Making #India the Medical Facility of the world- By Sanjay Dangi
“We need more education, rationalism and democracy if we are to become the hospital of the world; else, in spite of our potential, we will fare no better than our current condition” By Sanjay Dangi
Some professions ought not to exist, even though we celebrate them as noble. Soldiers and policemen, for example would not be needed if all of humanity was peaceful and law-abiding. Doctors and nurses and paramedics would not be needed, if we all lived healthy lifestyles and maintained good hygiene. But it is precisely because we are lesser mortals than our own ideals, that we need them. The second wave of COVID-19 has laid bare our weakness, both as individuals who failed to take medical advice and as a society that failed to provide for its neediest. Pictures and clips in the media only showed people lining up for oxygen cylinders, hospitals running out of essentials and the tragic black marketing of medicines.
How can we dream of building a 5 trillion economy for India? It may sound like a cruel joke, but I have my hopes. In this article, I will lay out some hard truths and challenges and then reveal the opportunities that cause me to hope.
The first truth — we are woefully short of medical professionals. Doctors and nurses require training and skills beyond the means and abilities of many Indians. Yet India trains over 30,000 doctors a year. Sadly, several of the best emigrate to lucrative jobs abroad. 50,000 India-trained doctors serve the UK population, while 1/5th of all doctors in Australia received their medical education in India. Sadly, this is because this noble profession in India is racked with inequalities. Most junior doctor jobs pay very little, and require much sacrifice. It’s only at the big league of senior doctors where the money really rolls in, creating sharp inequalities in the profession.
The second truth — we simply aren’t training enough doctors. We need 20 lakh doctors; we have 10 lakh. Their distribution among the population is also lopsided. While there is one clinic on every street in the metros, there is often none to be found for miles together in rural areas, especially in the Indo-Gangetic Belt. This has led to the rise of jhola-chhaap doctors (quacks), further endangering lives.
The third truth — our hospitals are woefully understaffed and under-equipped, even the expensive private ones that cater to the rich. The tragic story of the ex-ambassador who died of COVID-19 waiting outside a hospital is known to many — a warning that the shortages of beds, ventilators, equipment and medicines are so stark, that in pandemic-like conditions, even the rich and powerful are not spared.
The fourth truth — we simply don’t have enough hospitals. Data from the Institut Montaigne says there are 69,264 hospitals in India (43,486 of them private) with 1.98 million beds (of which only 0.7million are in government hospitals) — that is 0.0014 beds per human, if we count 1.4 billion Indians. That puts us in the honourable league of Nigeria, Uganda, Pakistan and Honduras. Countries not aiming to be the hospital of the world, like Belarus and North Korea, fare better.
The fifth truth — we as a population have an abiding suspicion of doctors and hospitals. Some of it has come from malpractices in the profession, such as overcharging for beds or conducting unnecessary, expensive tests. Various babas and maulvis have compounded the issues by making fun of the profession, spreading rumours about vaccines and promoting Ayurveda, Siddha and Unani over modern medicine.
These truths suggest that the challenges are many. But are they insurmountable? In fact, within each of these truths, is a kernel of opportunity which we can build upon, if we seize it.
The first opportunity — If we can supply other countries’ doctors, we are clearly not short of talent. The challenge is to provide an environment where this talent can bloom. We need a detailed policy that looks at paying doctors better, ensuring their career growth, prevents lopsided hierarchies and gives doctors better working hours and work-life balance. These are decisions in the hands of administrators, of both private and public hospitals.
But the opportunity is greater. Most medical interventions don’t require a full-time doctor. Trained nurses and ASHA workers can handle things like administering vaccines — after all, they were the ones who achieved the eradication of smallpox and polio. Several other professions like lab technicians and ambulance attendants don’t cost as much to train as doctors, and they are even more critically needed. Many so-called jhola chhaap doctors, who have gained half-baked information over the years, could in fact be trained to be first-level medical responders. The civil surgeon of Siwan in Bihar pioneered this idea for treating the surge of COVID-19, which sounds so radical that he was, unfortunately, suspended.
The second opportunity — India has no shortage of cement, builders, plumbers and electricians. We are the leaders in making personal protective equipment, medicines and several medical devices. There is nothing that therefore stops us from building more places of care, teaching and research. As an economy worth 3 trillion dollars already, we can also pay junior doctors and medical teachers better. 127 new medical colleges will be built in 2021, and state governments are building even more. Similarly, the concept of field hospitals and jumbo COVID care centres has helped expand capacity; surely these can now be tried for other illnesses, expanding care in rural areas.
The third opportunity — India Inc is more than capable of responding to market needs. In just two decades it could emerge as the world’s pharmacy, making 60 per cent of its non-COVID vaccines and 7.1 per cent of its medicines, including sophisticated ones like monoclonal antibodies. A country that had less than 3 lakh PPE kits in Jan 2020 could produce 2 lakh PPE kits per day by March. Similarly, carmakers could retool their lines to make ventilators at warp speed.
Can we do better? Yes, with more credit made available to drug and equipment makers, with fewer bottlenecks, lesser bureaucracy and reasonable taxes. While GST rates have been slashed and RBI has eased credit, more can be done to make the industry boom.
The fourth opportunity — Healthcare is not just about interventional care, which modern medicine does brilliantly. There is a huge opportunity in preventive healthcare, fitness and wellness — where ancient systems like Ayurveda and Unani excel. Kerala and Uttarakhand have long shown the way with spas and other wellness centres that attract foreign tourists looking for holistic solutions. What is stopping the other states?
But we can capitalise on these opportunities only if we have a culture of personal responsibility and seeking accountability from our rulers. A recent survey showed 39 per cent of Indians holding fate responsible for their condition. We need more education, rationalism and democracy if we are to become the Hospital of the World; else, in spite of our potential, we will fare no better than our current condition.
Like they say “Every adversity has equal opportunity”, it for us to decide to make this industry a success and expedite our way and move towards making the 5 trillion economy a reality.
