Medical Education and Healthcare in the country

  • The Committee on Estimates (Chairperson: Murli Manohar Joshi) submitted its report on ‘Medical Education and Healthcare in the country’ on December 21, 2017.
     
  • Overall expenditure on health: The Committee observed that private doctors are the most important source of treatment in both the rural and urban areas.  Further, among the Brazil, Russia, India, China and South Africa (BRICS) economies, India has emerged as the country with the largest out of pocket expenditure on health which leads to the impoverishment of poorer sections of society. 
     
  • The Committee has noted an increase in spending by the Ministry of Health and Family Welfare over the years. However, it also noted under-utilisation of the funds and overall fund releases below the total allocations to states.   For example, the Committee highlighted that out of Rs 2,539 crore allocated to 15 states as recommended by the 13th Finance Commission, only Rs 1,757 crore were released to these states.  The Committee also stated that the stoppage of central grants to states by the 14th Finance Commission will further deteriorate the delivery of proper health care facility in the poor and backward regions of the country.  The Committee recommended enhancing not just the allocations for health care, but also enhancing the capacities for utilisation of funds by various schemes implemented by the central and state governments.
     
  • Functioning of the Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH): The Committee observed that the budgetary allocations made for the Ministry of AYUSH during the last three years have seen drastic reductions at the revised estimates stage.  Further, the allocated funds are not utilised fully.  The reasons for under-utilisation of funds have been stated to be pending utilisation certificates, unspent balances of previous year, non-receipt of adequate proposals, among others.  In this context, the Committee would like the Ministry of AYUSH to closely monitor the utilisation of allocation of funds besides determining the requirement of additional funds to strengthen AYUSH systems of medicine.
     
  • The Committee also highlighted other issues with regard to the functioning of AYUSH systems of medicine: (i) skewed doctor population ratio of AYUSH (5,778 AYUSH physicians available per crore population), (ii) while Ayurveda and Homeopathy systems are comparatively well established, Unani and Siddha lag behind in research and popularity, (iii) low number of national institutes of higher learning in AYUSH, and (iv) large scale contractual employment of AYUSH physicians in the public health care delivery system.
     
  • Shortage of medical practitioners: The Committee noted shortages of doctors across different states and that the Ministry of Health and Family Welfare has not conducted any study in this regard.  For example, about one-third of the posts of doctors in government hospitals are vacant.  The Committee stated that because of an increase in number of patients, there is an urgent need to increase the number of post graduate seats in various colleges with the quality of medical education is not being compromised.  It also noted an acute shortage of nurses in the country and recommended opening more nursing colleges.  It also recommended broadening the syllabus of nursing so as to train them to prescribe certain drugs, anaesthesia, etc.  The Committee stated that such steps would help in overcoming the shortage of medical practitioners.
     
  • State of medical colleges: The Committee noted that there is an urgent need to set up more medical colleges to address the issue of shortage of doctors.  It highlighted certain issues with regard to medical colleges: (i) growth of post graduate seats is low as compared to growth of under graduate medical seats, (ii) majority of the existing medical colleges (two thirds) are concentrated in southern and western parts of the country, (iii) charging of capitation fee for admission by certain private medical colleges, and (iv) shortage of faculty in medical colleges.  The Committee recommended additional seats both for under graduate and post graduate courses, and upgradation of district hospitals situated in those districts which have no medical colleges.  Further, it also recommended that the Medical Council of India needs to review its rules pertaining to appointment of faculty and come up with solutions to address the shortage of faculty.
     
  • Construction of hospitals: Under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), the government sets up new AIIMS in selected states and upgrades existing state government medical colleges.  In this regard, the Committee observed that the work under PMSSY is yet to be completed even after more than a decade since its launch.  For example, out of 6 new AIIMS, 5 are yet to start functioning.  Some of the new AIIMS do not have specialist clinical services, no functional blood bank, no emergency or casualty services, among others.  The Committee recommended that the operationalisation of all the essential medical services at these new AIIMS should be completed in a time bound manner.

 

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