A Possible Remedy for Poor Health Care in India

By M H Ahssan

India wants to be a preferred destination for medical tourism, but its health care offering for its own citizens is lacking. The doctor-to-population ratio for the country is 6:10000, compared to a global ratio of 14:10000. It is estimated that over the next two decades, India will need twice as many doctors, three times as many nurses and four times as many paramedics it has at present.

With 60% of the hospitals and 80% of the doctors belonging to the private sector, and 70% of the health care resources in India concentrated in the top 20 cities, rural India is hit the hardest.
To address this problem, the Medical Council of India (MCI) has proposed a truncated medical course for practitioners in rural areas. Called the Bachelor of Rural Medicine and Surgery (BRMS), it is a three-and-a-half-year course aimed specifically for students from rural India to take care of the basic health care needs of the target population.

The proposal for the BRMS, initiated by the MCI a couple of years ago, has recently received the backing of the country’s Planning Commission. A report released by an expert group within the Commission notes that the course should focus on “high quality of competence in preventive, promotive and rehabilitative services required for the rural population with a focus on primary health care.” It also recommends that by 2020, India should have BRMS colleges in all districts with a population of over 500,000. The report clarifies that this is not a shortened version of a traditional medical degree (MBBS) course, but a unique initiative to address the country’s rural health care issues.

Not everyone is convinced of the efficacy of the BRMS course. In an address on the website of the Indian Medical Association, its president, Vinay Aggarwal, points out that the course is akin to “promoting and legalizing quackery.” He adds: “While modern medicine is experiencing a knowledge explosion, and a five-and-a-half-year MBBS course is insufficient to provide basic information to would-be doctors … how can reducing the duration of training be the remedy to the maladies plaguing rural health? Compromised education, and training in institutions where infrastructure and faculties have been compromised, will compromise the health of villagers …. An army of half-baked doctors for villagers with a three-and-a-half-year curriculum is a gross injustice.”

Rana Mehta, executive director, PricewaterhouseCoopers, India, disagrees. “I see it as a positive step,” he says. “In one way it is a compromise, because you don’t do the [traditional-length] course, but given the huge shortage of doctors in India, this is a very good and innovative move.” The only caution that Mehta adds is that BRMS practitioners “need to keep within the paradigm of the knowledge that they have.”

There have been other innovations in India’s health care sector. At Devi Shetty’s cardiac care hospital, Narayana Hrudayalaya, for instance, patients are treated for heart ailments at a fraction of what it would cost elsewhere across the globe. Shetty attributes this to “process innovation.” And at the Indian arm of GE Healthcare, the goal is to innovate and make affordable and accessible health care products to meet the specific needs of the Indian population.
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It now remains to be seen whether the BRMS ranks among these and other innovations from India — or whether it will prove the skeptics right.