Opinion Bad prognosis

At every turn, structural and systemic deficiencies derail both access to and the quality of healthcare, especially for the poorest citizens, those most vulnerable to health shocks. (Express Graphic by Pradeep Yadav)

Doctors — or, more broadly, medical practitioners — are the most important cogs in any health delivery system. They diagnose the sick, devise a course of treatment and follow it through, the lead problem-solvers, as it were. As a series in this newspaper has shown, however, doctors, particularly in the public health system, are overworked and forced to cope with high-pressure situations for long stretches of time. Resident doctors work inhumanly long shifts — 36-48 hours — and, unsurprisingly, make more mistakes, with fatigue-induced lapses in concentration contributing to more serious errors while dispensing care and accidents that might cause harm to themselves. Despite the risks, there is little discussion within the Medical Council of India, the autonomous regulator which oversees medical education and practice, on the need to reduce shift hours for junior doctors in public hospitals.

Of course, public hospitals are structured in a way that very long workdays are only one aspect that affects the quality of care health workers are able to provide. Scarcity defines healthcare in government-run or -aided hospitals, whether of medical and paramedical personnel, equipment, beds or money. For instance, according to the National Health Profile, 2013, India’s doctor to population ratio (including Ayush professionals) is one per 1,200 people — well below the World Health Organisation-recommended one per 1,000. India also has the dubious distinction of providing fewer beds per 1,000 people than Equatorial Guinea, Gabon and Kenya. Hospitals report shortages of basic equipment like surgical gloves, syringes, saline drips, sutures and even cotton gauze, callously asking patients and their families to source their requirements themselves instead.

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At every turn, structural and systemic deficiencies derail both access to and the quality of healthcare, especially for the poorest citizens, those most vulnerable to health shocks. Often, it isn’t a lack of funds but a corrupt tender process that is responsible for a lack of equipment, halting regular acquisition until rents are collected. With shambolic administration and little oversight, this state of affairs is allowed to continue. The MCI, too, is to blame. It has routinely scotched attempts to devise alternative learning programmes that could address the demand for medical professionals, ostensibly to protect the quality of training and healthcare, creating an artificial scarcity. The expansion of private medical training facilities on the other hand, overseen by the MCI, has been badly regulated. Standards are lax, and many of these institutions have grossly inadequate facilities, an acute shortage of faculty and poor-quality training, producing health workers who are both overburdened and incompetent.