Open Forum
New
Delhi, 24 March 2021
Medical
Education
CAN PPP MODEL DELIVER?
By Dr. Oishee Mukherjee
It
is an unfortunate and well-known fact that the country suffers from an acute
shortage of doctors and nurses. Specialists are rarely found in sub-divisions,
few are located in small towns and most are concentrated in big cities.
Obviously, this sends out a terse message to our policy planners the urgent need
to expand health infrastructure and in fact medical education so that it can
partially meet the requirements. The Centre as well as State governments have
over the years decided that district hospitals should henceforth be set up with
public-private participation, meaning in real terms that the private sector take
over these health centres.
It
is therefore pertinent and prudent to analyse what does it cost to become a
doctor and the charges that those wanting to do MBBS entail. As per available
data, about 28 per cent of such seats cost over Rs 10 lakh officially but
around Rs 50 lakh unofficially. The high fees, obviously, makes these seats a
quota for the rich, even larger than those for the SC (15 per cent), ST (7.5
per cent) or OBC (27 per cent).
In
fact, about half the seats in private colleges are in the management quota or
NRI quota. For all these seats, the total official amount, approved by the
Medical Council of India (MCI) or the Dental Council of India (DCI) almost
triples for candidates who are enrolled. Even entrance examinations, which are
held in medical and dental colleges, are manipulated and those giving the extra
amounts find their names in the final list. States like Karnataka, Rajasthan
and West Bengal charge heavy premiums, sometimes going up to Rs 80 lakhs.
Even
some government colleges, mostly in Rajasthan and Gujarat have management
seats. These quota seats range above Rs 10 lakhs, going up to Rs 20 lakhs per
annum. In fact, some other States are also planning to introduce management
quota to meet their expenses as the official support is meager. Apart from
these costs, one must also consider hostel charges and other attendant
expenses.
If
one considers that 80 per cent of Indian families earned around Rs 10,000 per
month, the educational charges for private medical and dental colleges are affordable
for the rich and the upper middle class and others would have to take recourse
to bank loans. At the same time, having spent a high amount for education in
private medical colleges, the doctors would concentrate on recovering the
amount by opting for big hospitals in cities and not have the commitment to serve
the poor and impoverished.
The
other problem of medical education is the need for its spread and this can only
happen if many more such hospitals with medical colleges are set up in
districts and sub-divisions. However, the PPP model wouldn’t work well as again
the private sector would be looking at making profit. So the question is will
private medical colleges look into the larger interest of serving the society
and offer options for lower income groups.
Besides,
a close look at the recent budget is necessary, where health has been allocated
Rs 2.23 lakh crore for ‘health and well-being.’ But this amount includes
outlays for drinking water and sanitation (Rs 60,030 crore), nutrition (Rs 2700
crore), Covid-19 vaccine related allocation (Rs 35,000 crore) and Finance
Commission’s grants (Rs 48,214 crore for health and water and sanitation). The
allocations reveal that the budget for health and family welfare has decreased
in absolute terms by Rs 8349 crore from 2020-21 (from Rs 85,251 crore and
revised estimates Rs 76,902 in 29021-22). The government’s flagship programme,
Ayushman Bharat has not seen much increase while the National Health Mission
(NHM) in rural and urban areas has been increased by a paltry amount.
The
only silver lining is that the PM Atmanirbhar Swasth Bharat Yojana shall have
an outlay of over Rs 64,000 crore over a period of six years to upgrade
primary, secondary and tertiary care facilities, strengthen existing heal
institutions, building new institutions for research etc. However, all these
are at the announcement stage with no reflected in the budget document.
In
such a situation, the government has virtually no plans or programmes to set up
hospitals to impart medical education on a bigger scale. The need for medical
education being within the reach of the lower segments of society is what it
needs to ponder over. This also brings to the fore the bigger challenge of various
health facilities being made available to the marginalised sections.
The
elitist character of successive governments, and including the NDA, sadly has
not given the health sector the attention it deserves so that prevalent communicable
and non-communicable diseases are brought under control. Moreover, if students
from low income groups of rural and semi-urban areas get medical education, the
shortage of doctors in the countryside will no longer be a problem and adequate
health facilities could in the near future in rural health centres may become a
reality.
It
is indeed tragic that while we boast of being an emerging economy, the
allocation towards health has been much less than most countries in spite of
repeated promises. Even in the recent Economic Survey it has been pointed out
that India should increase its spending on health from an average of 1 per cent
to 2.5 per cent of GDP, as aspired in the National Health Policy of 2017.
Earlier also, during the last decade or so, experts have repeatedly pointed out
that at least 2 per cent of GDP should be allotted towards health but this has
never been dome.
There
is also no sustained action plan about the geographical spread of diseases and
the need to set up health centres in rural areas and hospitals in blocks of
backward regions. Though figures are dished out regarding shortage of doctors
and nurses, precious little has been done, except privatising medical education
and facilities that help the upper middle class. For a country of India’s
stature, the scenario speaks very poorly of the political leadership and its reluctance
to go all out to a lot more as desired.
The
government must ask itself whether it really wants that the lower echelons of
society to enter the field of medical education as also ensuring that these are
not deprived of their rightful due. The elitist and pro-capitalist outlook needs
to change so that the silent majority can enter the mainstream of life and
activity and ensure a healthy and robust society, at every level. ---INFA
(Copyright, India
News & Feature Alliance)
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