Increasing doctors’ retirement age is only one of many steps to improve healthcare, writes PRITHVI PAl SINGH
Recently, Prime Minister Narendra Modi announced that the retirement age for doctors in India will be increased to 65 years. This news has been met with widespread applause. While this decision is somewhat of a solution to the inadequate patient-doctor ratio in the country, one must also appreciate the other related issues to address the overall problem plaguing the delivery of healthcare services in India.
Provisioning for universal health is a State responsibility which much ensure that every citizen will be provided with quality care and state-of-art health services. In 1978, the World Health Organisation (WHO) at its Alma Ata Declaration exhorted nations to ensure health for all by 2000 through primary health care system. Fifteen years since the deadline, India still lags behind in achieving this basic development goal and universal health remains an unfulfilled dream.
Sustainable Development Goals (SDGs), which the world agreed to in September 2015, revisits the gaps in achieving global health targets and emphasises on an urgent need to take action to ensure healthy lives and promote well-being for all at all ages. For State Governments, SDGs bring a new opportunity to meet the goal of universal health coverage through targeted intervention.
India lacks both in health infrastructure and human resources, falling abysmally short of delivering quality health care services. There is acute shortage of doctors and paramedics, both in urban areas and rural areas. This shortage of healthcare staff is prevalent at every level — be it teachers, specialists, general duty medical officers (GDMOs) or resident medical officers.
The primary reason behind the skewed demand and supply gap in the country on health indicators is the failure of successive Governments to anticipate the future need in time so as to fill the requirement. Targeted interventions over the last few years have only ensured that medical services for curative health get concentrated in the big cities only with private sector taking the maximum share.
Government and private health services at present are in a 30:70 ratio, where tertiary five star hospitals under the private sector are absorbing more medical personnel every year. At the same time, excellent medical practitioners are leaving the country and settling abroad to find better lifestyle and opportunities, thereby exacerbating the situation.
Further, public health and primary healthcare is being neglected because there is no up-gradation or provision of adequate infrastructure in the Government health sector. In this scenario, enhancing the age of retirement of doctors may only benefit a handful of senior doctors, especially those working in big Government hospitals in capital cities.
When most good doctors join the private sector after retirement, raising the age of doctors doesn't make much difference in bridging the vast gap of patient-doctor ratio. In addition, the trend shows that many doctors take voluntary retirement after 20 years of Government service and join private sector to receive better remunerations, the present problem will remain unaddressed.
The health sector today is faced with a multitude of problems which needs holistic intervention with innovative approach. India's ratio of 0.7 doctors and 1.5 nurses per 1,000 people is dramatically lower than the WHO average of 2.5 doctors and nurses per 1,000 people. Regular conflicts, ego clashes are commonly found amongst various categories of doctors-specialists and GDMOs who are working under pressure in a Government facility.
This is prevalent in almost all major hospitals impacting the delivery of health services which requires better coordination within several departments. Solutions proposed by Tikku committee report in 1998 needs to be revisited to adapt to the pressing demand. One of the solutions proposed requires the ratio of GDMOs to specialist which needs to be changed from 3:1 to 1:1.
It also suggests that by revising the qualification criteria for a specialist position, will help ensure quality care available round the clock in the hospital run directly by States. As a one-time measure, GDMOs, who have a post-graduate degree can be made specialists, simultaneously increasing the number of resident doctors posts in the hospitals to bridge the gap between what is needed and what is available.
In addition, the following suggestions can be applied to improve the health care service in India.
Increasing the doctor's retirement age from 60 to 65 is, therefore, just one of the many steps which is taken in the direction towards realising the dream of a healthier India. Whatever may be the present situation, this news does give hope to many and reassures that universal health coverage target is achievable if focused attention is paid by State Governments.
(The writer is former medical superintendent of Hindu Rao Hospital, Delhi)