By: Vijay Garg
Russia’s invasion of Ukraine has drawn unexpected attention to the Indian medical education system. The visuals of Indian students stranded in several cities of war-torn Ukraine are disturbing. One classic case of a student who found himself in the grip of a fierce battle in his efforts to reach the border of neighboring countries needs a special mention here. The evacuation brought back memories of the evacuation of Indian students stranded in the Chinese city of Wuhan, almost two years ago, at the start of the Covid pandemic.
It is well known that a large number of Indian students go to foreign universities to get medical education, but such a large number in Ukraine has surprised them. In the light of this scenario, it becomes necessary to undertake a holistic review of India’s medical education system.
One of the main reasons behind Indian students pursuing medical studies in foreign universities is the high fees in India and lesser seats in indigenous medical colleges. But this is partly true, the real problem is much deeper and is related to the state of our health system. The only way to rectify the problem would be through structural changes in the health system and medical education is a part of it. The first survey on the health system including medical education was conducted by the Health Survey and Development Committee headed by Sir Joseph Bhore in the year 1940. Many of the recommendations of this panel were implemented after independence and new institutions were created to meet the health needs of the people and medical education curriculum was improved according to the situation. Such a comprehensive and comprehensive survey of the health system was not done again, although expert committees were definitely formed from time to time on specific subjects.
In the 1980s, when the health system allowed corporate private hospitals to run, their influx of people’s real needs and tailored medical education fell apart. Prior to this time, private sector participation in healthcare and medical education was limited to the opening of charitable hospitals, charitable and minority health centres. The policy decision allowing for-profit or corporate players opened the door for private medical colleges and hospitals in place. Legally, the subject of medical education is the responsibility of the government, but some state governments put more emphasis on promoting private medical colleges.
As a regulator, the Medical Council of India (MCI), which should have been a self-control body, did the opposite by helping private players. The surplus from the agriculture sector has gone towards investing in medical and engineering education, with many private colleges either owned by politicians or are running in the name of their pawns. On the other hand, the court also in its decision gave the right to private vocational education colleges to charge more fees than government institutions. Categories like Non-Resident Indian (NRI) and Promoter quota were added to ease recruitment. Medical seats were sold to the highest bidder.
The result of all this was that like a business, medical colleges grew like a mushroom here and there. In addition, the increase in the number of private medical colleges has occurred mostly in the western and southern provinces, making medical colleges more concentrated in the region than in the rest of the country. There are also more government-run medical colleges in the southern states. Such a large number of colleges were sanctioned for dental education that some institutions are finding it difficult to even reach students. The salary that a dental doctor who passed out from here gets is less than that of a driver and a plumber. The standard of medical and dental education declined. Many private medical colleges have neither qualified staff nor attached training hospitals. The only thing is that the demand for medical and dental college seats kept increasing. Since high salaries or private practice in corporate private hospitals in urban areas generate good income, parents of children who simply did not have the capacity to pay high in private colleges, gave their children an ‘open’ education abroad. Started sending to ‘shops’.
Experience shows that the experiment to improve the system by making participation of private medical colleges in education has proved unsuccessful. There is a shortage of properly qualified medical personnel in rural areas even today. The concentration of doctors is much higher in the urban-suburban area. There is a high demand for certain types of pathologist courses, while other disciplines such as preventive medicine, public health and communicable diseases are less inclined to specialize. Some states are given more priority in allotment and expansion of medical colleges. Access to medical education has become out of reach of the poor. Above all, the cost of getting treatment in the private sector has skyrocketed. In such a scenario, it is futile to expect that all the gaps in the health infrastructure can be addressed through the private sector, including the process of students moving to countries like Ukraine.
Government agencies that are pushing for more privatization must heed some of the solutions given by experts who have suggested solutions in the past few years. Some of these ideas have been suggested by the Panel on Universal Health Care over the years. In these it was said that the governments should open medical colleges and attached hospitals in the deprived districts. Local students should be given preference for recruitment in these. In this way, the deprived areas will get medical colleges and those doctors who have studied there will be able to serve in their rural areas because they themselves are from this area. Also, gaining experience in treating local health problems during training will enhance their competencies and clinical experience. Some special rural needs related to treatment such as snake-bite, reduction in maternal and child mortality, leprosy, contaminated water-borne diseases, etc. will get special expertise. In addition, training of doctors should be made part of the overall health workforce plan rather than in isolated institutions. Many innovative ideas can be implemented according to the local specific needs of different regions and states. Adopting such schemes is very important if India is to achieve the goal of getting public health care enshrined in the Sustainable Development Goals. The tragedy of young Indians trapped in the battlefield can be an eye-opener to this need.
