Relevance: GS-2: Issues relating to the development and management of Social Sector/Services relating to Health, Education, Human Resources

Key Phrases: Ukrainian crisis, National Health Mission, Reproductive-Maternal Neonatal-Child and Adolescent Health (RMNCH+A), Ayushman Bharat Scheme, National Medical Commission Act, 2019

Why in News ?

• In the backdrop of the recent Ukrainian crisis, and the plight of Indian students, many of them are pursuing medicine in Ukraine.
• Amidst the turmoil, Prime Minister Narendra Modi, at a webinar on the Union Budget announcements on the health sector, stated that many young Indians were going to “small countries of the world for medical education” and, therefore, the private sector should be encouraged, along with cooperation from States, to set up more medical colleges and hospitals locally so that such aspirants remain in India.

Why are Indian students moving towards foreign nations for Medical Education?

1. Quality vis a viz Cost:
   • Most sought-after international destinations: traditionally, for medical education the U.S., the U.K. and a few west European countries — are, however, too now becoming little costlier for most Indians.
2. Mushrooming of Affordable quality education in other countries:
   • In the last few decades, Russia, China (countries larger than India) and Ukraine (one of Europe’s largest countries), with their historical commitment to public health care have been able to offer more affordable, yet quality, education.
   • India’s huge population still continues to be predominantly rural, but most of the trained medical doctors, paramedics and nurses gravitate towards cities
3. Anemic spending on health:
   • For several years, India’s spend on healthcare has consistently trailed several countries comparable to its size which is why there is barely one doctor for every 1,000 Indians and specialists often a tenth of what is required.
   • These shortcomings have lubricated the phenomenon of young Indians seeking affordable, quality, health-care education in other countries

What are the pitfalls in the Indian Medical Education system?

1. Indian Paradox: India’s main population lives in rural areas, but most of the trained medical doctors, paramedics and nurses gravitate towards cities. The below given table highlights this discrepancy.

   Population percentage	Doctors percentage
   Rural - 70% population	Rural - 30 % doctors
   Urban - 30% population	Urban - 70 % doctors

2. Infrastructure Deficit: The very nature of medical education, an empirical field, requires significant infrastructure — land, equipment, and trained faculty at the post graduate level — all of which are in short supply and uneven in their spread.
3. Abysmally low government spending: The Government needs to make health care the centrepiece of its economic rebuilding. Without significant government spending, India cannot expect to dramatically increase the availability of medical personnel.
4. Outdated syllabus, teaching style: Regular breakthroughs take place in the medical field every day, but the medical studies syllabus in India is not updated.New domains of medical science research and specialization are barely touched upon. Lack of skilled teachers as teachers for medical institutes are selected based on their degrees and not their clinical experience.
5. Not following Global standards: India doesn't follow the use of OSCEs (objective structured clinical exams) to test medical candidates. Thus, their clinical skills are not tested till they start practicing.
6. Problems with private medical colleges: Many medical institutes are owned by businessmen and politicians, who had no experience of running medical schools. While there were 100 government medical colleges and 11 private medical colleges in 1980, now, the government colleges have doubled while the private institutes have increased twenty-fold. Also, private colleges are known for high capitation fees and low standards.

What are the recent steps taken by the government to improve the Indian healthcare system?

1. National Health Mission: It encompasses its two sub-missions,
   • National Rural Health Mission (NRHM)
   • National Urban Health Mission (NUHM).
   • The programme include Health System Strengthening in rural and urban areas, Reproductive-Maternal Neonatal-Child and Adolescent Health (RMNCH+A) and Communicable and Non-Communicable diseases.
2. Ayushman Bharat Scheme : It has two components-
   • Health and Wellness Centre
   • National Health Protection Mission
3. Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana: To provide affordable generic drugs through various kendras.
4. National Medical Commission Act, 2019: Replace the medical commission of India with the national medical Commission as the top regulator of Medical Education. AYUSH practitioners are allowed to practice allopathy after completing the bridge course.
5. Financial support to states: Support is provided to States under NRHM, to strengthen the health infrastructure.
6. Training of Accredited Social Health Activists (ASHA) and Auxiliary Nurse Midwives(ANMs) who act as a link between community and healthcare facilities.

Way Forward

• Long-term commitment could reduce the phenomenon of Doctors Dearth, Quacks Spurs:
  1. Merely having private establishments start medical schools, a necessary training and post-graduate education, could lead to a repeat of the engineering fiasco after the dotcom boom: a surfeit of engineering colleges without adequately trained faculty or infrastructure that churn out students who need a further skills upgrade to be employable.
  2. Sustainable investment and better institutional-regulatory framework will provide a steady supply of quality doctors and trained supporting staff.
• Indeed, Government must do:
  1. Ease procedures for establishing medical colleges
  2. Spend more on infrastructure
  3. Provide incentives for a health-care ecosystem to develop in rural areas
• While not a quick-fix, over time government policy and monetary support could facilitate the growth of private and public medical colleges that could stem the outflow of students aspiring to be doctors.

Source: The Hindu BL

Mains Question:

Q. Highlights the issues faced by medical education in the country. Discuss what are the new steps taken by the government to remove the existing lacunae in the medical education system.( 15 marks).