Heal the country before you heal the rest of the world

Strengthening of health human resource has been a major focus of many recent initiatives and policy announcements of the Central Government. Union Health Budget 2022 In line with the recommendations of the Fifteenth Finance Commission, which laid clear emphasis on utilizing the existing capacities at the district and sub-district level to train various cadres of health care workers, beautiful appropriations were made for the same. Much to the enthusiasm of public health advocates, the health ministry recently released a set of implementation guidelines for the long-pending Indian public health cadre.

However, another recent announcement raises concerns over the coherence of India’s approach to health human resources. The Center is reportedly developing a comprehensive online repository of all categories of healthcare professionals in the country as part of the Ayushman Bharat Digital Mission and the “Heal by India” initiative. While there is a great need for such innovation due to the current fragmented nature of such data, one of its proposed primary objectives is to assist external stakeholders, viz. overseas employers and patients in finding a right Indian match for their respective needs. It is a nostalgic return to the widely discarded principles of liberalization in health care, which are not only unnecessary today but also dangerous.

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WHO forecast for India

The concerns are legitimized by current and future estimates of health manpower in the country, which paint a non-profit picture. A World Health Organization (WHO) 2020 report has estimated the need for India to require about two million more doctors and nursing professionals to achieve the minimum threshold ratio of health care professionals to the population.

According to a study by WHO and Public Health Foundation of India, apart from a real shortage of health care workers and their heterogeneous skill-mix in many states, there is unlikely to be any significant improvement from the current pace of their development. in the density or skill-mix of health care professionals by 2030. Such inadequacies are further compounded by the legions of health care professionals who remain inactive and out of the labor force. To meet these colossal challenges, the current measure which aims to micro-invigorate medical tourism and worsen the exodus of health care professionals from the country, is completely counter-intuitive.

soft power launch

In the mid-1990s, the General Agreement on Trade in Services (GATS) aimed to create an unprecedented scope for cross-border trade in medical and health care services. While the health equality implications of this neoliberal branch are well known and its central tenets have been widely criticized, the post-COVID-19 era has been a fertile ground for health care countries to project soft power. Is – sometimes even at expense. For the country’s own health interests. An important distinction must always be drawn between export products such as vaccines and healthcare professionals.

While the former is characterized by a very simple transactional math, training of health care manpower requires large subsidies (even a fraction is realized through remittances and skill transfers), Thus there is a net withdrawal of resources from the country of origin.

A similar draw on scarce national health care resources is determined through medical tourism which is almost always to the detriment of health equity, especially in developing settings such as India. The magnitude of these can be reduced to some extent by the use of telemedicine and virtual platforms, although major concerns remain. While neither medical tourism nor migration needs to be completely eliminated, at least to actively pursue them when the country grapples with an acute shortage in an aspirational decade of access to health care. is necessary.

India needs a registry

It is also difficult to justify the urgent need for this measure. While an online healthcare professional repository will certainly assist overseas stakeholders in finding their right options, there is neither a strong demand-side frustration nor a significant supply-side crunch that would keep the market well in its absence. prevents it from working. For example, a recruiter from a developed country who is willing to hire Indian nurses and remunerate them well did not work hard to find suitable candidates regardless of the help provided by online repositories and the latter will be only marginally helpful.

Instead, it is at the national and sub-national level that such a detailed and updated registry of health care professionals is the need of the hour to address the many challenges and disparities in health manpower availability, distribution and skill mix. This will also come as a complement to measures such as an integrated public health cadre and initiatives to train, deploy and retain more local manpower.

In health care, which is characterized by perennially scarce resources and a plethora of challenges, everything revolves around identifying the right priorities. And no amount of political or geopolitical expediency or cultural conservatism should be allowed to undermine national health interests. It is time to address the challenges of the national health care workforce and heal the nation before embarking on a healing cruise of the world.

Dr. Soham D. Bhaduri is a physician, health policy expert and editor-in-chief of ‘The Indian Practitioner’.