With a shortage of 6 lakh doctors and centre’s non-committal attitude to Public health, where are we headed?

Written by Sushmita | Published on: April 16, 2019

Shortage of 6 lakh doctors, 2 million nurses and 57 million people pushed to poverty: CDDEP study


Health care
Image Courtesy: LiveMint

Indian has a shortage of an estimated 600,000 doctors and 2 million nurses, say the findings of a study by the Center for Disease Dynamic, Dynamics, Economic and Policy (CDDEP) in the US. This was reported by scientists who seemed to have found that the lack of proper training in administering antibiotics is preventing patients from accessing affordable life-saving drugs.
 
CDDEP produces “independent, multidisciplinary research to advance the health and wellbeing of human populations in the United States and around the world.”

Limited government spending for health services contribute to high medical costs for patients, reported the study by the CDDEP.

The health expenditure in India is largely out of pocket, as much as a staggering 65%, and such expenditures push more than 57 million people into poverty each year.

To identify key barriers in access to antibiotics in low and middle income countries, the researchers at CDDEP conducted stakeholder interviews in Uganda, India and Germany apart from literature reviews.

Gaps galore
There is a glaring gap in the international standards of health as defined by the World Health Organization (WHO) and as is practised in India. For example, though the WHO prescribes a doctor to patient ratio of 1:1000, in India, the study found that there is one doctor to every 10, 189 people. This implies a deficit of more than six lakh doctors. The nurse to patient ratio is 1:483 and has a glaring shortage of two million nurses!

Highlighting the accessibility or procurement of drugs as the primary challenge, Ramanan Laxminarayan, director at CDDEP said, “Lack of access to antibiotics kills more people currently than does antibiotic resistance, but we have not had a good handle on why these barriers are created.”

Recommendations of CDDEP study
The recommendations of the study say, “Interventions to improve access to antibiotics must take into account differences among countries. Healthcare institutions, both public and private, and regulatory, procurement, and supply chain systems need to meet users’ expectations and clinical best practices.”

It added that healthcare in many Low-Middle Income countries “requires fundamental changes, more government spending, and better regulation.” The study recommended that countries’ long-term visions should include plans to incorporate access to essential antibiotics into priority programs, such as infectious disease surveillance, HIV, Tuberculosis, malaria, and mother and child health programs, where efficient supply chains have already been established.

Emphasising the importance of National Health insurance schemes, it said, “National health insurance schemes can reduce out-of-pocket payments by patients, adequately fund health ministries, and dedicate funding for essential medicines, including antibiotics.”
“Ultimately, rising antibiotic resistance may be the biggest barrier of all. If resistance renders treatments ineffective, efforts to improve access to antibiotics will be futile, and the consequences will be felt worldwide. Antibiotic stewardship and infection prevention must therefore be pursued alongside improvements in access. All stakeholders—international bodies, government leaders, health and agriculture ministries, patients and medical practitioners, farmers and veterinarians, academia, and the pharmaceutical industry— must slow the emergence of resistance to existing antibiotics to ensure affordability and access everywhere,” the study concluded.

India’s spending
However, India’s public health expenditure is amongst the lowest in the world at 1.02% of its GDP in 2015 (a figure that has remained unchanged since 2009). This figure is lower than most low income countries.

The equivalent proportion of GDP spent on health in the Maldives is 9.4%, in Sri Lanka 1.6%, in Bhutan 2.5% and in Thailand 2.9% as per an IndiaSpend report.

Not surprisingly then, India has become the sixth biggest private spender on health among low-middle income countries. Out-of-pocket health expenditure pushed 55 million Indians into poverty in 2011-12.