Under Operation Ganga India evacuated its stranded citizens from Ukraine along with around 20,000 medical students who went to eastern European countries aspiring to become doctors. What draws these aspirants to medical colleges in Ukraine? The answer lies in the fact that they are affordable for middle class families, provide quality education and the license to practice abroad.
Ukraine, like Romania and Bulgaria, is a popular destination for medical students because of lower costs. A student pursuing a six-year medical course needs to spend about Rs 20 lakh. Indian medical students have no compulsion to take any national medical examination; all they have to do is clear NEET in India and they are eligible for admission to Ukrainian colleges. Before 2019, even clearing NEET was not mandatory.
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Most colleges impart education in English, making the country a favoured destination for Indians. To elaborate, some countries such as Ukraine, Belarus, Georgia, Russia, Armenia, China, the Philippines, Trinidad etc. do serve as a haven for several thousand students every year. They offer relatively good quality medical education at nearly one third the cost of private medical colleges in India. Ukraine has the fourth largest number of graduate and postgraduate specialisations in the field of medicine in Europe.
The universities there are less expensive ~ MBBS costs range from $3000 to $5000 annually which is quite affordable for many Indian students. Along with low tuition fees, Ukraine offers various benefits such as food and housing. The institutions are generally accredited by WHO, UNESCO and different European countries. Medical degrees offered by these universities are also recognized by the European Council of Medicine, General Medical Council of UK and Pakistan Medical and Dental Council.
According to Ukraine’s Ministry of Education and Science, 24 per cent of its overseas students are from India. Back home, the website of the National Medical Commission shows that there are 605 medical colleges in India with a total of 90,825 MBBS seats a year. However, it is not encouraging when one looks at the fact that around 1.6 million students wrote the NEET in 2021. The aspirants who could not manage to secure a seat by dint of their merit are willing to spend considerable sums.
Some private medical colleges come to their rescue charging hefty amounts from them. As per data from the National Medical Commission, in 2021-22, there were 596 medical colleges with a total of 88,120 MBBS seats. More than the lopsided demandsupply situation, it is the failure of the regulatory structures which is reflected in the exodus of medical aspirants.
There are many medical colleges without proper facilities and qualified faculty. It is a matter of concern that not a single medical college in India features in the list of top 100, as per QS World Ranking in 2021. The WHO recommended doctor-population ratio as 1 per thousand whereas in India it is 0.9 per thousand. There is a big disparity between rural and urban areas. Currently India has one doctor per 1456 people as against the WHO recommendation of one doctor for every 1000 people.
At the time of independence, the country had a population of 30 crore. There were about 50,000 medical graduates and 25,000 nurses belonging to the modern system of medicine to provide healthcare to the population. Soon the country embarked on a massive expansion of medical and paraprofessional training so that health manpower needs for the proposed expansion of the health system institutions were met through training within the country.
The country succeeded in producing large numbers of skilled professionals to man major hospitals and teaching institutions in the country and abroad. But even after more than seven decades of independence, there are huge gaps in critical health manpower in primary healthcare institutions in remote rural and tribal areas. Initially, most of the medical colleges were funded by either State or Central governments.
The Indian Medical Council Act was amended in 1993 providing that no person shall establish a medical college, open a new or higher course of study or training or increase its admission capacity without prior permission from the Central government, because it was presumed we had an adequate number of doctors to meet the healthcare needs of our population. Over the decades, several medical colleges were set up in the private sector. There were disparities galore in the criteria for admission and fee structure between private and government ~funded medical colleges.
Judicial intervention, to some extent, moderated the differences in the criteria for admission and fee structure. However, even today large sums of money are spent for admission in many medical colleges indicating that the demand continues. It is important to meet the demand for medical education in a manner that would enable the country to meet the growing healthcare needs of the vast population.
The rationale for investment in health manpower development is to provide good quality healthcare to the citizens and improve health indices of the populace. The outcome and impact of all the efforts to improve health status of the people depends upon the knowledge, competence, skills, aptitudes, and commitments of persons providing healthcare. We must recognize that some of the smaller countries like Ukraine with far less investment in health manpower development have better health indices.
Over the years, there has been a perception that the quality of medical education in India has declined. This might partly be due to difficulties the teachers and students had in coping with the explosive expansion in medical knowledge and technology during the last couple of decades. Mushrooming of medical institutions with inadequate staff and infrastructural facilities has undoubtedly contributed to the decline in quality.
All the committees constituted by the Health Ministry and by the Planning Commission for health manpower development have recommended that medical education be reoriented to meet the requirements of the population. The National Medical Commission Act 2019 is indeed a welcome step in this regard. Creating more medical colleges will be advantageous only when access and availability can be ensured. This may not be possible by resorting to private enterprise only.
The State and Central governments may start medical colleges, as recommended by NITI Aayog, by utilizing district headquarter hospitals, and expanding infrastructure. India with its excellent faculties and abundant clinical materials can become a global player in medical education.
(The writer, a former Associate Professor, Department of English, Gurudas College, Kolkata, is presently with Rabindra Bharati University)
