Union government to convert district hospitals to medical colleges

 Setting up a medical college in a district is a popular policy response that masks the real problem — of the inadequate provisioning of secondary-level health care

A Kerala Woman's Fight To Find Who Left A Surgical Instrument In Her Stomach Five Years Ago 

1 A recent report of a patient having suffered for almost a year before she found out that a surgical instrument had been left behind in her stomach —

 2 a case of medical negligence in one of the 

• leading medical colleges in Kerala, 
• a State with one of the most advanced health care systems in the country — 

3 growing vacancies in seats to Bachelor of Dental Surgery and Master of Dental Surgery courses 

in dental colleges across the country are two happenings that raise questions about the potential role played by medical colleges in India. 

Union government to convert district hospitals to medical colleges 

1 The policy proposal of 2019 by the Union government to convert district hospitals to medical colleges, 

2 sanctioning an All India Institute of Medical Sciences (AIIMS)-like institution in every State, 

3 but this 

 highlights the need to examine the contribution of medical colleges in patient care from a public health perspective.

A medical college 

college is an institution that has dual purposes: 

first  is its educational role: 

1 as primarily an institution for the 

• education and 
• training of students
•  to become medical professionals 
• through teaching and apprenticeship (internship).

2 apprenticeship 

to ensure bedside care, a mandatory requirement for apprenticeship, and is the most crucial component in medical training.

 Its secondary purpose 

1 is to offer medical care. 

2 Hence, population norm was never a concern while establishing medical colleges 

3 and it is expected that patients with serious illnesses can avail services from medical colleges anytime when they have a referral from the lower-level facilities.

Colleges and myths

Profit 

Added to this is the potential real estate and other infrastructure boom near medical colleges

 along with the nurturing of false security and hope that the chances of children living there getting a medical seat will also increase. 

 producing more medical professionals is the solution to the issue of inadequate access to health care.

 but here presents a different picture 

1 But a close examination of the evidence and experiences around medical colleges and district hospitals and their contribution to people’s health care presents a different picture.

 2 secondary-care facilities need to be prioritised over large state-of-the-art medical colleges if curative care needs of the people are the priority.

Tertiary care needs

 Which nedded tertiary care 

1 First, it is a well-known fact that those needing advanced tertiary care will comprise approximately 1% of the total population annually. 

2 requirement of 575-700 specialised beds 

 So, for a district with a population of three million, this would mean a bed requirement of 575-700 specialised beds (for a medium-size district) if we consider 100%-85% bed occupancy. 

Most district hospitals are expected to cater to this need for specialised tertiary care. 

Unfortunately, district hospitals that are  face multiple challenges

in the form of poor infrastructure that includes a 

• lack of specialists, 
• and no referral system, 
• which is partly due to non-functional secondary-level care facilities.

•  there is an overload of all kinds of patients (from those needing primary care to those needing most advanced care) who await treatment from these higher-level facilities, i.e., district hospitals or medical colleges. 

दीर्घकालिक और टिकाऊ आधार पर कुशल देखभाल  

In places where better secondary facilities are functional and which have a referral system of some kind that works, there are district hospitals that are doing well 

(their patient care has specialities such as cardiac care and surgery, regular dialysis services and cancer treatment with a network of regional cancer centres), 

thus rendering efficient care on a long term and sustainable basis.

  best trauma care responses 

It is a truism that some of the best trauma care responses after road traffic accidents are by the district hospitals with their limited capacity. 

This is a model to be emulated / copy . Some district hospitals have a history of resisting the proposal to convert to medical colleges and are still doing well in patient care.

well-functioning medical colleges across the country face problems 

1 such as crowding of patients in need of primary and secondary care which could otherwise have been handled by the lower-level facilities.

2 not really warrant treatment under tertiary specialty care 

Medical practitioners in most medical colleges in the country will agree that more than 80% of the cases that are treated in medical colleges do not really warrant treatment under tertiary specialty care. 

What needed

There can be effective treatment at the lower level by ensuring basic facilities at that level. 

Patients who are in need of primary and secondary care always seem to go to either medical colleges or well-functioning district hospitals for their immediate treatment. 

The perennial / permanant  failure of India’s health services to implement a referral system in tertiary-care facilities 

If strengthened, secondary-level care can be the face of public sector curative care for people 

and can even win trust as these patients , which private commercial players look to in search of business.

 excluded from any health insurance scheme ? 

Most secondary-care needs do not require hospitalisation and hence are excluded from any health insurance scheme. 

In the south, such as Kerala and Tamil Nadu, the significant contribution of the government in addressing the curative care needs of people is through better functioning secondary-level health-care facilities.

Popular versus people-centric policy

 establishment and the creation of a medical college 

 it propagates an ‘image’ of advanced technology and development. 

There are two obvious challenges

as establishing new medical colleges in areas where there is poor infrastructure and connectivity will face serious setbacks as the experience of several of the new AIIMS projects across the country shows. 

In addition, if district hospitals are converted to medical colleges

the priority shifts from a treatment centre to that of an education and research centre, where patient priorities become secondary. 

In either case, the challenges of ensuring a referral (gate keeping) will continue unless secondary facilities are developed adequately. 

There is a need to shatter the myth of medical colleges being the ideal site for health-care solutions as far as the masses are concerned. 

Instead, strengthening secondary-level curative care can be the best policy for governments to strengthen their health-care system. If this is done, it can be a strong regulator for the commercial private sector which survives on the less complex secondary-care needs of people.