As India moves towards a progressive future medical education must not lag behind. The idea of creating good medical health services for each and everyone in our country is no longer to be considered a luxury. In a developing nation like India, proper health services play a very important role in the well-being of their citizens and indirectly in the economic and overall development of the nation.
Today, India has 362 medical colleges. Our institutions have produced many world class physicians. However, paradoxically, the majority of the population still do not get proper medical care. More than half of the children in India are not immunized and more than half of the women do not receive proper prenatal care during pregnancy. The doctor-patient ratio is nowhere near the WHO standards, the lack of doctors in rural areas and a high number of appalling statistics clearly depict that the Indian medical education system contains many fundamental defects and badly needs a revamp.
The medical education system suffers from low numbers of graduating doctors, maldistribution, invalid student selection processes, curriculum that lacks focus on essential goals, lack of learning during the crucial internship year, poor assessment, neglected research and lack of faculty development programmes.
A new strategy is required to drive the present medical education system to a new level of excellence. To upgrade medical education what is needed is proliferation of new medical colleges, curriculum reform, accreditation standards for all medical schools, proper selection of medical students, and faculty development.
NEW MEDICAL COLLEGES:
The UN/WHO describe the ideal doctor-population ratio as 1:1,000, and India is approximately at half of that. Though medical schools in India have rapidly proliferated in the past 25 years, doubling since 1980 to a current total of 362 and producing 27,676 doctors each year, we are still left with a meagre statistic of a 0.5 doctors per 1,000 people (compared with 2.3 per 1,000 in the United States).
To attain the ideal ratio, the report lays down the need for 59,187 more medical teaching government institutions in India before 2022 at an estimated cost of Rs.100 crore per medical college. We might need 600,000 more doctors and one million nurses along with lakhs and lakhs of primary, community and rural health workers. Are we doing anything to get there?
Half of India’s medical seats are in private colleges. Though privatisation has broadened the scope of health care, it has resulted in the commercialisation of education. Capitation fees for admissions are to the tune of 50 lakhs to 1.5 crore. High capitation fees are one of the reasons that thousands of Indians enroll in medical colleges in China.
Graduates returning from China have to pass a screening test by the MCI. The sad part is that less than 25% of these graduates pass the test because, supposedly the test is of a difficult post-graduate entry level. That leaves many doctors with a degree but no license to practice in India.
The Medical Council of India has a pivotal tole to play in the number of medical graduates that become available for service in the country. The MCI frames rules, regulates the formation and continuation of medical colleges. It carries out a yearly inspection of every single medical college in the country. This inspection decides whether the college maintains quality standards and whether they can be given permission to continue taking admissions or not. For the year 2014-15, the Council denied permission for renewal to 45 colleges offering 3,820 seats citing lack of infrastructure and shortage of staff.
What about creating new medical colleges? Seems the most sensible solution doesn’t it? Sadly, the formation of new medical colleges is fraught with all kinds of complexities. The MCI for some reason, only accepts applications in the month of August and only recently launched an online application portal.
The law that governs the qualifying criteria to form a college is the Establishment of Medical College Regulations, 1999. The main criteria are possession of adequate land, an essentiality certificate, consent of affiliation, an operational hospital and submission of financial guarantees.
The specifications for the land required have undergone eight amendments since November 2008, but relaxation of rules hasn’t helped much to increase the number of colleges. Then there is the requirement of an essentiality certificate, a statement by the government that a medical college is required in that area. This does not seem to be in the least necessary and is a useless bit of red tapism.
Consent of affiliation is a certificate issued by a university affirming that the college can issue degrees in its name. Private parties must submit two bank guarantees based on the number of admissions, one crore for the first 50 admissions and fifty lakhs more for every additional 50 admissions. The second is based on the number of beds in the hospital starting with 3.5 crore for 400 beds.
Governments just have to show that their budgets have the necessary funds allocated, but even that doesn’t seem to have helped them. The whole process of starting up new medical colleges seems to be tied up in red-tapism. Some say that the MCI is to be blamed.
It seems that the MCI disapproved dozens of applications for medical colleges, addition of seats, renewals of permissions and recognitions. Almost 94 percent applications that came in from the private sector to establish new medical college, i.e. 74 applications were disapproved as against the 79 applications that MCI had received in 2016-17. This translates into a loss of almost 8000 doctors for India.
Furthermore, almost 87 percent of the requests for new seats were disapproved. Even government applications for new colleges and new seats were disapproved in a large percentage.
However, Justice Lodha gave amnesty to over 175 private medical colleges who were denied approval this year and also the chance to re-submit their representations to the health ministry.
This was an encouraging move, but it has been over 100 days since the Lodha Committee was commissioned and we are yet to hear of plans for the future of medical education in India.