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What the National Health Policy 2017 Missed — Medical College in Every District and Postgraduate Training for Every Doctor

I welcome the announcement of National Health Policy 2017. In particular, raising public health expenditure to 2.5% of GDP by 2025 is a laudable target as is the aim to spend most of the government resources on primary care. I have argued previously that we cannot modernise our healthcare whilst ignoring the primary care. Primary care facilities need to be upgraded, provided with basic diagnostic facilities and funded to be able to lure doctors and nurses to work in remote corners of the country.

Dr Kamal Mahawar
Dr Kamal Mahawar

It is not enough to continually ask doctors and nurses to sacrifice themselves for humanity whilst others in society continue to enjoy their power and wealth. We currently have no training programmes for doctors to specialise in primary care upon obtaining qualification and that needs to be urgently examined as it is not fair for either the doctors or the patients for us not to be able to provide postgraduate training to every single newly qualified doctor. In fact, it should be a mandatory requirement before any doctor is given independent practising privileges. It is also not enough to continue to expect trainee (resident) doctors to work twice as hard as any other professional in society for wages that are typically a third.

The policy makers need to understand that doctors can only provide patient-centric care when they have a reasonable workload and have a socially fulfilling and economically productive life. When things go wrong, the blame is often wrongly placed at the shoulder of frontline junior doctors without even an attempt to understand that the people really responsible for these failures are those managers (senior doctors included), bureaucrats, and politicians who fail to ensure the well-being of these doctors and provide them with world-class infrastructure.

I further welcome the announcement to provide most of the secondary care at the district level but I do not understand how they can provide this care at the level of districts, which in their own words is “currently provided at a medical college hospital”. This is a fundamental lack of understanding of how modern medicine functions. Most of the advanced medical care cannot in this day and age be provided outside hospitals and my suggestion would be that instead of developing substandard district level facilities that are neither here nor there, we develop an ambitious plan to have a medical college (with its own hospital and nursing college) in every single district of the country. Yes, it will need resources but that will set us firmly on the right path in the 21st century.

Rest of the policy is full of a number of disease-specific targets that I am not a big fan of. In my humble opinion, you cannot fix healthcare by going after diseases individually. You either have a modern healthcare or you don’t. Everything else is tinkering around the edges.

Following his graduation from Calcutta Medical College and post graduation from Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Dr Kamal Mahawar is now a Consultant General and Bariatric Surgeon with Sunderland Royal Hospital in the United Kingdom. He is also an Associate Clinical Lecturer with Newcastle University and editor of renowned scientific journals. His recent book ‘The Ethical Doctor’ published by Harper Collins India examines some of the serious issues affecting Indian healthcare.

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