Why is India not able to train doctors and nurses in the numbers that it needs?

This table shows World Health Organization (WHO) figures for the density of doctors & specialists, and the density of trained nurses & midwives, as well as certain mother and child health indicators for a few countries. India has the worst health indicators as well as the lowest numbers of doctors + nurses for every 10,000 people in comparison with the other countries listed here. The density of doctors, at 6 per 10,000 (not including ayurvedic and homeopathic practitioners), is expectedly far below the numbers for developed countries. The density of nurses in comparison with the developed countries is even more glaring.

Even the comparison with Brazil, China, Russia, and South Africa is not flattering. What comes as a surprise is that South Africa is marginally better than India in health indicators and has a better health worker density. While the health indicators depend on various factors including nutrition and hygiene, it is in some measure also linked to the access to health workers.

The Rural Depths

The above figures do not reveal the real picture though as they do not account for the urban rural divide. 

Rural healthcare provided by the government has a three-tier structure – Sub Centre, Primary Heath Centre (PHC) and the Community Health Centre (CHC). The PHC is the first place available for the rural poor to see a doctor. Each PHC by design must have at least one doctor and one nurse and currently serves, on average, a population of 31,000. For specialist consultation, people are expected to go to the CHC. Each existing CHC must have 4 specialists – a surgeon, gynecologist, physician and pediatrician – supported by 7 nurses and currently serves, on average, a population of 1.7 lakhs. It is probably safe to assume that medical care in rural areas is almost entirely provided by the Government. With this assumption, the physician density works out to < 0.6 and density of trained nurses/midwifes to < 0.5 in rural areas.

The shortfall of medical personel to man the existing CHC's and PHC's is reported by the Government as follows: Doctors short by 3537; Specialists short by 11033; Nurses short by 18021.

The shortfall of specialists must be seen in the context of the numbers of specialists trained every year in India - currently about 12,000 across all specializations. It will take many years to fill specialist positions in rural health centers even if all newly trained specialists moved there for a period.

How is Government policy towards medical education changing to cope with this shortage? These issues are examined in this India Together piece

Links:

Govt. press briefing on plans to rlx norms (Mar. 2008) - Livemint Report
Knowledge Commission: report of working group on medical education
Faculty transferred for a day - TOI Report on Karnataka Govt. Colleges
WHO Global Health Observatory
MOHFW: Bulletin on Rural Health Statistics