Bridge course to legalize fake doctors or quackery

Why we need more qualified and quality doctors rather than just trained quacks ? 

Dr. Harjit Singh Bhatti 

National medical commission (NMC) bill 2017 introduced to parliament by our honorable union health minister on 29th December 2017, has a clause of bridge course to register alternative medicine (AYUSH) practitioners to evidence based medicine. Though there is no specification given in the bill behind this move but most probably it was done to tackle with shortage of doctors in India which is a matter of serious concern.

We are dealing with an urgent and critical shortage of doctors, without implementing changes thousands of people in the poorest countries in the world will continue to suffer,” said Lord Nigel Crisp, co-Chair of the Task Force for Scaling up Education and training for Health Workers. So this is quite clear from the above statement that lack of doctors is a global problem but the question is about the political commitment for the cause. Whether public health is a priority for government or not. World health organization (WHO) in a statement made in 2006 says that even if the country has worlds best health care system they can’t deliver the basic services to their public if they lack doctors

In India no one exactly knows about Doctor Patient ratio because we don’t have computer based database. All the figures mentioned anywhere is arbitrary. Health ministry claims that it is 1:1674, which is based on Indian Medical Register which shows around 9.29 lakh registered doctors. Then by assuming 80% availability of doctors we get a magic number of 7.4 lakh. whereas a parliamentary committee report on the functioning of Medical council of India (MCI) said that it’s 1: 2000 or more as Indian medical register is not live database and contains names of doctors who may have passed away or retired from active practice, by now, as well as those with a permanent address outside India and there is no mechanism in place for filtering out such cases.out of all the strength of medical professionals only 20% work in rural areas. Government of India has three tier system of healthcare centres: sub-centres manned by assistant nurse practitioners at the base, primary health centres with one or two general physicians in the middle, and community health centres with four specialists at the top. According to 2015 data from the Union health ministry, in primary centres, 11.9% of the doctor positions are vacant. And at community health centres, a staggering 81.2% of specialist positions are not yet filled.

Now comes the issue of quacks or unqualified, unskilled, unregistered or fake doctors, according to a recent survey it was seen that 60 % of primary healthcare is dependent on these quacks. They are deep rooted into the healthcare system of India. 80 % of rural population is dependent on them. Though many laws are intact to tackle quackery but no major action was taken by any successive governments to tackle quackery, neither any action was taken nor any major landmark conviction to stop quackery.  They are playing with lives of people. It was estimated that India have more than one million quacks which is almost double the strength of registered doctors. It was also observed that most of these fake allopathic doctors are graduates of Ayurveda, Unani, Siddha, homeopath or other forms of alternative medicine.

Government of India knows this reality but they don’t know how to use them for political benefits, so they came with the concept of legalising fake doctors by bridge course. It will improve India’s statistics by showing that India has increased healthcare professionals to tremendous level but in reality nothing will change only this one million quacks get legalise and can be used into statistics. whole world will say that India’s healthcare has a major shift but in reality everything remains same. Those quacks will continue to work the same way and continue to play with the lives of people but now without fear and with permission from government.  It’s in the same way as legalising murder and loot will decrease crime rate. So is that accepting and legalising the faulty methods are the only option for development. Whole of India’s brilliantly minded bureaucracy and politicians has only this as an option of last resort. I think something differently.

Instead of legalising them to register into the medical commission and calling them doctors, it’s better to train them, post them into rural areas and call them “rural health workers” as our health system has Accredited social health activist or ASHA, government of India can employ them as rural health workers and make them take part to revolutionise healthcare in India.

Why we need more qualified and quality doctors rather than just trained quacks? the answer is simple but needs political commitment for understanding. They firstly need to understand what is health and how to define health care system.

According to WHO 1983 definition “health is a state of complete physical, mental, social and spiritual well being and not merely the absence of disease or infirmity” so today even after 70 years of independence our definition of health is restricted only on diseases and infirmities. We are not concerned about mental health and only discuss about life expectancy. Statistics has shown a glorified rise in life expectancy from 27 years at 1947 to 68 years at 2017. But no one thinks about those who don’t want to live. Who is responsible for those who end their life at the age of 20, is that life expectancy of even 100 years matters for them. Mental illnesses can be prevented and reverted but due to poor governmental policies that will remain out of the domain of health care.

Social health involves your ability to form satisfying interpersonal relationships with others. These relationships are above religion, race and caste. Concept of social health is based on equity. Where all are equal and everyone have their role in society.  It also relates to your ability to adapt comfortably to different social situations and act appropriately in a variety of settings. With sound social health comes empathy, feeling of responsibility and accountability. This is governments responsibility to make appropriate policies to improve social health. But our Government can’t able to think beyond Hindu and Muslim so they made everyone sick in social health but no one cares.

The spiritual health is the most complicated and controversial one because it implies to a phenomenon that is not material in nature, but belongs to the realm of ideas, beliefs, values and ethics that have arisen in the minds and conscience of human beings, particularly ennobling ideas. Spiritual health represents the independence of thoughts, where you are allowed to think, speak and criticise the way you want. You will not be trolled and become a victim of bullying by gangs of political parties just because you are thinking independently. So the question is, is that our government wants us to be spiritually healthy? The answer lies in the current situation of India.

When it comes to health care system, the most acceptable definition is given by Hsiao (2003) “A health system is defined by those principal causal components that can explain the system’s outcomes. these components can be utilized as policy instruments to alter the outcomes” Hsiao emphasised on three different dimensions of health system; Policy lever, intermediate outcomes and ultimate ends. These three of the dimensions need strong political commitment rather than blaming the doctors to accomplish the ultimate goal of health for all. To find the real culprit behind this crumbled health system we need to introspect more into these three dimensions.

First and most important policy lever is financing, means how much a government invest in health care. India invest 1.4 % in health care out of 7 % of GDP expenditure on social services. Global average is 5.99 % of GDP. In new health policy 2017 government promised to increase health care expenditure to 2.5 % of GDP in a time bound manner. Today around 70 % of urban and 63% of rural population depends on private health sector. The main reason for moving away from public sector is poor quality of services, non availability of latest technology, long waiting time, long distance from home as most of the good public hospitals are located in cities far from the reach of poor rural population. So instead of spending so much money on travel they prefer to seek medical advice from private practitioners near their home. Due to poor functioning of primary and secondary care centres of India, it’s an irony that India have more accessible private than public sector. So first and foremost government must improve financing at least at par as global average, second is ease out the payment options –recently government has decreased % of GDP on health care by saying allocated funds are not utilised by concerned authorities for public health. but the reason behind non utilisation is the cumbersome process of getting funds and their expenditure. That process is so time consuming that it passes the time period of its release and the funds go back to government. Third is regulation of private sector involvement into public health. Since the introduction of private sector into health care since early 80s health has became a commodity rather than fundamental right. 62 % of Indians spend out of the pocket expenditure (OPE) for health related cost. this means they buy their health, this pushes around 69 million of people into below poverty line every year. 3rd most populous country of the world with maximum reliance on private sector, US citizens spend only 13.4% of OPE. And the last is financial risk protection, it’s a responsibility of state to take care of their people. They must be protected financially. 2014 Indian government study shows that only 17% of population is insured for health, which is provided by private health insurance schemes.  They only cover hospitalisation and associated costs but not consultations or medications which is the main cost consuming things. Rashtriya swasthya Bima Yojana (RSBY) provides health insurance to unrecognised sector worker belonging to the BPL category. National health for all assurance 2017, which also shows focus on moving from “sickness” to “wellness” reflects some commitment from government but when this assurance will convert into reality is a long standing wait and a matter of debate.

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About the Author

Dr. Harjit Singh Bhatti

Author & Senior Resident _

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Dr. Harjit Singh Bhatti is President, RDA AIIMS, New Delhi
Senior Resident, department of Geriatric Medicine, AIIMS, New Delhi
National Convener, National Health for All Movement

Disclaimer : The views expressed by the author in this feature are entirely his own and do not necessarily reflect the views of INVC NEWS.