Incorrect Dosage

India’s blinkered preference for specialist doctors

01 November 2015
Dr Yogesh Jain, who trained as a paediatric oncologist, described himself and his specialist colleagues at the Jan Swasthya Sahyog hospital in rural Chhattisgarh as being in a constant state of “de-specialising.”
tom pietrasik
Dr Yogesh Jain, who trained as a paediatric oncologist, described himself and his specialist colleagues at the Jan Swasthya Sahyog hospital in rural Chhattisgarh as being in a constant state of “de-specialising.”
tom pietrasik

The Jan Swasthya Sahyog hospital in Ganiyari, in Chhattisgarh’s Bilaspur district, has 62 permanently over-subscribed beds, an operating theatre, a laboratory and a pharmacy, all spread across a low-rise complex. Its outpatient clinics see over 300 people a day, from a catchment area the JSS calculates as taking in over a million people. Besides the hospital, the JSS, a non-profit rural health organisation, also trains community health workers and runs mobile clinics. The demand for its services is immense. Bilaspur, according to the 2011 census, has a population of 2 million people served by only 60 doctors, and over half of its 1,566 villages have no medical facilities whatsoever. The average wait for an appointment at Ganiyari is between five and seven days, during which patients and their families cook on the roadside outside the complex, and, if they can find space, sleep in the organisation’s dharmashala.

I visited the hospital, located a three-hour drive north from Raipur, in April, and was shown around by Dr Yogesh Jain, one of the JSS’s founders. Despite the hospital’s heavy caseload, the atmosphere was calm. Patients hid from the sun in the shade of wide verandas, or beneath flowering bamboo in the complex’s central compound. “I know,” Jain told me on my first morning. “The fire doesn’t feel like a fire.”

Every day, the JSS confronts some of the most critical clinical and logistical problems in Indian public health. Key among them is a chronic shortage of doctors. The country’s doctor-to-patient ratio stands at 0.7 per 1,000, while the World Health Organisation’s recommended minimum is 1 per 1,000. In rural India, the ratio is far worse: figures from the Central Bureau of Health Intelligence show that the 68 percent of India’s population living outside its cities is attended to by only 33 percent of the country’s doctors.

Anna Ruddock is a PhD candidate at the India Institute, King’s College London. Before her return to academia, she worked as the India research analyst for the Foreign and Commonwealth Office in the United Kingdom.

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