Doctors and health in India

Abstract

Medical practice in India is under intense scrutiny, and hardly a day goes by without another scandal, about poor treatment meted out to patients, absence of doctors from the workplace in rural areas, fraud in the medical education system, and so on. With rising costs, access to modern medicine is becoming a challenge, and there is little assurance of quality services and patients feel vulnerable and powerless; a real ‘caveat emptor’. This is against the backdrop of a massive expansion in health services both in the private and in the public sector, the promise of increased government funding, reforms in medical education, and other policy initiatives with the potential to deliver equitable access to healthcare by all as suggested by the recent High Level Expert Group on Universal Health Coverage for India(HLEG) (1) Can we expect to eventually see the effects of planned development get down to the ‘common people’ in India, and make a difference to their lives? Of course, it will take time for these changes to have an impact, given the scale of the challenge and the need for massive reforms. However, time alone not is not enough; it will also require an active leadership and a change of mindset. If the last two decades were focused on economic prosperity, the next few years must be concerned with health services, since maintaining economic growth requires a healthy population. This cannot be done without the support of doctors; engaging them in policy making and planning of health services will be crucial. However, for doctors to gain the confidence of the public the medical profession must first do some reflection. This paper seeks to stimulate debate and action to promote professionalism in medicine, and to start a movement for leadership in health in India. I write this with some trepidation as I have been out of India since 1980 and have been working largely in the National Health Service (NHS) in the UK. Nonetheless, I hope that an ‘outsider’s’ perspective will be useful.