The demand for professional health services has never been higher in India. While the Covid-19 pandemic has undoubtedly raised the visibility and priority associated with health issues, consideration for physical and mental well-being has been on the rise for a few years.
The healthcare sector—including hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment—generated nearly $200 billion last year, and represents one of the country’s flagship industries, according to the India Brand Equity Foundation.
Such figures which appear at odds with the notion of a so-called ‘healthcare gap’ between demand and supply. Certainly, the supply (and accessibility) of quality, professional healthcare has never been higher; trends driven and accompanied by rising incomes and expectations regarding quality of life, in equal measure.
India is also training healthcare professionals in unprecedented numbers to meet these demands. The country’s 370 medical colleges produce nearly 50,000 freshly qualified medical doctors every year. Compare this with the U.S., for instance, which produces around 18,000 doctors annually, reports say. When it comes to nurses, India has the capacity to train nearly 80,000 diploma nurses, over 40,000 graduate nurses, and nearly 2,000 postgraduate nurses per year, it was reported in 2010.
Despite these record-breaking numbers, India’s doctor to population ratio remains at 1:1,445, significantly below the World Health Organization’s recommended norm of 1:1,000. Overall, looking at all skilled healthcare personnel, the ratio in India stood at around 30 professionals per 10,000 residents in 2016, compared to an average of over 50 globally, according to the Migration Policy Institute.
While efforts to increase the number of medical colleges in India are a positive response, they will be insufficient if qualified health professionals end up practising elsewhere.
For instance, over 69,000 India-trained physicians worked in the U.S., the U.K., Canada, and Australia in 2017, according to the Organization for Economic Cooperation and Development; this is equivalent to 6.6% of the total number of doctors registered with the Medical Council of India, the Migration Policy Institute says. Nearly 56,000 Indian-trained nurses currently work in the same four countries, equal to around 3% of the supply of registered nurses in India, it says.
It is inevitable—and even positive—that such qualified professionals will want to gain experience or complete their training abroad before returning to their homeland to practise. But this theoretical ‘virtuous circle’, however, doesn’t always bear up to scrutiny. Some years ago, the Ministry of Health and Family Welfare revealed that around 85% of the doctors who returned after completing a medical degree abroad subsequently failed to clear the Foreign Medical Graduate Exam required to allow them to practise in India!
Since independence, India has established itself as the world’s largest source of immigrant physicians, supporting and—in many cases—building the celebrated healthcare services of other countries. This is a reputation about which the country’s healthcare profession, and the country, can be rightly proud of.
However, such ‘medical outflows’ are no longer sustainable or beneficial for the country. In fact, they further widen India’s healthcare gap—the alarming divergence between the demand for professional healthcare services and its supply.
Public expenditure on healthcare has been notoriously low. But increased public spending alone is not going to resolve this aspect of India’s healthcare gap.
If the health sector is going to really drive the economy, the private sector will also have to play its part in creating career opportunities and incentives to keep India’s healthcare professionals practising here. One aspect is restoring meaning and prestige to the profession, so that can represent a compelling career when young people are making career choices.
I must recognise that one side effect of the current pandemic is the increased awareness and appreciation society is paying to the entire sector. The National Commission for Allied and Healthcare Professions Act, 2021, which was recently passed by Parliament, is a case in point. The legislation provides a statuary basis for the maintenance of standards of education and services by allied and healthcare professionals in India. It will ensure standards and provision for training across the entire healthcare ecosystem—from doctors and nurses to lab technicians and radiographers.
This law represents precisely the type of initiative that will encourage and protect more professionals building careers within India’s healthcare sector. This is not merely a question of economic sense; such professionals are essential for India to achieve its full potential in terms of quality of life for all its citizens.
Views are personal. The author is India managing director at Merck Specialties Private Ltd.