Time IMA demanded affordable medical education

Indian students evacuated from Ukraine arrive in Mumbai on Sunday. Pic/ANI

In a welcome move, the Indian Medical Association (IMA) has urged Prime Minister Narendra Modi to allow medical students returning from war-hit Ukraine to be accommodated in the colleges in India as a one-time measure. Now, it's time the IMA took up the demand for providing affordable medical education in the country. It should tell the PM that to achieve this affordability, the country needs at least one government medical college (MBBS degree) in each big district, where seats for post graduation can also be created when they fulfil the norms. As of now, the ratio of affordable government and highly expensive private medical colleges is almost 50:50. Besides, in addition to government and private medical colleges, private institutes, which are given PG seats costing a bomb for students, are mushrooming. The fees for undergraduate and PG courses in private medical colleges is much higher than in the government colleges in India and countries like Ukraine where over 18,000 Indian students are at the various stages of their courses. Most of them have returned home to face an uncertain future.

The IMA is considered the most influential superstructure of allopathy doctors (MBBS, specialists and super specialists). Its members work in hospitals and medical colleges run by the government, semi-government, private and corporate entities. The members also practise individually in the urban, semi-urban and rural areas. They know well about the quality and quantity we need to make healthcare affordable in the country of 140 crore people. Parliament was informed last winter that the doctor-patient ratio in India was 1:834, better than the World Health Organization's recommendation, assuming 20 per cent availability of 13 lakh allopathy doctors and 5.56 lakh Ayush doctors. The number of allopathy doctors may appear bigger than others, but we are still behind the WHO-prescribed ratio of 1 MBBS doctor per 1,000 patients. We plan to achieve it by 2024. The question is even if we achieve the ratio, how many of the allopathy doctors, especially specialists, will be affordable to the economically weaker sections (EWS) of the society?

Doctors who have an MBBS degree from a government college but didn't get a PG seat may settle in such ‘poor' areas. Entrepreneurs among them may set up speciality hospitals, but they would soon become expensive for the EWS, despite being covered by the government for serious ailments through various schemes. In such a situation, the EWS depends on government clinics, primary health centres and district hospitals that are always short staffed and don't have qualified MBBS and specialist doctors. The patient's last hope lies with better equipped government/civic hospitals such as Mumbai's which are the most sought after healthcare destination for the EWS and middle class. Not all may be aware that the medical colleges that are attached with these government/civic hospitals produce the country's finest doctors. Government facilities in Pune, Nagpur and other places are no different. These government colleges are allotted to students who get higher grades in the entrance; the general as well as the reserved categories.

During the Covid-19 pandemic or any other emergency, the government facilities, big or small, urban or rural, are burdened the most despite the lack of human resources and infrastructure. The lack of a public healthcare budget is another subject. We are exploring the ways of bringing more well-educated allopathy doctors to affordable public healthcare, especially where they are not available. The process begins with making medical education cheaper, and providing better salaries and perks to the doctors who are willing to work with the public healthcare set-up. The government may make the law stringent to hold them back in service, but should not make them feel they are second-class professionals when compared to their counterparts working in the corporate and private sector.

Recently, the National Medical Commission came out with guidelines that the fees for 50 per cent seats in private medical colleges and deemed universities (government quota seats) should be charged equivalent to the government medical colleges of a parent state. Capitation fee is barred. The guidelines will be effective from the next academic session, but upset over the diktat, the people in private medical education say that it won't be that easy for the government to make it mandatory, indicating a possibility of litigation against ‘not-for-profit' guidelines. Delaying implementation as long as possible will save these institutes a huge financial loss.

The IMA has shown its humane side in urging the PM to absorb the war-hit students, who are almost one-fourth of the country's total MBBS intake. The old provision of allowing foreign medical students in distress to intern in Indian medical colleges has been notified again. As a rule, these foreign graduates, like others, will have to crack a qualifying examination for procuring licence to practise in India. Their juniors have a long way to go. The Russia-Ukraine war has exposed us to a reality that most of us were unaware of.

Dharmendra Jore is political editor, mid-day. He tweets @dharmendrajore
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