Will a National Medical Register solve India's quack problem?
By Arunima Rajan
With 1 million quacks practising in the country, we look at what the authorities and medical practitioners are doing to ensure authentic medical care
With uneven access to healthcare, and a medical education unaffordable for many aspirants, unqualified medical practitioners, or quacks, continue to be an issue in India. The official data on the number of quacks in the Indian healthcare system is sizable. A 2016 WHO report on the health workforce in India shocked everybody by stating that 57.3% of those practising allopathic medicine did not have any medical qualification. This claim was later rubbished as “erroneous” by then Union health minister JP Nadda in the Lok Sabha. Let's look at the facts, and some ways to combat this issue.
Weeding out Quacks from the system
Supporting WHO’s report, the IMA claims that India has about 1 million quacks performing medicine among which 600,000 offer allopathic treatments. The rising concern of quacks in the country has recently been addressed by the Indian government’s plans to develop a digital, national register under ABDM (Ayushman Bharat Digital Mission) to verify healthcare professionals from all medical systems and professions, including pharmacies and paramedics. However, such listings must incorporate expert opinions. Dr Harish Pillai, CEO of Metro Pacific Hospital Holdings Inc. states that “Quackery is a bane of any healthcare system and erodes the credibility and trust that is a paramount expectation from any patient towards a care provider. The effort made by the National Register to remove unqualified individuals who have not got through the rigour of mandatory training and licensing is definitely the need of the day and a step in the right direction.”
He adds that quacks are never the answer to the shortage of doctors as we cannot shrink the curriculum and cut corners to increase quantity. The National Medical Commission, along with State Councils should educate the masses through social media campaigns on how to identify and report quacks to the regulator. Moreover, blockchain technology could be used to ensure that valid degrees cannot be forged by anyone and all the necessary steps should be adopted to increase the production, training and retention of healthcare workers.
Re-orientation of processes, people and systems to ensure focus on public health is vital. While the Bhore Committee designed the aspects of Preventive and Community medicine in the curriculum, it is unfortunate that public health-oriented professionals are extremely few in number. Hence, we need a re-orientation in the educational system to produce more professionals who can be tasked with the crafting of health policies.
Anand Garg is the former CEO of Seven Hills Healthcare Private Limited. He points out, “there is a paucity of doctors in India; there is no doubt about that. However, if we look at the global benchmarks vs actuals in our country, we find the WHO lays down a doctor-to-patient ratio of 1:1000 and India’s ratio stands at 1:1674. However, there is a greater concentration of doctors in metros and urban areas thereby creating a big healthcare divide in the country. On one hand there is a shortage of doctors while on the other, there are a large number of unfilled medical seats. So, adoption of technology in a pervasive manner coupled with removal of the above anomaly may address the problem to a large extent.” Another important initiative is to strengthen and equip a large number of defunct primary healthcare centres nationally. If these PHCs can be upgraded by deployment of telemedicine and HealthTech tools under the purview of Ayushman Bharat program, then the latent demand for quacks will gradually but surely dry up, he adds.
Digitization of Healthcare- A Welcome Move
Vasanth Kattalai Kailasam MD, Founder & Chief Medical Officer of CareMe Health says that “In the US, there is a National Providers Identification (NPI) number and anybody can look up any provider. Moreover, each medical board maintains the certification status of the physicians. For example, the American Board of Psychiatry and Neurology (ABPN) website would have the status of my credentials. It’s available in public for both potential employers and patients to access and improves the transparency in the system, but I doubt whether it is going to curb the rampant quackery in Indian healthcare. If you look at the way they practise, they make money by prescribing medicine and as long as everyone has access to medicines without a legal prescription, the problem is going to continue. Hence, regulation in pharmacy and prescription practice would have a bigger impact in curbing quackery. I think this is a move in the right direction and a good place to start.”
Accessibility of doctors, a problem bigger than availability
Sohit Kapoor, Founder of Driefcase, a digital health start-up that uses longitudinal healthcare data to help stakeholders get better control on their health journeys, asserts, “I don't think shortage of doctors is the major issue. The issue is about their geographical spread. Doctors tend to be concentrated in large urban centres, thereby creating a shortage in semi-urban and rural areas but unqualified professionals cannot be an answer to this problem. We believe that the solution to the problem of access lies in technology. If you can connect patients from these areas to doctors in urban centres, the role of unqualified professionals will reduce significantly.”
No reliable way to check credentials of professionals
Today, there is no reliable way for the public to check the credentials of a doctor. So, the health professional registry is a good start and is an important part of the larger Ayushman Bharat Digital Mission (ABDM). Healthcare delivery in India needs a lot of resources and the Heal in India program of the Government will add to this requirement. While unqualified professionals can't be trained to become doctors, they can be trained and leveraged as healthcare workers at various other levels.
Informal healthcare workers with little to no training provide more than 70 percent of all primary care in rural India. “The Rural Medical Practitioners are quite often the first point of contact especially in underserved areas, there is a body of evidence that suggests engaging them through capacity building and creating enabling environment for them to report notifiable diseases such as TB has strengthened the TB control programme. I don't think weeding out these informal providers is an answer,” says Oommen John from George Institute of Health.
“One needs to look at the definition of practising allopathic medicine. When a medical shop sells antibiotics over the counter it's a form of practice of allopathic medicine, they ask for symptoms, based on which they give medicines over the counter without a prescription. I am not approving what they are doing, but it's not them alone who are the problem. The lack of implementation of strict policy on OTC is probably the first step,” he opines.
Offering a perspective on the way ahead, Sohit Kapoor concludes, “Unqualified professionals are a cheaper alternative to qualified doctors. Strengthening the PHCs and inclusion of OPD in the Pradhan Mantri Jan Arogya Yojana (PMJAY) insurance scheme can address this issue. We believe that the Ayushman Bharat Digital Mission (ABDM) is a great initiative by the Government, one that can transform healthcare delivery in India and go a long way in achieving our goal of universal health coverage.”