State of Indian Healthcare system

The first of these cancers, and perhaps the most worrisome, is the emergence of malpractice in the as yet nascent “organised” health care delivery sector. Increasingly, we get to hear stories from patients and their attendants who claim to have been subjected to uncalled-for (expensive) investigations and medical procedures, extended stay in hospitals, and unnecessary visits from “specialists” who come to patients’ rooms merely to mark their attendance and add visitation fees to the bill. Also reported are instances of irregularities in pricing, with prices and procedures markedly different – and higher – for those covered under some kind of medical insurance. Even worse is the deteriorating quality of outcome despite inflated costs.

There is understandably a vehement denial from many of these operators or a studied silence since there is little regulatory or market-driven pressure on them. Currently, India has less than 700,000 functional hospital beds, of which more than 40 per cent are located in the top-20 cities. On a conservative note, given the geographical spread of population, India urgently needs almost 1 million additional hospital beds and another million by the end of the decade.

The second of these cancers is the unchecked proliferation of adulterated and expired medicines and devices across India. There are no reliable estimates of the extent of penetration. However, considering that most government agencies tend to under- report the magnitude of this malaise, the number could be as much as 20 per cent – or even higher – of all drugs. Delhi (and north India) seems to be the hub of this nefarious trade.

The third of these cancers is the unregulated entry of unqualified medical practitioners into the health care system. Under the garb of accepting, and even encouraging, all forms of medicinal systems, including those with little or no scientific basis, India has created a situation in which there may be more quacks than qualified practitioners. Going by Medical Council of India data, there are less than 650,000 qualified medical professionals in India. This estimate could be guided by optimism. India urgently needs an additional 750,000 to 1 million doctors if universal access to health care is to be attempted. With the current capacity of less than 45,000 seats for Bachelor of Medical and Bachelor of Surgery (MBBS), and less than 10,000 Doctors of Medicine (MDs), it isn’t surprising that all kinds of charlatans flaunt fancy fake qualification certificates and ply their trade openly. If fake pilots can gain entry into airlines, it is far easier – and more lucrative if not as glamourous – for doctors to start business by putting a signboard outside their shop.

According to Medical Council of India the current doctor-population ratio in India is 1:1700 when compared to a world average of 1.5:1000. The committee came to a consensus that targeted doctor population ratio should be 1:1000 by 2031. There are 330 medical colleges with an intake of approximately 35,000. And with the current intake of doctors, their shortfall is estimated at 9.54 lakhs by 2031.

Was this the state envisioned by Charaka, Sushruta and Hippocrates ?

Issue of Clinical Trials in Developing country -India

A Union health ministry probe has revealed that pharmaceutical majors conducting clinical trials in India have not given compensation to majority of the volunteers who died during the trials. Of the 671 deaths that were reported in 2010, the ministry has evidence of just three cases of compensation.

The ministry has asked 44 pharmaceutical companies, including global drug majors such as Eli Lilly, Novartis, Pfizer, Bayer, Merck, Johnson & Johnson and Sanofi Aventis, to explain why they have not given the compensation, which is mandatory under the current drug laws.

A Novartis spokesperson said the clinical trial investigator (who conducted the trial for Novartis) had asserted the deaths were not because of the study medication but due to progression of underlying disease (which won't necessitate compensation). Similar arguments were made by most pharmaceutical firms that figured in the list.

According to Maneka Gandhi, the increasing number of clinical trial deaths -- 137 deaths registered in 2007, 288 in 2008 and 637 in 2009 -- is turning regulatory monitoring increasingly important. ++++ MORE ON CLINICAL RESEARCH