Healthcare is one of the significant indicators of development. But it has not yet received a decent share of attention in India. The second wave of the recent pandemic that has already started in India points to the need for better quality healthcare infrastructure. Except in a few cities, the country does not have advanced medical facilities. As per the latest World Bank data, the number of physicians per 1,000 people in India is only 0.9, against the WHO’s recommendation of 1.0. This number is 1.0 in Pakistan, 2.2 in Brazil, 2.0 in China, and 0.9 in Myanmar, Nepal and South Africa. India’s position is much below the average ratio (1.3) of low- and middle-income countries.
One crucial factor for quality healthcare is the availability of qualified doctors. Due to a low doctor-population ratio and poor public spending, there has been an increased possibility of the entry of “quacks” or less-than-qualified doctors in the health sector. According to a 1996 Supreme Court ruling, anyone who practices allopathy without an allopathic degree is a quack. Quacks usually provide cheaper medicine to the locals and put patients at risk. They usually do not charge consultation fees and are easily approachable. But the consequences have often been adverse (BMJ, 2016).
In the present scenario, when the number of coronavirus-affected patients is increasing, the problem of a lack of qualified doctors is also surfacing along with the miserable condition of healthcare facilities in India. In fact, the Government of India has allowed medical students, interns and dentists to take care of Covid-infected patients, according to reports. But the government had no other better option then and now. This also encourages the entry of quacks (also called lemons) in healthcare.
It was reported that a 47-year-old man from Tamil Nadu who succumbed to Covid had been treated by a quack (30 June 2020, The New Indian Express). It is almost a nightmare to imagine quacks using a single syringe for multiple patients while promising cheap treatment. The consequences are miserable. There are other similar cases in the country during the pandemic where quacks are treating Covid-infected patients. The Tamil Nadu government, in fact, formed a special team of doctors to check quacks treating Covid patients. The team was mainly formed to see if quacks are qualified to treat Covid patients under the banner of AYUSH. Considering the shortage of qualified medical practitioners and lack of healthcare infrastructure, the pandemic is surely a curse for the nation but maybe a blessing in disguise for quacks.
The public spending on the health sector in India has been abysmally low (only 1.1% of GDP). Nonetheless, the present government has ambitiously proposed to increase the health spending to 2.5% of GDP by 2025. The Economic Survey 2021 has also highlighted the proposal of the government to increase public health spending, which may bring down the out-of-pocket expenditure on healthcare from 65% to 35%. But an increase in government spending alone in the health sector does not guarantee better quality of health service provisioning. There have been serious discussions on public health spending, while a justified amount of attention has been given to improving the quality of healthcare.
But still, the question arises regarding how to deal with the quacks without compromising on the quality of healthcare. There are suggestions about giving training to quacks, but will a small crash course justify the entire syllabus required for medical practitioners? An informal training programme was undertaken by J-PAL South Asia in West Bengal in 2013-2014 and the result was some improvement in the quality of treatment provided by quacks, but it did not reduce the prescription of unnecessary medicines by them (Science, 2016).There should be sufficient spending on monitoring healthcare providers. This might help bring in some regulation in the healthcare sector amid the prevailing crisis. Regulation will provide a baseline of quality and protect the public against unlicensed or unscrupulous practices. It will
also help place a cap on the fees that private-sector providers charge. Such an initiative by the government might help reduce the issue of quackery and save the lives of many more people amidst the already existing crisis.
Pratap C Mohanty
Teaches economics, specialises in healthcare research, IIT Roorkee
Senior Doctoral Fellow in economics of healthcare, IIT Roorkee