Can middle-class health providers compensate for the shortage of doctors in rural India?

A recent paper published in National Medical Journal of India stressed the need to include a group of middle level health providers (MLHPs) in health systems to compensate for the shortage of doctors.

Written by Soham Bhaduri, a public health expert and independent researcher, this paper argues that the MLHP model can create win-win combinations in healthcare that can benefit patients, doctors, health care funders and the general public.

In order to compensate for the shortage of doctors, several countries around the world have introduced a group of MLHPs into their health systems to take on many of the usual responsibilities of a doctor. However, in India, the introduction of MLHP has time and again been met with opposition from organized medicine.

“Policymakers will need to work to gain greater acceptance of MLHPs among the existing health professions, by demonstrating their complementary role in patient care and addressing the traditional concerns of When combined with practice models that ensure long-term growth and career progression, MLHPs can strengthen India’s journey to achieve and sustain health security,” Dr. Bhaduri said in the paper.

Severe shortage of doctors in rural India

According to the Health Dynamics of India (Infrastructure and Human Resources 2022-2023) report released in September this year by the Union Ministry of Health and Family Welfare, community health centers (CHCs) in rural India are facing a shortage of about 80% of experts like. dated March 31, 2023.

The report, previously published as Rural Health Statistics, showed that of the 21,964 specialist doctors needed in rural CHC areas, only 4,413 were available by March 2023, it said. What is the deficit of 17,551 (79.9%).

Across 5,491 rural CHCs in 757 districts across the country, there is a need for 5,491 doctors, nurses, gynecologists and paediatricians in these facilities. However, the report showed that rural CHCs had a shortage of 4,578 surgeons (83.3%), with only 913 doctors in position against the required 5,491.

Similarly, a shortage of 4,078 women doctors (74.2%) was reported in the rural CHC areas, with only 1,442 available against the required 5,491, while a shortage of 81.9% was reported among the of doctors, only 992 are available. A similar trend was observed among pediatricians, with only 1,066 in rural CHCs, leading to a shortage of 80.5%.

And this is not a problem limited to a few States within the country. Even countries with consistently good health facilities face these issues. Take the example of Karnataka, for example, the number of doctors/medical officers in rural PHCs here has increased from 196 in 2005 to 340 in 2023.

According to experts at CHCs, out of 758 required experts, only 451 jobs have been sanctioned. Of these, 178 posts are lying vacant due to shortage of 455 professionals in Karnataka’s rural CHCs, according to the report.

In fact, staff shortages are a perennial problem in Government-run hospitals. By 2022, the Karnataka Health Vision Group had identified a wide disparity in the distribution and availability of specialized and specialized staff in state hospitals. It had recommended a clearly defined Health Human Resources (HRR) policy.

The case for MLHPs

To talk to A HinduDr. Bhaduri said the paper explored the new case for MLHPs in India in light of recent developments and possible future opportunities that Indian healthcare might consider.

“Evidence shows that MLHPs, under certain conditions, can provide care of equal quality and safety to physicians at lower overall costs, across a wide range of conditions. They have also been found to be alive equally or better in terms of patient satisfaction and confidence, with clear contributions to improving health care access and utilization in underserved and rural areas -MLHP are unlikely to migrate and may live in unstable areas – two prominent problems that have been attacking health systems when it comes to doctors,” he said.

In India, the Central and State governments have from time to time conceived bridge courses in allopathy to address the shortage of doctors in rural areas. In 2010, a proposal was made to start a short doctorate in rural health, which was supported by the Planning Commission. States like Assam and Chhattisgarh have successfully deployed State-level MLHP cads to improve access to health care in rural areas. However, attempts to include MLHPs have been repeatedly resisted by organized medicine, mainly on the grounds that they could exacerbate theft and discriminate against rural populations, Dr. Bhaduri said.

Confirming the views of Dr. Bhaduri, former director of NIMHANS G. Gururaj, who headed the Karnataka Health Vision Group, said MLHPs can boost India’s journey to achieve and sustain Universal Health Coverage (UHC).

Stating that some recent policies and legislative measures have given renewed hope for the systematic revival of MLHP in India, Dr. Gururaj said that the Comprehensive Primary Health Care (CPHC) initiative under the central government agency Ayushman Bharat Mission is making arrangements for public health care. officers (CHOs) in smaller units. They can provide expanded primary care services and refer them to physicians for additional treatment, he said.

“Since MLHPs are located in health centers, close to the community, it is ensured that patients continue to receive care. They should not diagnose the condition/disease but provide preventive care and encouragement while ensuring that patients who have been diagnosed by doctors are properly cared for, especially with follow-up care. They work in collaboration with ASHA workers and Auxiliary Nurse Midwives (ANMs) and have a good understanding of the community,” he said, adding that MLHPs can conduct a potential screening but not a clear diagnosis. “There will be no meeting of their duties with doctors,” Dr. Gururaj pointed out.

Validating quackery?

However, the Indian Medical Association (IMA) has been opposing the introduction of MLHPs saying that it will only allow legal fraud within the country.

“This is nothing but cheating. Allocating MLHPs to rural areas is tantamount to giving discrimination to the rural population. Will these artists agree to be treated by MLHPs?” asked RV Asokan, national president of IMA.

Regarding the lack of doctors in rural areas, Dr. Asokan said there is sufficient availability of medical professionals. “According to the statement of former Union Health Minister Mansukh Mandaviya in the Lok Sabha in February this year, the population ratio of doctors in the country is 1:834 which is better than the WHO standard of 1:1000. According to the statement of his, there are 13,08,009 doctors registered with the State medical councils and the National Medical Commission (NMC) as of June, 2022,” he said.

Asserting that there has been no recruitment of doctors through public service commissions in the last 10 to 15 years, Dr Asokan said: “The government only randomly appoints doctors through the National Health Mission (NHM) and to pay them about Rs. 30,000 every month. Doctors are made to sign bonds, which is nothing but slavery. It is wrong to say that doctors are not ready to work in villages rural when there is no regular employment,” he confirmed.