The Union Health Ministry’s data reveals a startling truth; over half (57.3%) of personnel currently practising allopathic medicine in India lack a medical qualification. This situation places rural patients in jeopardy due to an urban to rural doctor density ratio of 3.8:1 and India’s poor doctor-population ratio of 1:1456. This stark contrast to the World Health Organisation’s recommended standards of 1:1000 further compounds the problem. The government’s records indicate a total of 11,46,044 allopathic doctors registered with the State Medical Councils/ Medical Council of India as of December 31, 2018. However, these numbers still fall short compared to the country’s population.
The Issue of Unqualified Practitioners
The Indian Medical Council Act’s Section 15 (1956) imposes a prohibition on individuals practising medicine without enrolment on a State Medical Register. Violation of this provision results in punishment including imprisonment and fines. Since health is a State matter, the responsibility to handle such cases primarily lies with the respective State governments. Yet, this issue persists, compromising the quality of healthcare delivered, especially in rural areas.
Alternative Medicine Practitioners in India
In addition to allopathic doctors, India boasts 7.63 lakh Ayurveda, Unani and Homeopathy (AUH) doctors. Assuming an 80% availability rate, approximately 6.1 lakh AUH doctors are estimated to be available. Combining allopathic and AUH doctors gives a doctor-population ratio of 1:884 – an improvement, but still insufficient to meet the WHO’s standard ratio.
| Doctor Type | Number |
|---|---|
| Allopathic Doctors | 11,46,044 |
| AUH Doctors (80% availability) | 6.1 lakh |
| Total Available Doctors | Approx. 17.5 lakh |
The Emergence of Mid-level Healthcare Providers
In an effort to alleviate the burden on overworked specialists, the Health Ministry is contemplating introducing mid-level healthcare providers. The vast gaps in comprehensive primary healthcare services in rural communities necessitate their presence. These mid-level providers, trained, technologically enabled and legally empowered, can provide essential care where it’s needed most.
Countries like Thailand, the United Kingdom, China and cities like New York have successfully incorporated community health workers or nurse practitioners into mainstream health services, resulting in improved health outcomes. In India, states like Chhattisgarh and Assam have experimented with these community health workers revealing promising results according to independent evaluations carried out by Harvard School of Public Health.
Understanding Mid-level Healthcare Providers
Mid-level healthcare providers are health workers who, after 2-3 years of post-secondary school healthcare training, carry out tasks usually performed by doctors and nurses. This includes clinical or diagnostic functions. They are increasingly used to render services autonomously, particularly in rural and remote areas. Despite their growing role, they are seldom properly integrated into the health system, leading to inadequate planning and management for these potentially vital healthcare contributors.