healthcare manpower economics in india - (w)health check - jan 2014 - kapil khandelwal - equnev...

8/13/2019 Healthcare Manpower Economics in India - (W)Health Check - Jan 2014 - Kapil Khandelwal - EquNev Capital

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Health Biz India January 2014

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between primary care andsecondary and tertiary care);and its geographic distribution.For the first-time in India, anational-level healthcare skillsurvey is being undertaken byNational Skill DevelopmentCouncil (NSDC) that willinform us on some of the threedimensions mentioned.

Last week, the CabinetCommittee on EconomicAffairs (CCEA) on cleared aMinistry of Health and Family

Welfares proposal to add10,000 seats in state andcentral government medicalcolleges for the undergraduate

(MBBS) level in a moveaimed at reducing the nationsdisease burden. The decisioncomes a week after CCEAcleared a proposal to setup 58 government medicalcolleges with 100 seats each.While as doctors providehealth care services that, withsome exceptions, cannot be

provided by non-doctors,the size, composition andgeographic distribution of thedoctors in India affects theamount and type of healthcare services available. I am abit surprised at the nature andthe timing of all this. Thereis also a question on whetherwe are taking the right policydecisions in addressing Indiashealth manpower economicsthrough various medical andnursing Councils that existstoday in India and work intandem.

Opportunity Lost forAffordability, Acessabilityand Assurance inHealthcareAffordability: The Cost andBenefits of Developing Careersin Healthcare in IndiaIt costs approximately ` 2crores per seat to set up amedical college for 100 seats inIndia. While this may beeconomical, investmentsin medical colleges anddoctor training is a lengthy

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What isthe futureof MedicalEducation?As per the Milbanks Reporton the Future of AcademicMedicine 2025, thereare 3 key trends that areimpacting medical education

1. Digitalisation ofHealhcare New science andtechnology, particularlygenetics and IT Speed of internet anddigitalisation 24/7 society Lack of agreement onwhere healthcare beginsand ends

2. Personalisation ofHealthcare Rich and poor gap Seeking wellnessand rise of self-care &sophistication Increasing anxiety aboutsecurity and ethical issues Emergent diseases

3. Globalisation ofHealthcare Gap between what can bedone and what can beafforded Increasing accountabilityof all institutions Loss of respect forexpertsEconomic and political riseof India and China


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process; therefore, changesimplemented to alter supplydo not have immediate effectson the supply of trainedhealthcare professionals.Hence the proposedinvestments made by theGovernment in medical collegewill require a couple of yearsfor the impact to be visible inthe healthcare system. Whilenew medical colleges are beingplanned, investors in existingmedical colleges are lookingat exits as they expectationon their investment is notattractive due to the size ofquota seats and capitation,

creating a revolving doorphenomena.

To better understand theattractiveness of medicine asa career in India, a couple ofyears ago, we had carriedout an interesting exercise intrying to compare differentcareers in healthcare in Indiaand their life time value tocompare them on a commonparameter in rupee terms. Thechart below vividly comparesthem.

It is interesting to notethat although surgeons andmedical adminstrators in Indiacommand a higher life-time

value within the healthcaremanpower spectrum, whencompared with other sectors,their respective attractivenessis low, resulting in relative

enrolments in medical schoolsand also para medical schoolsremaining low and in somecases even the seats not beingfilled in.

Accessibility: Providing trainedstaff in different parts of IndiaDue to overpopulation and atremendous disease burden,along with inadequateresources and policies, therehas been a perpetual demand-supply gap of medicalprofessionals as well as healthcare resources in most partsof the country, especially inrural India, with demandalways exceeding supply. Themajority of medical schooland residency training occursin hospital settings, wherethere are fewer primary carerole models and a greaterorientation toward specialtycare. Role models andexposure are important factorsin specialty choice; therefore,hospital-based training mayinfluence medical students

It is important tobetter understand the attractivenessof medicine as acareer in India

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toward specialties. Hencethere is pent up demand andpremium for specialty MDseats in India with somespecialties such as radiology

commanding a premium ofover crores of rupees.A recent estimate reveals

that as many as 40 per centof rural posting by trainedmedical graduates and postgraduates in different statesin India are not fulfilled.There is a huge shortage ofgynaecologists, cardiologistsand child specialists in ruralhospitals in the governmentsectors. Hence the governmentannouncement to increase thesupply of medical graduatesmay still not address theaccessibility issue.

Assurance: Training to medical professionals meets globalstandards to perform in anyhealthcare systemMedicine in globally iscomplex, and there issignificant variability intraining programs in Indiaand elsewhere. Much of howmedical care is provided inany part of the world is rootedin local and regional culturalstandards, and mastering thesestandards can be achievedonly by total immersion inthat system of medical careover time and under strictsupervision. Medical educationare supposed to be overseen bythe different Councils of India,

which is responsible forensuring the quality of boththe infrastructure and theprofessors at Indias medicalinstitutes and also provideassurance that they meetthe global standards. Sincedemand is high, it is difficult

for schools to retain facultyover the long term, whichcreates a lack of continuity

in both the schools practicesand its policy. The plethoraof new and underequippedmedical schools will createmore doctors and healthcareprofessionals on paper, butwill lower the quality of thedoctors produced, furtherexacerbating the preexistingshortage. So, while attemptingto alleviate a shortage ofdoctors, India has managedto create a completely newcrisis on top of the preexistingone - the shortage of teachingprofessionals in these medicalcollages. Various estimatesput this somewhere between75,000 to 100,000 trainedteachers and professionscurrently.

Another issue of assuranceis that Indian trained doctorshave to undergo additionaltraining abroad or have tocompromise with lower payand status as a doctor abroadinspite of have similar degreeas compared with doctorscoming out from medicalcolleges abroad.

Healthcare ManpowerEconomics Where do wego from here?In order to achieve our

healthcare outcomes and meetthe growing requirements ofskilled and trainedhealthcare professionals inIndia that is meeting globalstandards, rather than a siloedapproach to planningthrough various councils inIndia. My recommendationis a holistic approach fromplanning manpowerand human resources actionsto working on individualsobjectives and assurancethat the healthcare systemdelivers to the requirementsof Indias population healthoutcomes. As many expertshave postulated that thefuture of medical educationwill play on three key themes.It is necessary to prepare ourhealthcare manpower forthe future.

Summing UpMere policy announcementfor opening up more medicalcolleges in India is not thepanacea for solving theshortages in the supply ofhealthcare professionals andthe people to train healthcareprofessionals. It is time welook at the issues holisticallyand plan for the future!

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About the Author:

Kapil Khandelwal has earned

recognition as an angel

investor, venture capitalist

and expert in health sciences,

education, agri, clean tech and

information communications

and technology (ICT). His

expertise positions him as one

of the thought leaders in India,

Asia Pacic and emerging

markets. In his 25 years of

his career, he has carried out

over 30 transactions includingcross-border and buyouts.

He has chaired various

committees at various industry

bodies. Kapil runs an early

stage investment fund and his

own investment banking and

advisory services company

EquNev Capital Private Limited.

He can be contacted at: kapil@

kapilkhandelwal.com

healthcare manpower economics in india - (w)health check - jan 2014 - kapil khandelwal - equnev...

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