New Delhi: In the Lok Sabha Wednesday, Prime Minister Narendra Modi described doctors and nurses as “reincarnations of God” who saved India from Covid-19. But the fact is that the country suffers from an acute shortage of medical professionals, particularly doctors and nurses.
Every allopathic doctor in India caters to at least 1,511 people, much higher than the World Health Organization’s norm of one doctor for every 1,000 people. The shortage of trained nurses is even more dire, with a nurse-to-population ratio of 1:670 against the WHO norm of 1:300.
These figures have been reported by the 15th Finance Commission, in a first-of-its-kind stock-taking exercise in the backdrop of the Covid-19 pandemic. The panel has put out some appalling statistics about the chronic shortages in India’s health system, and also drawn international comparisons to drive home the importance of strengthening the health system.
The Finance Commission, in its report submitted to the government last year and made public last week, dedicated a chapter to health for the first time. “In 2018, there were 11.54 lakh registered allopathic medical doctors, 29.66 lakh nurses and 11.25 lakh pharmacists in India,” it said.
The population per allopathic doctor varies widely, ranging from 380 in Goa to 17,060 in Nagaland. The same is true for nurses — Kerala has the best numbers, with 111 people per trained nurse, while Jharkhand is last with 4,019.
“Among the major states, Jharkhand, Chhattisgarh, Uttar Pradesh and Bihar fare very poorly. Among the major states, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Maharashtra and Uttar Pradesh are way behind others in government doctors-to-population ratio. The shortfall of nurses is highest in Bihar, Jharkhand, Sikkim, Telangana, Uttar Pradesh and Uttarakhand,” the report said.
“There is also a significant shortage of all categories of health workforce in government health facilities. Seats in medical colleges are highly skewed across states, with two-thirds of all MBBS seats in the country concentrated in seven states (Tamil Nadu, Kerala, Andhra Pradesh, Telangana, Karnataka, Maharashtra and Gujarat),” the commission noted.
Poor beds-to-population ratio
The Finance Commission report described the hospital beds-to-population ratio as a “crude proxy” of the vulnerability of a health system.
“India is estimated to have a total of 18,99,228 hospital beds (over 60 per cent of which are in the private sector), that is, roughly 1.4 beds per 1,000 population. This is lower than in many comparator countries: China’s bed density exceeds four per 1,000; Sri Lanka, the United Kingdom and the United States have around three per 1,000; and in Thailand and Brazil, hospital beds exceed two per 1,000 persons,” it observed.
“Within India, hospital bed densities are particularly low in Bihar, Odisha, Chhattisgarh, the erstwhile state of Jammu and Kashmir, Jharkhand, Manipur, Madhya Pradesh and Assam. Gujarat, Uttar Pradesh, Maharashtra, Andhra Pradesh, Haryana and Telangana have relatively low densities of public hospital beds, but this is made up by the availability of private beds,” it stated.
However, the commission clarified that hospital beds alone do not present a complete picture of the health system. India, for example, has a three-tier system, which means sub-centres, primary health centres and community health centres make up the first rung of the health system. The commission found that there was a significant shortfall in the number of centres required, ranging from 23 per cent for sub-centres to 28 per cent for PHCs to 37 per cent for CHCs. There is severe deficit of public health facilities in Bihar, Jharkhand, Uttar Pradesh and West Bengal, it said.
“The Covid-19 pandemic has exposed various fault lines in the country’s health sector. Low investment, sharp inter-state variations in the availability of health infrastructure and in health outcomes, supply side problems of doctors, paramedics, hospitals and inadequate number of healthcare centres like primary health care centres, sub-centres and community health centres are some of the structural challenges that exist. Consequently, we find about 70 per cent of expenditure on health is out of pocket, one of the highest globally,” the commission stated.
National health programmes have done well
The 15th Finance Commission recognised the role played by national health programmes in tackling diseases like malaria and tuberculosis and the strides that the Universal Immunisation Programme (UIP) has made in enhancing coverage of childhood vaccines such as polio, measles, diarrhoea etc. UIP, which includes 11 vaccines, aims to vaccinate all mothers and babies in the country.
It also noted the advances made in maternal and child health with reduction in maternal and infant mortality over the years, alongside a healthy dip in birth rates, even as institutional births have gone up steadily.
“National health programmes have played a crucial role in tackling several serious health concerns. The malarial death rate in India declined to 0.02 deaths per 100,000 population in 2018 from 0.10 deaths in 2001, and the country has achieved the Millennium Development Goal (MDG) of halting and reversing the incidence of tuberculosis (TB) by 2015. There has been significant progress in achieving immunisation coverage through the Universal Immunisation Programme (UIP) which provides protection from six vaccine-preventable diseases,” said the report.