Increase the availability of allopathic doctors to 1 per 1000 population,

with specific thrust on underserved populations, through the establishment of medical colleges in high focus states, during Twelfth and Thirteenth Five Year Plans.

a) Along with the establishment of new medical colleges in underserved districts, the admission capacities of existing colleges in the public sector should also be increased. Partnerships with the private sector should be encouraged with conditional reservation of 50% of seats for local candidates, fixed admission fees and government reimbursement of fees for local candidates. b) Medical colleges who have the requisite academic

infrastructure and are associated with 750 bed hospitals could be an ideal hub for nursing and other health professional colleges, enabling inter- professional education.

c) The revised MBBS curriculum proposed by the Medical Council of India (MCI) should be refined to include greater focus on preventive, promotive and rehabilitative health care. Measures such as a compulsory posting of one year for all MBBS FIGURE 2: PROJECTED HRH AVAILABILITY (2012- 2022)

graduates immediately after internship, with 10% extra marks weightage for one year of rural service and 20% extra marks for 2 years of rural service in the postgraduate entrance examination should be included.

d) The recent policy stipulated by the Medical Council of India has doubled the number of seats for postgraduate training and will help to meet future requirements. Postgraduate medical education reform should be aligned with principles and framework of universal healthcare coverage. Postgraduate seats should be specifically enhanced in high focus states and districts. e) The National Board of Examinations (NBE) should

be strengthened to enable post-graduate medical education in qualified hospitals not attached to medical colleges, to produce required number of specialists as per national needs. This will also help to provide required faculty for medical colleges.

Rationale

As per MCI data, 31,866 new MBBS doctors were registered during the year 2009-2010 and 34,595 students were admitted in 300 colleges for the academic year 2009-2010.2 _{Based on adjusted figures} as per HLEG’s estimations, the number of allopathic doctors registered with the MCI has increased progressively since 1974, to 6.12 lakhs in 2011 - which yields an adjusted ratio of 1 doctor for 1,953 persons. This density of 0.5 doctors per 1,000 population is higher than that of nurse- rich countries such as Thailand and Sri Lanka and much lower than doctor- rich nations like the UK and the USA. Moreover, this density has a strong urban skew and is concentrated in very few states.

The production of allopathic doctors in the country as per current trends is both inadequate and uneven. India currently has a density of one medical college per 38.41 lakhs population. Presently, 315 medical colleges are spread over just 188 of the country’s 642 districts. This skew is worse in certain states: there

lakhs in Bihar, 95 lakhs in Uttar Pradesh, 73 lakhs in Madhya Pradesh and 68 lakhs in Rajasthan whereas Kerala, Karnataka and Tamil Nadu each have one medicalcollege for a population of 15 lakhs, 16 lakhs and 19 lakhs, respectively.

With respect to specialist doctors, changes in MCI regulations concerning faculty-student ratios will double the number of postgraduate seats in the coming years. While this yields more specialists, it will result in fewer graduates opting to focus on primary health care. This creates an additional need for medical colleges to produce enough doctors so that primary health care needs may be met. The National Board of Examinations (NBE) presently engages hospitals, which are not attached to medical colleges for postgraduate training, in conventional disciplines as well as in disciplines like rural surgery, which are not taught in medical colleges. Strengthening the NBE will help meet the shortages in specialists as well as the faculty needed for new colleges.

Expected Outcome

The HLEG proposes a phased addition of 187 colleges in underserved districts during the XII and XIII plans for equitable health care accessibility across the states. Like in the case of nursing, these norms may also be achieved in four phases (Phase A: 2012-2015; Phase B: 2015-2017; Phase C: 2017-2020 and Phase D: 2017-2022). Through this phasing process, by the year 2022, India will have one medical college per 25 lakh population in all states except Bihar, Uttar Pradesh and West Bengal.

The implementation of HLEG recommendations will enable the additional availability of 1.2 lakh doctors by the year 2017. This production would, during the XIII plan, be enhanced further from newly added medical colleges so that 1.9 lakh additional doctors would be added during 2017 to 2022. This production would yield a doctor population ratio of 1:1,058 at the end of Thirteenth Plan. With this rate of growth, it is expected that the HLEG target of 1 doctor

year 2027. The provision of fewer medical colleges during the next two Five Year Plans (i.e. slower phasing of medical college production) would further delay the

goal of 1 doctor per 1,000 population. (See Figure 3) The HLEG recognises that the establishment of such a large number of new medical colleges is a FIGURE 3: PLANNING FOR 1 DOCTOR PER 10,000 POPULATION - FEASIBILITY OPTIONS

Source: HLEG Secretariat

logistical challenge, due to shortage of faculty and the scarce financial inputs for the requisite infrastructure. The HLEG believes, however, that linking the new medical colleges to district hospitals will considerably reduce financial burdens, as the existing district hospitals need only to be expanded and academic infrastructure constructed. Additional concerns about ‘over-medicalisation’ must be balanced against the need to correct the adverse health care imbalance in states with very high preventable morbidity and mortality.

as an integral part of the health system, responsive to and partly responsible for the health needs of one or two districts with training and service opportunities for various cadres. We believe this purpose can be served by functionally linking medical colleges to district hospitals to contribute towards the normative provision of 2 beds per 1,000 population. These new medical colleges being attached to the district hospitals would facilitate local student enrolment and also be the district hub for other professional colleges

Source: HLEG Secretariat

Recommendation 7: Utilize available doctors