Last year, the World Health Organization published a report titled the Health Workforce in India, which brought forth eye-opening statistics on the situation of healthcare in the country. It found that in 2001 nearly one-third of the practitioners calling themselves ‘allopathic doctors’ were educated up to only secondary school level, while a whopping 57.3 per cent did not have a medical qualification. Expectedly, this scenario was more distressing in rural areas where only 18.8 per cent of the ‘allopathic doctors’ had any medical qualification.
The report also suggests a huge skew in availability of doctors in favour of urban areas with the urban density of medical practitioners 4 times higher than rural. The document states that together, Allopathic, Ayurvedic, Homeopathic and Unani medical practitioners accounted for a strength of 79.7 doctors per lakh population in India.
While the World Health Organization mandates a doctor-patient ratio of 1:1000, in India it is as low as 1:1674. More recent data by the Medical Council of India tells us that the total number of doctors in India as on 30. 09. 2014 was 9.32 lakhs. Apart from them, 6.8 lakh Ayush practitioners also practice across the country.
When seen in this light, the government’s proposal to initiate a process of integration of Ayush doctors into the fold of modern medicine makes some sense. The government is contemplating a radical move to provide a short ‘bridge course’ to Ayush practitioners to equip them to dispense basic medical care at the primary healthcare level. According to media reports, the health ministry has already worked out details of an MoU with IGNOU for providing such a course for Ayurveda, Yoga, Unani, Siddha and Homoeopathy practitioners that will pave the way for them to prescribe basic allopathic medicines as well (albeit after approval by the Medical Council of India).
Debate is rife on whether this move will have more negative outcomes than benefits. The proponents of the initiative consider it a positive move that will help India inch towards meeting the goal of universal healthcare by improving access and delivery in remote areas. On the other hand, the Indian Medical Association is strongly opposed to the proposal, which they consider tantamount to legalizing ‘quackery’.
The reality, however, lies somewhere in between the two extreme views!
Improving access in remote areas
For those of us who have spent most of our lives in relatively affluent urban zones, it is hard to fathom the extent of deprivation faced by India’s rural masses, especially in the healthcare domain. A pragmatic analysis of the condition of healthcare in rural and remote areas will tell us that shortage of doctors is a major problem bedeviling the rural hospitals and primary healthcare centres. According to Rural Health Statistics 2014-15 of the Ministry of Health & Family Welfare there is huge shortfall of doctors and specialists in the rural healthcare system. The report tells us that shortfall of allopathic doctors in Primary Health Centres (PHCs) was 11.9 per cent of the total requirement for existing infrastructure and even sanctioned posts were lying vacant in these remote facilities. There was huge shortfall of surgeons (83.4 per cent), obstetricians and gynaecologists (76.3 per cent), physicians (83.0 per cent) and paediatricians (82.1 per cent). Overall, there was a shortfall of 81.2 per cent specialists at the Community Health Centres (CHCs) vis-a-vis the requirement. What is shocking is that around eight per cent of the Primary Health Centres across rural India are running without a doctor. Primary health care deals with basic medicine, treatment of minor ailments, immunization, child healthcare as well as natal and postnatal care. With little or no presence of private hospitals in rural areas, this leaves a large section of the rural population effectively without access to a doctor. In such circumstances, training Ayush practitioners to fill the gaps in healthcare delivery at primary level can improve the doctor-patient ratio and provide the poorest masses in remote areas some medical assistance.
Some kind of ‘doctor’ is better than no doctor
The nearly 7 lakh Ayush practitioners currently practicing in India already dispense basic medical care on a daily basis. In a country bedeviled by shortage of medical practitioners, they arguably provide some medical support to large swathes of populations deprived of healthcare facilities. In remote regions and villages where there is no MBBS trained doctor in sight for hundreds of kilometers at a stretch, thousands of Ayush practitioners help dispense basic medical services and even help save lives by minimizing fatal effects of easily treatable conditions like diarrhea. Unless and until trained doctors are made available, millions of people will continue to flock to these practitioners anyway in desperate need of medical help. In such a situation, training these practitioners in providing the right care for minor diseases and identifying and referring serious conditions to specialists seems a viable solution in the short term. Right training can help reduce the public health challenges of anemia, malnutrition, pneumonia, diarrohoea, and other communicable diseases.
Is it workable on the ground?
While the idea makes social sense theoretically, there are critical challenges to its flawless implementation. While the nod to Ayush practitioners is for primary healthcare centres, how will government agencies ensure they do not claim to know modern medicine and practice in other areas where qualified doctors are also available? In short, how will the authorities ensure the bridge course trained practitioners stick to their job description of dispensing only basic medical care in rural or remote areas? Patients with serious conditions who need immediate critical care often end up aggravating their disease or even losing their lives in the hands of untrained doctors.
Any such training to Ayush practitioners must therefore strictly be aimed to enable them dispense basic medical care and only in areas where qualified MBBS doctors are absent. This must strictly be a stop gap arrangement, not a long term solution. The long term solution lies only in producing more doctors and increasing the presence of public and private healthcare to remotest of regions.
(Author is managing director of Paras Healthcare)