Mithilesh Chaudhary, 21, coughs weakly as he struggles to get up after spending the night outside the state-run All India Institute of Medical Sciences (AIIMS) in New Delhi.
“We’ve been sleeping on the pavement for two nights,” said his grandfather Bhim Lal, as the two waited in a queue of around 100 people outside the hospital’s main gate, seeking an appointment.
“He suffers from chest congestion and no one has been able to tell us exactly what the problem is. We have been to many hospitals in our district and finally a doctor from a private hospital asked us to visit AIIMS in Delhi.”
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Chaudhary, who lives 750 miles away in the state of Bihar, has no appointment and has not been named by a doctor. His only recourse is to stand in line until he gets one of the few spots that open each morning for those waiting outside.
His plight and that of others queuing up every day starting at dawn highlights the shortage of specialist doctors and health workers in rural India, home to more than two-thirds of its 1.43 billion people.
Prime Minister Narendra Modi’s government has built more than a dozen similar medical institutes for specialist treatment since he took office in 2014. The government has plans to build at least one large hospital in each of India’s 761 districts.
The problem is a shortage of doctors, a shortage that is reaching crucial levels as India becomes the world’s most populous nation.
India’s doctor-to-patient ratio reached a record 1.2 doctors per 1,000 patients in 1991, according to the World Health Organization (WHO), but as its population has grown, the ratio has dropped to around 0.7 in 2020.
The WHO recommended level is 1 and China, with a population comparable to India, is at 2.4.
Mithilesh Chaudhary, a 21-year-old patient, looks on as his mother Anita Devi, 30, and grandfather Bhim Lal Chaudhary, 59, wait to make an appointment outside the All India Institute of Medical Sciences in New Delhi, India, in May 1, 2023. (REUTERS/Anushree Fadnavis)
Health Minister Mansukh Mandaviya told parliament in March that India did indeed have a ratio of 1 doctor to every 834 patients, well above the WHO level, but the figure included doctors who practiced traditional forms of medicine such as Ayurveda. , Homeopathy and Naturopathy.
The WHO and medical groups such as the Indian Medical Association do not include traditional medicine practitioners in their calculations.
Opening the first specialist medical institute in northeast India last month, Modi said his government had sought to increase the number of doctors by creating more medical schools.
“This deficiency has been a major barrier to quality healthcare services in India,” he said. “So our government has worked on a massive scale to increase medical infrastructure and medical professionals over the past nine years.”
The number of public hospitals, excluding specialized institutes, increased by about 9% during Modi’s tenure, government data show.
rural gaps
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The government almost doubled the number of places for graduation in public and private colleges to 101,043 in March, from 51,348 before 2014, according to data from the Ministry of Health.
More than 1.76 million students auditioned for these places last year.
Still, there were more than 3,000 vacancies for physicians in 31 major federal government hospitals, including more than a dozen specialized institutes, according to a response from the Ministry of Health’s parliament in February. Nurses and support staff vacancies were more than 21,000.
At Jawahar Lal Nehru Medical College, an 800-bed hospital in Bihar’s largely rural Bhagalpur district, a senior doctor said the department of medicine – the first point of contact for patients – for example, had only half the number of physicians needed in the past five years.
“We have to provide proper patient care, no matter what…but with inadequate staff, the workload increases and it becomes very difficult to manage, especially since we also have to teach undergraduate students,” said the doctor, who did not want to be identified.
Outside the big cities, the lack of specialized care is especially acute. The government says there was a shortage of almost 80% of surgeons, doctors, gynecologists and pediatricians in community health centers in rural India in March 2022.
There were 4,485 specialists working at these small hospitals against a need of 21,920, according to government figures.
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Specialist doctors tend to go abroad or join the private sector in metropolitan and other large cities, said Dr. K. Srinath Reddy, non-profit Public Health Foundation of India.
“They were trained in tertiary care settings and may not be adequately skilled or emotionally aligned to rural conditions in low-resource settings,” Reddy said.
Dr. Vandana Prasad, technical adviser to the non-profit Public Health Resource Network, said people in rural areas tend to go to cities for treatment.
“There is a certain trust in the hospitals that exist in the big metropolitan cities and there is a kind of environment that suggests to people that they should seek more and more expensive or more specialized care,” she said.
That was the main reason for the large number of cases and the crowds outside the hospital, said Dr. Syed Ahmed, resident physician at AIIMS in Delhi.
“Many of the cases can be treated at the primary care level,” he said.
