Opinion Medical education: It is time for a health check

Medical education is in urgent need of a revamp to rescue it from falling standards and rampant commercialisation.

sujatharao

February 25, 2011 02:06 AM IST First published on: Feb 25, 2011 at 02:06 AM IST

India lacks a comprehensive policy to address the acute shortage of human resources in healthcare,which is a key driver of health costs and a huge constraint on scaling up public-health programmes. There are three reasons for the present-day crisis. One,a flawed public policy,which focuses on promoting private sector in the field of medical education. Two,poor governance,with the result that there is no standardisation of health-care providers in a manner that is relevant to the countrys needs. Three,corruption,an outcome of unregulated privatisation of medical education,that has severely compromised its quality.

In the 1990s,medical education was opened up to private investment without putting in place appropriate systems and institutional mechanisms for enforcing quality and standards. During 1995-2006,of the 106 medical colleges established,84 were private. Today,there are 313 medical colleges,of which 163 are in the private sector; 31 are deemed universities,with some reportedly misusing their autonomy by guaranteeing degrees for a price (Yashpal Committee). Considering the high premium on medical degrees in India,establishing a medical college has become a lucrative business opportunity,resulting in several non-serious players with political clout entering the area.

Medical colleges in the private sector have high tuition fees. This results in admissions being denied to meritorious students interested in medicine as a career option,since the criterion becomes the ability to pay capitation fees rumoured to be around Rs 50 lakh for an MBBS seat and Rs 2 crore for a post-graduate seat. For those students who get admitted to such colleges,recouping the investment becomes the key concern,pushing them to go abroad or practise in private hospitals and urban centres,or even resort to unethical practices. Combined with this is a highly decentralised,extremely chaotic admission procedure that requires a student to take eight-nine entrance exams. The result is a sharp reduction in the number of students opting for the medical profession,and almost one-third of seats not being filled.

The commercialisation of medical education has made qualities such as dedication,compassion and a strong sense of public service once considered a doctors prerequisites secondary. Instead,it has led to a fall in ethical standards,evident in doctors prescribing unnecessary tests and providing sub-standard treatment at a high cost,particularly in private-sector hospitals.

In 2010,to restore public confidence in the Medical Council of India,its elected body was replaced by a body of six experts through an ordinance. Several steps were taken to relax the norms and standards required for setting up medical colleges. Nineteen new courses were notified and a draft bill was prepared for establishing a National Commission for Human Resources for Health (NCHRH). The NCHRH is expected to revamp the regulatory authority by separating the three key functions of examination and standards setting; accreditation of colleges; and governance of medical practice. The overall objective of this reform is to ensure that one should feel the same level of comfort being treated by a doctor in a private college in Uttar Pradesh or Karnataka as in AIIMS in Delhi.

Reform in medical education is not easy due to entrenched interests but is urgently needed. The key areas that require attention are: establishing the NCHRH; instituting a nation-wide examination to determine college admissions; earmarking medical and nursing education for public investment,making private capital an exception; increasing the remuneration of teaching faculty and expanding their gross availability by inviting foreign faculty alongside increased use of technology; working out a fair fee structure for private medical education; creating new cadres of health professionals who are trained to address the needs of the rural population. There is,equally,a need to review the current fee structure in government medical colleges,as the monthly fee of Rs 200 is a scandal,particularly when students are under no obligation to serve the country or meet public health needs. This needs to be corrected by making a three-year service in public hospitals mandatory in return for subsidised education,a policy that should be extended to private colleges as well.

Shortage of doctors affects the poor who do not have easy access to healthcare services. Policy pronouncements and intentions to provide universal healthcare can be just wishful thinking unless backed by a political will to make education affordable and accessible to all.

The writer is former secretary,ministry of health and family welfare