Coercing medical grads to serve in rural areas will not fix the gap, incentivising rural posting will
If India’s poor doctor density—a government report says the country has just 7 registered allopathic doctors per 1,000 population—wasn’t alarming enough, a KPMG-OPPI report on access to healthcare states that 80% of these doctors serve just 28% of the country’s population (largely residing in urban areas). And, that’s not all—60% of the country’s hospitals and 75% of its dispensaries, too, serve only this population. This skewed distribution’s fallout is understaffed government hospitals and health-centres; this leads to increased spending on healthcare for people from rural areas as they seek out local private facilities—this, as per the NSSO, is a growing trend—or travel to nearby urban centres for treatment at a government facility. Given poor insurance penetration and shrinking government support—this covers barely a third of the expenses—out-of-pocket expenditure is increasing for the population with poor access. Those who simply can’t afford these costs are being forced into extended morbidity.
The UPA government tried remedying this by making rural posting mandatory for MBBS graduates seeking a PG-level admission. However, incentivising rural posting with higher remuneration than urban posting or special consideration for grads who serve in rural areas—something that the present government is considering—could prove more effective. At the same time, hiring more AYUSH (Ayurveda, Yoga, Unani, Siddha and Homoeopathy) professionals could help, too. But, the long-term solution has to be creating more doctors—this would mean commensurate creation of capacity in medical education—and this is where the government really needs to step up its act. A 4.1%-of-GDP spending on health—one of the lowest in the world—simply won’t do. The government also needs to make it easier for more private medical colleges to open—NITI Aayog’s call for greater freedom for private medical colleges is a step in this direction.