Lack of infrastructure has led to the growth of substandard private medical colleges that charge exorbitant fees.
The shortage of doctors, paramedics, and public healthcare institutions, coupled with a lack of significant development of public healthcare infrastructure in the last 10 years, has taken a toll on medical healthcare availability and affordability for the common man in India. This has led to the mushrooming in the last few years of private medical colleges with substandard infrastructure, charging exorbitant capitation fees.
Among the 476 medical colleges that function in India, fewer than 170 are government medical colleges, and among the 56,000 undergraduate seats on offer for MBBS across the country, only 8,000-9,000 are in government medical colleges, while the rest are with private medical colleges that often charge exorbitant fees as well as very high capitation fees for admission into these private colleges.
According to NIRF (National Institutional Ranking Framework) ranking of 2018, only four government medical colleges for undergraduates have featured on the list of top 10, offer less than 550 seats in total for medical aspirants into top government colleges in India.
On the condition of anonymity, a senior doctor and former member of the Medical Council of India (MCI) told this correspondent that successive governments have failed to provide government medical colleges to the lakhs of aspiring medical students who end up in private colleges many of which lack even the basic infrastructure.
“We have a dearth of good medical colleges in India. Children of rich parents often go to study medicine abroad when they cannot make it to good colleges here in India, because most of the private medical colleges that have come up in the last few years have little or substandard infrastructure and the amount of fees and capitation fees that these colleges charge is exorbitant. It is also not unknown how licences are granted to these newly started colleges by the MCI. Therefore, what can one expect from such colleges?” the doctor asked.
The Parliamentary committee on health and family welfare that presented its report to both Houses of Parliament in 2016, had also observed about the illegal and exorbitant “capitation” fees being charged by private medical colleges and the disconnect between public health and the medical education system in India. This was observed by the committee when they were probing the 82-year-old Medical Council of India responsible for regulating and granting licences to medical colleges.
For instance, for completing MBBS from Medical College and Hospital in Sangli, Maharashtra, a student needs to pay over Rs 1 crore, while the same degree costs over Rs 1.2 crore at the Medical College, Pune.
Not only this, public healthcare infrastructure in India is also pathetic. India has a little over one million allopathic doctors for a population of 1.33 billion. This translates to a patient-doctor ratio of 1:1596 (assuming a population estimate of 1.33 billion), which is way higher than the mandated ratio of WHO (World Health Organisation) requiring a doctor to patient ration at 1:1000, which means one doctor per 1,000 population, according to data of the Ministry of Health and Family Welfare.
The data further provides that a total of 28.8 lakh nursing personnel are registered in the country as on 2016.
Experts have said that there is going to be a huge shortfall of nurses in the coming years as the rapidly increasing population in India would require over 6 million nurses in the country by 2030. On the contrary, several of the nursing institutes in various colleges are shutting down due to fewer takers wanting to join the nursing sector in India.
The condition of government hospitals in India is also very poor in terms of infrastructure as well as capacity. According to the National Health Profile report of 2018, in all, the country has a little over 23,000 government hospitals. Each government hospital in India serves around 55,000 patients, making the ration of one government hospital per 55,000 population.
The ratio of availability of beds per thousand population is such that not a single bed is available per 1,000 population in government hospitals; in fact, for 1844 persons, one bed in a government hospital is available as per the National Health Profile report of 2018. The report further provides a glimpse of how patients are forced to share beds in hospitals, mostly in the rural areas.
Making an observation on the shortfall of nurses, doctors and hospitals, former health secretary Keshav Desiraju, told The Sunday Guardian, “The country is facing a huge shortage of doctors and nurses. We will not be able to achieve any of the targets we are setting for ourselves in the health sector unless we address these issues. We will have to have the right staff and specialised staff to support the growth of our healthcare system. The specialised doctors currently there in the country are too pricey and are mostly out of bounds for the common people.”