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

Health Check

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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!

Health Check

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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:

mahboob804@yahoo.co.in

India January 2014 59