For want of doctors, the Covid Third Wave was lost…

When Chandu, a cloth merchant of Sant Hirdaram Nagar (old name Bairagarh) of Bhopal, got a message on his mobile phone informing him that he had been certified fully vaccinated for Covid-19 he was not very happy.

The reason was that in reality he had not received even a single dose of vaccine till then. The message was a fake one prompting him to complain about it to health workers in the area. More than two weeks later he still hasn’t got a reply as to how this mistake happened.

Chandu is not alone and hundreds of people in Madhya Pradesh and neighbouring Rajasthan are getting similar fake messages on their mobile numbers about their vaccination status.

According to official data the first dose of the vaccine has been given to 61 percent of the Indian population and the second dose to 43 percent, since the campaign began in early 2021. However, the fake accounting of vaccination as in the case of Chandu has raised doubts about the figures being put out by government agencies.

Claims have also been made about improvements to the health infrastructure since the second wave of Covid ravaged many states in the middle of last year. However, there is also no credible information about availability of oxygen supplies that may be required by Covid patients affected by the third wave of the pandemic.

The biggest issue of all that nobody is talking about though is the shortage of doctors across the country, estimated to be more than 5 lakh doctors. In the meanwhile, junior doctors are agitating everywhere over the last month or more demanding various things. One of the major grievances they have is that the NEET exam, for medical college admissions, was conducted late.

Further, the NEET Post Graduate counseling, which was to be held in October 2021 is yet to be conducted. Till late December 2021, junior doctors have agitated in many states across the country, including Delhi and MP. They have returned to work only on the assurance of Union Health Minister Mansukh Mandaviya that their demands will be looked into.

COVID Response Watch LogoThis is the situation when India has lost lakhs of its citizens in the first and second wave of Covid. India it seems has not learned any concrete lessons from the massive devastation in both the waves. The discontent among junior doctors for example was easily avoidable and the fact that they are agitating shows the indifference of the Indian government to the fate of the public.  State-run hospitals in the country, which have been at the forefront of the Covid response over the last two years, depend on junior doctors for providing their services.At the level of health infrastructure, in most states only the number of beds in city hospitals has been increased. ICU beds have not increased much as compared to what existed earlier. New hospitals have also not been opened. The number of oxygen plants has definitely increased, but there are doubts that they will be able to replenish the oxygen when demand peaks.

A bulk of India’s large population lives in villages where neither the health infrastructure has been strengthened nor the shortage of doctors addressed. There are no facilities for testing for Covid in rural areas. There is one community health center for every 150-200 villages and that too in poor condition. In these, far from ICU beds, there is no provision of even oxygen cylinders for 50 patients simultaneously.

Many states do not even have the number of ventilators for Covid patients with severe symptoms. This has come to the fore during the first and second wave of Covid, when thousands of patients died due to lack of ventilators.. Even then the number of ventilators that states have is not proportionate to the number of people likely to become ill. However, after the second wave, the Union Ministry of Health and Family Welfare has given some ventilators to the states, with MP allocated 1611 ventilators, to be delivered by December 2021.

According to the World Health Organization (WHO) there should be one doctor per 1000 people, but in India, on an average, there is only one government doctor for 11082 people. There are private doctors to be found everywhere but they charge exorbitant fees.

According to the records of the Medical Council of India, a total of 10.41 lakh doctors were registered till the year 2017. Of these, there were 1.2 lakh doctors in government hospitals and the rest were working in private hospitals.

There are fewer doctors than patients in four states namely Uttar Pradesh, Chhattisgarh, Odisha and MP. Apart from these, the condition of Bihar is the worst. There is one allopathic doctor for a population of about 28000 people. According to WHO data in 2016, a third of all practicing allopathic doctors in India also did not have a medical degree.

In Madhya Pradesh there is only one doctor for 16,996 people. Of the about 9000 posts of doctors sanctioned in the state, only about 4900 posts are filled. According to an estimate, there is a shortage of more than 16 thousand nursing staff in the state.

Among the reasons for shortage of doctors and other health staff in Madhya Pradesh are low pay, poor working conditions, the burden of too much administrative work and lack of respect from both government and the public. The lack of sufficient staff in turn has given government hospitals a poor reputation as the doctors  working there are given too many responsibilities and are unable to live up to the expectations of the public. The blame for all this is finally laid on the doctors, who then feel  cheated and demoralized.

Maharashtra, Kerala, Karnataka, Andhra Pradesh, Tamil Nadu and Punjab have doctors as per WHO standards, but even in these states, doctors are available mostly in cities. The shortage of doctors in rural parts persists in these states as well so the population living in rural areas have to wait in queues for doctors.

The government itself has accepted that there is a shortage of doctors in the country. The Union Health Ministry had released the Rural Health Statistics Report in 2019-20. According to this report the shortage of doctors in community health centers is 76.1%, while the shortage of surgeons is 78.9%, physicians at 78.2% and pediatricians at 78.2%. Despite the Covid crisis this situation remains as it is and nothing has been done to improve the situation.

According to a WHO statistics report released in 2018, about 23 crore people in India had to spend 10 percent of their earnings for health-related expenditure between 2007 and 2015. The report said that a total of 3.9 percent of the country’s population i.e. 51 million Indians spend more than a quarter of their household budget on treatment, while in Sri Lanka the percentage of  population in a similar situation is only 0.1 percent, in Britain 0.5 percent, America 0.8 percent and 4.8 percent in China.

Ashok Kapse is a journalist based in Bhopal

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