India’s Rural Health Crisis
February 13th, 2008
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In an op-ed in Economic Times, Arvind Panagariya tells the story of Indian rural health crisis. He then provides some policy prescriptions,
This can be best accomplished by providing the poor cash transfers for out-patient care and insurance for in-patient care. Once this is done, a competitive price must be charged for services provided at public facilities as well. The government should invest in public facilities only in hard to reach regions where private providers may not emerge.
Second, the government must introduce up to one-year long training courses for practitioners engaged in treating routine illnesses. This would be in line with the National Health Policy 2002, which envisages a role for paramedics along the lines of nurse practitioners in the United States.
The existing RMPs may be given priority in the provision of such training with the goal being replacement of all RMPs by qualified nurse practitioners.
Finally, there is urgent need for accelerating the growth of MBBS graduates to replace unqualified “doctors” who operate in both urban and rural areas. Taking into account the evolution of medical colleges and assuming that doctors remain active for 30 years after receiving their degrees, there are at the most 650,000 doctors in India today. [link]
Many of these recommendations have been advocated by this blogger previously. (Here and here). Nevertheless, Pangariya’s claim that the increased number of M.B.B.S graduates would help solve the rural health crisis is not quite correct. As Policy Wise had argued,
Currently, around 600,000 doctors are registered with the Medical Council of India. The physician-population ratio of 56 per 100,000 is inadequate and below the levels recommend by the World Health Organization. However, the distribution is heavily skewed and the physician-population ratio in urban areas has been estimated to approach 200 per 100,000 which approximates the physician concentration in developed countries. In other words, India faces a severe shortage of physicians in rural areas, a problem which is not amenable merely to increased number of physicians[link]
Considering the extremely poor infrastructure in most of India’s rural areas, it is unlikely that fresh M.B.B.S graduates would be able to give up the lure of practicing in cities. The issue here is not of renumeration; doctors in rural areas are not necessarily poor. In fact, an average M.B.B.S is more likely to make money in a remote rural area than in an urban setting. (Higher prevalence of disease, low competition e.t.c.) It is the abysmal infrastructure (electricity and water, no educational facilities for children) which prevents even the struggling city physician from considering the option of migrating to rural areas. Therefore, state’s focus should be directed on training the current health professionals in rural areas to ensure that they can provide a minimum level of care. It is not to argue medical education should not be freed from the stranglehold of the government but the ameliorative effect of such a policy change on rural health–at least in the short term–is questionable.
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2 Responses to “India’s Rural Health Crisis”
Vivek Kumar February 13th, 2008 at 10:23 pm #
Well-reasoned. And it is such a vast and complex issue..
In fact, an average M.B.B.S is more likely to make money in a remote rural area than in an urban setting.
I really doubt it, despite higher prevalence of diseases and lower competition. The difference in paying capacity itself ought to be enough, but the rural folk are also less likely to approach a doctor in the first place.
Like for many other things, building good roads will probably go a long way in improving rural health. My native village doesn’t have a doctor, and the village is not asking for one. There are two medium-sized towns within 30 km range, and the roads are good (both are toll roads) so it is usually a matter of 30 mins max to reach a reasonably qualified doctor.
You would notice that in case of heavy traffic, it can take just as much time to reach a doctor in Delhi.
Occasionally, health camps are organized by the district administration to take care of education and awareness issues.
Sunita February 20th, 2008 at 6:36 am #
I disagree with Arvind Panagariya’s statement “Finally, there is urgent need for accelerating the growth of MBBS graduates to replace unqualified “doctors” who operate in both urban and rural areas.”. Many so called ” qualified” doctors (allopathic and alternative systems) behave as if “unqualified”. There need to better systems in the country as a whole to protect the poor both in rural and urban areas.
Driving while intoxicated blog May 1st, 2008 at 12:58 am #