There is no doubt that the West Bengal government could have handled the doctors’ protest in the state—following a junior doctor receiving a non-fatal, but grievous, injury at the hands of a patient’s family alleging medical negligence—a lot better. For one, the olive branch that chief minister Mamata Banerjee eventually extended should have come right at the protest’s germination. Instead, Banerjee gave the striking doctors an ultimatum, of joining work within four hours of her announcement or risking sacking. Thanks to the shoddy handling, doctors across the country struck work in solidarity, tripping the country’s already limping public healthcare system. And, of course, this allowed the issue to become politicised in an unbecoming manner. But, for all of Banerjee’s faults, the fact is that the pressure on the public health infrastructure and talent in the country is crushing and nurtures the conditions that lead to such patient-medico clashes, especially with an effective grievance redressal mechanism summarily absent.
According to the latest National Health Profile (NHP), the average government doctor in India caters for 11,082 patients. In West Bengal, this ratio stands at 1:10,411—while this may seem palatable in comparison to the national average and the worst-performing Bihar’s 28,391 patients per doctor, the WHO’s ideal doctor-to-patient ratio is 1:1,000. As per reports, India’s 462 medical colleges produce 56,748 MBBS graduates every year. Yet, to meet the needs of a population of 1.4 billion, and growing at around 26 million per year, this woefully inadequate—India falls short by as many as 600,000 doctors. Primary health centres bear the worst of this burden, lacking 10,112 female health workers, 11,712 female and 15,592 male health assistants, as well as 3,000 doctors. Close to 2,000 such primary health centres operate without a single doctor, and there is a shortfall of 5,000 surgeons in community health centres—this means nearly all the burden is on the district and municipal hospitals, government medical colleges/hospitals and medical research institutions in the metros.
The crisis of health workers is not limited to doctors; government hospitals in India are short-staffed on paramedical and nursing staff, too, which affects the quality of healthcare delivery. As per the WHO, the minimum is of 22.8 healthcare workers per 10,000 people, and India is among the 83 countries that fail to meet this standard. India lags behind the globally accepted standard for nursing assistants too—despite 3,123 training institutions graduating 125,764 nurses annually, India operates with only 0.1 nurses per physician, or one nurse per 10 physicians, as opposed to the norm of 2.8 nurses per physician. While the central government claims that these shortfalls shall be overcome by 2022 as the number of seats at medical colleges have been increased, government investment in healthcare remains abysmally low.
Compared with the global average of 6%, the government intends to invest only 2.5% of the national GDP in healthcare by 2025. According to the 2018 NHP, the investment currently stands at 1.02% of the GDP—or Rs 3 per person per day in absolute terms, as per an IndiaSpend analysis. This, of course, places a heavy burden on the patient—nearly 70% of the expenditure on health in India is met out of the patient’s pocket while the global average for out-of-pocket expenditure is 18%—and therefore the crushing pressure on the existing public healthcare infrastructure, including research institutions.