Time to Revisit Recommendations on Doctor to Population Ratio in India

A buzzword in Indian press and amongst the policy makers is that India is short of the WHO recommended doctor to population ratio of 1:1000. The recommendations were formulated to facilitate programs to achieve some of the health related UN-Millennium Development Goals (MDGs). Infections and malnutrition, which can be comfortably handled by a basic MBBS doctor, were the dominant health issues at the time of the formulation of the MDGs. However, all countries worldwide are going through health epidemiological transition and health impact of the non-communicable disorders (NCDs) can be no more ignored even by the low income nations. Very soon India will need large number of specialists and super-specialists to meet the challenge posed by the avalanche of NCDs, as an ordinary MBBS is not trained to handle the NCDs. One of the major flaws in the recommendations is that for the purposes of computation of the ratio, doctors of all hue, basic doctors, specialists and super-specialists are lumped together. It is time to define the requirements discipline wise and tailor medical education to produce specialists and super-specialists on a fast track. Expansion of specialization in medicine should be associated with simultaneous strengthening of primary health care, a challenged faced even by the most developed nations. To provide health services for routine minor health problems a cadre of Nurse Practitioners (NPs), a concept developed 50 years ago in the USA and now endorsed by many nations, could be adopted.