Dr Arun Jithendra & Dr Zeena Johar
India is a country of 1.2 billion people. One estimate, provided by the World Health Organization, suggests that, on average, one physician is required to serve 1,000 people, across all levels of care. This implies that we need a total of 1.2 million physicians to serve our population. However, the total number of formally-qualified allopathic doctors in the country is estimated to be only about half that number, with fewer than 30,000 being added every year, despite the fact that we have one of the largest number of medical colleges in the world.
It is clear from these numbers that there is a large gap in the availability of allopathic doctors that is likely to persist. It is also known that physicians who have formal degrees in Ayurvedic, Siddha and Unani disciplines are legally permitted to offer allopathic services to their patients. And, there are over 7,50,000 registered Ayurveda, Yoga, Unani, Siddha and Homoeopathy(AYUSH) practitioners in the country, about 70% of whom fall under the legally-permitted categories.
These numbers, when combined with the total number of physicians who are trained in the allopathic tradition, start to come close to the total requirement of medical practitioners that we need as a country. While examining this idea, it is also important to note that India is not alone in exploring this direction.
A number of other countries have successfully relied on personnel drawn from allied disciplines to make up for shortage of formally-trained medical practitioners addressing their unwillingness to serve in remote locations or in primary-care settings. In the US, for example, nurses have been asked to step up to the plate and fill in the enormous gaps in the availability of medical personnel both in urban as well as rural settings.
Having established that such personnel are indeed available and taking comfort from the fact that we are not alone in exploring the use of alternate and allied human resources, the next, and perhaps the most important question, concerns the competence of these alternate providers to offer allopathic medical care.
In the US, it is possible to get a registered nursing degree, with a focus on bedside and emergency-room nursing, after just a year-long training programme for a person who has taken biology and other life sciences in college. To qualify to be a nurse practitioner and practice allopathic medicine independently, an additional 11 months of training is required.
In India, the Ayurvedic, Unani and Siddha practitioners receive a longer, 5.5 years of intensive medical training.
A careful comparison of the academic training undergone by them with that offered to MBBS doctors reveals that their curriculum is designed in a very similar manner. The first three years of training in all the four disciplines is primarily structured around principles of biochemistry, anatomy, physiology, pharmacology, pathology and microbiology, along with subjects that focus on traditional medicinal learning such as medicinal botany and metal, minerals and animal kingdom.