Doctors, Nurses and Public Health System

Doctors, Nurses and Public Health System

----Ravi Duggal

Getting Doctors and Nurses to Work for the Public Health System

One major concern with the functioning of the public health system is availability of key functionaries, especially doctors and nurses. The question is not one of lack of production because that happens adequately with about 25000 each of doctors (allopathic alone, in addition about 20000 AYUSH doctors) and nurses being produced annually. Infact we produce enough to cater to the world and Indian doctors and nurses are in great demand all over the world – over 5000 doctors and 7000 nurses go abroad each year. But the public health system, both in rural and urban areas, is unable to attract the requisite human resources needed for running the public health system. This despite the fact that over 80% of such production happens with public resources.

It is time that the legislators of this country give serious attention to this shortage of human resources for the public health system if the National Rural Health Mission has to achieve any significant success. Apart from doctors and nurses the public health system also needs managers under the architectural corrections mandated by the NRHM.

Over the years various mechanisms have been tried but they have failed because there was no legal backing for them. Whatever was done was done on good faith which is in fact the corner stone of the medical profession. But we all know that ethics in medical practice is getting even more distant with gross commercialization of healthcare and good faith is no longer a value cherished by this profession. This makes the role of the lawmakers of the country even more critical.

It is very clear that the only way of meeting the shortages of human resources for public healthcare and other public services is by instituting legislation that mandates compulsory national/state public service of 3 to 5 years. Thus all medical and nursing graduates as well as management, engineering, accounting, general stream etc.. graduates must put in compulsory public service as a social return for the investment in them by the public exchequer. This will not only provide the public system with human resources but it will also instill social responsibility and ethics in the professionals.

A number of countries have national public service, either military and/or non-military, and it is time India put in place such a mechanism. We need a legislation on national public service for anyone attaining age 21 with immediate effect otherwise the economic growth and development will have little meaning as we will increasingly lose skills and resources to the developed world one way or another.

We can learn from different countries, some have general compulsory public service and some target specific professionals like doctors and nurses. Since there is already a historical debate on the health professionals doing some compulsory service like in rural areas we can begin with this profession through a national ordinance making public health service compulsory with immediate effect and gradually bring in the broader legislation for a national public service.

We urge Parliamentarians to consider this with urgency and bring this into effect in the winter session of Parliament. Since 25000 each doctors and nurses graduate each year and over 10000 specialists also, we can immediately fulfill all shortages faced by the public health system with one stroke of the pen. Doctors and nurses will agitate and resist but the State must show strong political will to realize the critical objectives of our Constitution of social justice and equity. Similarly management graduates, especially from the IIMs should be targeted as for them it would be a great opportunity to prove their skills in efficiently managing public systems before they learn to manipulate markets. The NRHM needs these management graduates as much as they need doctors and nurses. Let the public health system become the experimental ground for a national public service because with healthcare needs addressed, a healthy population is the best guarantee for economic and social development.

(Published in IMPF Newsletter Vol. 2 No. 3, Winter Session, 2007)