.
Another issue of assurance is
that Indian trained doctors have
to undergo additional training
abroad or have to compromise
with lower pay and status as a
doctor abroad inspite of have
similar degree as compared
with doctors coming out from
medical colleges abroad. Healthcare Manpower
Economics – Where do
we go from here? In order to achieve our
healthcare outcomes and meet
the growing requirements of
skilled and trained healthcare professionals in India
that is meeting global standards,
rather than a siloed approach to
planning through various
councils in India. My
recommendation is a holistic approach from
planning manpower and human resources actions
to working on individuals
objectives and assurance that
the healthcare system delivers
to the requirements of India’s
population health outcomes.
As many experts have
postulated that the future of
medical education will play on three key themes.
It is necessary to prepare our
healthcare manpower for the future. Summing Up Mere policy announcement
for opening up more medical
colleges in India is not the
panacea for solving the
shortages in the supply of
healthcare professionals and
the people to train healthcare
professionals. It is time we
look at the issues holistically
and plan for the future!
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About the Author: Dr.Mahboob khan has earned
recognition as an healthcare
consultant in health sciences,
education, JCI,NABH
Innovative tech and
information communications
and technology (ICT). His
expertise positions him as one
of the thought leaders in India,
Asia Pacific and emerging
markets. In his 12 years of his
career, he has carried out over
16 projects leads on quality He has chaired various
committees at various
Healthcare industry bodies.
Dr.Mahboob is an advisor for
healthcare services He can be
contacted at:
India January 2014 59