“Doctor population ratio for India - The reality”

India plans to establish some 200 new medical colleges in the next 10 years to meet the projected huge shortage of 600,000 doctors. The projections are based on recommendations that have several caveats and therefore somewhat arbitrary1. As compared to their pre-independence levels, all health parameters have shown remarkable progressive improvement even in rural India2. Shortage of doctors for primary health care has been hyped. In fact, States like Maharashtra are now producing surplus MBBS doctors. The Government of Maharashtra has, therefore, decided to scrap the service bond to serve rural sector given by all students in government medical colleges3. On the other hand, India is already facing gross shortages of medical teachers4. The proposed massive expansion, which would reduce the medical colleges to pathshalas (primary schools), is ill advised. It will not solve India's woes of poor health services, but only downgrade country's standing in the medical world. More attention should now be paid to quality of medical education to facilitate establishment of hubs of excellence in medical services, education and research. Rural health services are today actually in dire need of well trained specialists and super-specialists. The basis for arriving at this huge projected shortage is the recommendation about minimum doctor population ratio of 1:1000 made by ‘High Level Expert Group (HLEG) for Universal Health Coverage’ constituted by the Planning Commission5. The concept was originally developed by the Joint Learning Initiative (JLI)1 and subsequently more or less adopted by the WHO5. The two parameters used by the JLI to arrive at the concept were magnitude of coverage of measles immunization and births conducted by skilled attendant. Both of these are low level medical skills that could be easily done by paramedics. However, the issue is more complex as there are several caveats to the recommendations. Several nations and Indian States have achieved health indices of global standards with much lower doctor population ratio1,5.