India’s healthcare system needs urgent surgery, medication

A cosmetic dentist from Toronto blogs that stripped of pretence, doctor-prestige and professional posturing, ‘dentists are basically tooth carpenters and dental hygienists are gum gardeners.’ It is an interesting thought. If dentists are nothing but ‘tooth carpenters’ or ‘gum gardeners,’ can  carpenters and gardeners be equipped with basic dentistry skills  in a country that is woefully short of dentists?

Facetious as it may sound, the argument goes to the heart of a raging debate in India.

The past week provided snapshots of the multiple failures of India’s public health system. Television channels showed us a ward boy (who reportedly doubled up as a janitor) undertaking a surgical procedure in a government hospital in Uttar Pradesh. Barely had that image registered, there were similar reports from other places — a cleaner without surgical gloves assisting in an operation in another UP government hospital; a generator operator treating patients in Bihar and a janitor caught administering sutures to a patient at West Bengal’s largest and eastern India’s premier medical research institute.

In the beginning was shock and outrage. Everyone was appalled though there was little in those images that we did not know or suspect. The reactions follow two distinct schools of thought. The first slams the medical establishment for tolerating such a state of affairs and demands action. The second posits that instead of demonising the ward boy and the hospital administrations, we should actually be lauding them because India’s alarming shortage of physicians and health workers means we have to use innovatively use whatever human resources that are available.

The two viewpoints may appear to clash. But they can make common cause.

Everyone knows that India’s healthcare system is in shambles and this is partly due to the desperate shortage of human resources. A recent report by the Federation of Indian Chambers of Commerce and Industry pointed out that in the next 10 years, the number of doctors needs to be doubled from its current figure of 0.75 million; nurses need to be tripled from 3.7 million and paramedics and technician assistants need to be quadrupled from 2.75 million.

Dealing with this problem is not easy but it is not rocket science. States like Tamil Nadu and Gujarat have shown how scarcity of medical and health professionals can be handled through better management and innovative steps. Proposed changes in the medical education system will have an impact in the long run. But till then, we have an emergency on hand.

What should be done? First, as the dentist blogger said, we have to start demystifying the medical profession. An MBBS doctor is not vital for every task in every health setting. It is not just the paddy farmers in China, trained to be Barefoot Doctors, who have proved so, there are many indigenous examples. Community workers in the tsunami-ravaged Nicobar Islands who underwent training in Integrated Management of Neonatal and Childhood Illness saved many newborns amid death and destruction.

‘Task shifting’ is an idea whose time has come. My grouse is that we are passing up a valuable opportunity to address the issue seriously. High decibel outrage has led to the shunting out of the Chief Medical Superintendent of the Bulandshahr government hospital and suspension of the ward boy who was carrying out tasks meant for medical personnel. Both are knee-jerk, damage-control measures.

Instead of that, we should be task shifting, especially when there is a shortage of doctors or in an emergency situation. Yet, we must have minimum standards and agree on non-negotiables in a health centre or hospital. We can train people who don’t necessarily have MBBS degrees to do many tasks that doctors traditionally undertake. But such people must first go through a standardised paramedic training course that has a proper syllabus and certification. Shortages and resource constraints notwithstanding, any institution offering healthcare has to maintain minimum standards in critical areas and be open to continuous monitoring. This does not mean we should turn a blind eye to doctor absenteeism.

The Clinical Establishments (Registration and Regulation) Act, 2010, is a step in this direction. But it is being vigorously opposed by various doctors’ bodies. They call it undue interference. Then, there is the hypocrisy from many policymakers and policy commentators — demanding a functioning healthcare system but resenting any attempt to invigorate it through additional funds. So, the circular arguments continue. It’s time to get beyond that. India’s healthcare system needs surgery, medication and stitching up. They do not have to be done by the same set of people.

The author is a Delhi-based writer
patralekha.chatterjee@gmail.com