India has more doctors than WHO standards, says Centre. Is that a valid claim?

The Union government, counting AYUSH practitioners or professionals trained in traditional medicine at par with MBBS doctors, has claimed that the doctor-population ratio in India is now 1:834, better than the standard prescribed by the World Health Organisation (WHO).

In a written reply to a question in the Rajya Sabha on July 26, Union minister of state for health and family Bharati Pravin Pawar said that there were 13,08,009 allopathic doctors registered with state medical councils and the National Medical Commission as of June 2022.

“Assuming 80 percent availability of registered allopathic doctors and 5.65 lakh AYUSH doctors, the doctor-population ratio in the country is 1:834, which is better than the WHO standard of 1:1000,” the reply said.

The response by the government comes barely two months after the Rural Health Statistics Report 2020-21 showed that while the number of doctors at primary health centres (PHCs) in rural India has improved remarkably over the last five years, a major crisis of specialists in community health centres (CHCs) persists across the country.

As per government figures, the number of doctors in rural PHCs grew from 26,464 in 2015-16 to 31,716 in 2020-21, a rise of 20 percent.

But during the same period, the number of specialists at CHCs in rural areas grew from 4,192 to 4,405, marking an improvement of just about 5 percent. This is despite the significant rise in MBBS and PG medicine seats in most parts of the country.

The latest claim, meanwhile, has evoked mixed response with some experts saying it is a misleading argument and others highlighting that the obsession with the number of doctors in India should now give way to focusing on the quality of their training and services.

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Misleading parameter?

Dr Antony K R, public health expert and independent monitor for the government’s National Health Mission, for instance, said that it is irrational to calculate the doctor-patient ratio by including AYUSH doctors in the same category as MBBS doctors.

“The WHO formula is globally applicable for comparative assessment and tampering with it is misleading,” he emphasised.

Dr Antony went on to say that the government is facilitating nothing sort of misrepresentation or impersonation by posting AYUSH doctors in primary and community health centres for want of MBBS doctors. These persons are then asked to conduct deliveries, do minor surgeries and prescribe allopathic medicine of which they know little, he said.

“Just because it is a common practice in many north Indian states doesn't make it less of a crime. Why not train pharmacists or nurses to do the same?” he said, pointing out that in health and wellness centres, nurses perform the same function.

According to Dr Antony, in many PHCs and CHCs, ordinary people believe that the AYUSH doctors are MBBS doctors and that is where impersonation comes up as an ethical question.

Dr R V Asokan, a senior member of the Indian Medical Association (IMA), the largest network of doctors in the country, pointed out that the WHO uses the doctor-populations ratio only in relation to doctors practising modern medicine.

The Indian government can have its own measuring methodology, he said, but it needs to be transparent and the government should make public the components of statistics.

“To that extent it seems to be a dishonest attempt,” Dr Asokan said, but added that in India’s context the ratio should factor in points such as disparity in the distribution of medical colleges and the divide between north-south, east-west and rural and urban areas.

‘Need to change outlook’

On the other hand, Dr Ravi Wankhedkar, a former IMA president, said that considering AYUSH doctors as medical practitioners may now be rational as the Centre now officially recognises them as such.

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“Also, it is a fact that they are now one of the mainstays in providing primary health care in the private sector,” he opined.

According to Dr Wankhedkar, it may be important now for the government to rethink its policies which were always based on the assumption that India doesn’t have enough doctors.

For instance, he said, the government should now concentrate on improving the quality of doctors produced rather than only quantity.

“Due to the strict guidelines of the medical education regulator, Indian doctors were highly respected and in demand worldwide but the recent policy changes and mixopathy (amalgamating alternative medicine systems with modern medicine) has put this reputation in danger,” he said.

Dr Wankhedkar also said that there should be a move to address the skewed ratio between urban and rural areas by incentivising the setting up of rural area health infrastructure and added that the commercialisation of the healthcare delivery system should stop.