Reforming Medical Education

Context: Critical analysis of Government’s market approach strategies to medical education.

Issues in India’s healthcare system

• Workforce crisis: The serious shortage of health workers, especially doctors, in some northern States is a major impediment in achieving the health-­related Sustainable Development Goals.
• Imbalances within the country: Doctor-population ratio in northern States is far short of the required norm, while southern States, barring Telangana, have enough doctors in possession.
• Urban-rural divide: General lack of adequate staffing in rural areas.

Government approach

• Market-oriented approach towards medical education: NITI Aayog’s proposal of allowing private entities to take over district hospitals for converting them into teaching hospitals with at least 150 MBBS seats.

Issues cited in market approach to medical education

• Excludes poor: Corporatisation will make services costly and exclude the poor from getting care.
  • Effectiveness of public-private partnerships (PPPs) remains poor in increasing access to primary and tertiary care for the poor.
• Unlikely to meet shortages in under-served areas: As it would shut the door on a large number of medical aspirants who would otherwise have a strong motivation to work in rural areas but do not have the means to finance themselves.
• Supporting urban bias: Medical graduates trained in such private sector ‘managed’ medical colleges will prefer to find employment in corporate hospitals and not in rural areas to regain their investment.
• Not aligned with India’s national health policy goals: Like achieving universal health care and health equity.

Way forward: Need of long-term thinking and commitment from political leadership

• Making medical education a public good: Medical education is a public good as its purpose is to improve population health and decrease disease burden.
• Substantial step-up in public investment in medical education: By establishing new medical colleges, Government can increase student intake as well as enhance equitable access to medical education.
• Focus on existing medical colleges: Allocate adequate financial resources to strengthen the overall capacity of existing medical colleges to enrich student learning and improve output.