Heal the nation before healing the rest of the world

Political or geopolitical expediency or cultural chauvinism should not be allowed to undermine India’s health interests

Political or geopolitical expediency or cultural chauvinism should not be allowed to undermine India’s health interests

Strengthening human resources for health has been at the center of many recent policy initiatives and declarations by the Union government. The Union health budget 2022 has made significant allocations for the same, in line with the recommendations of the Fifteenth Finance Committee which placed particular emphasis on utilizing existing capacities at district and sub-district levels to train various cadres of health personnel . Much to the delight of public health advocates, the Ministry of Health recently released a set of implementation guidelines for a long-awaited Indian public health framework.

A more recent announcement, however, raises concerns about the consistency of India’s vision for health human resources. The Ayushman Bharat Digital Mission Center and Heal by India Initiative would develop a comprehensive online repository of all categories of healthcare professionals in the country. While such innovation is much needed due to the currently fragmented nature of this data, one of its primary proposed goals is to help external stakeholders viz. foreign employers and patients find an Indian match suited to their respective needs. It is an atavistic return to the largely shunned principles of the liberalization of health care, not only free today but also threatening.

WHO forecast for India

Concerns are legitimized by current estimates and future projections of the country’s health workforce, which paint a grim picture. A 2020 report by the World Health Organization (WHO) predicted a need for nearly two million additional doctors and nurses for India to meet the minimum threshold ratio of health workers to population. population.

According to a study by the WHO and the Public Health Foundation of India, beyond a genuine shortage of health workers and their skewed skill mix in a number of states, their current rate of growth is not expected to not lead to significant improvement. in the density or skill mix of health professionals by 2030. These deficiencies are further compounded by the legions of health professionals who remain inactive and out of the workforce. Faced with these colossal challenges, the current measure which aims to subtly strengthen medical tourism and aggravate the emigration of health professionals from the country is completely counter-intuitive.

Smooth Power Projection

In the mid-1990s, the General Agreement on Trade in Services (GATS) aimed to create unprecedented scope for cross-border trade in medical and healthcare services. While the implications of this neoliberal offshoot on health equity are well known and its central tenets have been widely criticized, health care, especially in the post-COVID-19 era, has been a terrain fertile ground for countries to project soft power – sometimes even at the expense of national health interests. A crucial distinction must always be made between the export of products such as vaccines and that of healthcare professionals.

While the former is characterized by much simpler transactional calculations, the training of health workers involves large subsidies (even a fraction of which is barely recovered by remittances and skills transfers), thus leading to leakage. net of the resources of the country of origin.

A similar drain on limited national health care resources is exercised through medical tourism, which almost always comes at the expense of health equity, especially in developing countries like India. . The magnitude of these could be somewhat mitigated by the use of telemedicine and virtual platforms, although the most significant concerns will persist. While neither medical tourism nor emigration can or should be abolished in its entirety, actively pursuing them when the country is reeling from acute shortages in an ambitious decade for healthcare is least justified. .

India needs a registry

It is also difficult to justify an immediate need for this measure. While an online repository of healthcare professionals will certainly help foreign players make the right choices, there is neither strong desperation on the demand side nor significant shortage on the supply side preventing a market to function well in his absence. For example, a recruiter from a developed country who wants to hire nurses from India and compensate them generously will have no trouble finding suitable candidates, regardless of the assistance provided by an online repository, and the latter would only be marginally useful.

Rather, it is at the national and sub-national levels that such a comprehensive and up-to-date register of health professionals is the need of the hour, to address the many challenges and disparities in the availability, distribution and range of skills of health workers. It would also strongly complement measures such as an integrated public health framework and initiatives to train, deploy and retain more of the local workforce.

In healthcare, which is characterized by perennially scarce resources and an overabundance of challenges, it’s all about identifying the right priorities. And no measure of political or geopolitical expediency or cultural chauvinism should be allowed to undermine national health interests. It is time to pull out all the stops to address national health workforce challenges and heal the nation before embarking on a healing cruise around the world.

Dr. Soham D. Bhaduri is a physician, health policy expert and editor of ‘The Indian Practitioner’

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