WHO panel wants health tax to fund research – Proposes country-specific taxes

An expert committee, constituted by the World Health Organisation (WHO), has recommended country-specific taxes to generate funds for research and development (R&D) in the health sector. The options being considered include taxes on activities harmful to health such as alcohol, tobacco and sweet or fatty foods.

The report of the Consultative Expert Working Group on R&D, which has India’s additional health secretary L C Goyal among its members, highlighted two possible taxes, financial transactions tax and tobacco solidarity contribution, which could be used to generate funds to be channelled through an international mechanism to supplement national resources.

“It is our hope that such an international tax could be agreed as part of a commitment by all countries to finance global public goods, including for health and health R&D relevant to developing countries. We noted that our position is that if any international tax is agreed upon, then a proportion of that tax should go to provide support to health services in developing countries and another earmarked for health research and development to meet the needs of developing countries,” the report said.

The working group wanted all countries to commit themselves to spending at least 0.01 per cent of gross domestic product (GDP) on government-funded R&D to meet the health needs of developing countries. In addition, the report suggested that developing countries with a potential research capacity should aim to commit 0.05-0.1 per cent of GDP to government-funded total health research and that developed countries should aim similarly to commit 0.15-0.2 per cent of GDP to government-funded health research in general.

The funds are meant to be utilised for capacity-building and technology transfer to developing countries, to promote partnerships and collaborations based on joint agendas, for the development and retention of human resources and expertise, institutional and infrastructure development and sustainable medium/long-term collaborations.

The working group preferred an “open knowledge innovation” model that generates knowledge which is free to use without legal or contractual restrictions. They include mechanisms such as pre-competitive R&D platforms, open source and open access schemes, milestone prizes, equitable licensing, patent pools, etc.

The working group’s report will be presented before the WHO member countries during the forthcoming World Health Assembly next month.

Source: Business Standard, April 8, 2012

India hopes to achieve WHO’s doctor-people ratio by 2028

India will take at least 17 more years before it can reach the World Health Organization’s (WHO) recommended norm of one doctor per 1,000 people. The Planning Commission’s high-level expert group (HLEG) on universal health coverage (UHC) – headed by Dr. K. Srinath Reddy – has predicted the availability of one allopathic doctor per 1,000 people by 2028. It has suggested setting up 187 medical colleges in 17 high focus states during the 12th and 13th Five-Year Plans to achieve the target.

HLEG estimates that the number of allopathic doctors registered with the Medical Council of India (MCI) has increased since 1974 to 612,000 in 2011 – a ratio of one doctor for 1,953 people or a density of 0.5 doctors per 1,000 people. The nation has a density of one medical college per 3.84 million. There are 315 medical colleges that are located in 188 of 642 districts.

There is only one medical college for a population of 11.5 million in Bihar, Uttar Pradesh (9.5 million), Madhya Pradesh (7.3 lmillion) and Rajasthan (6.8 million). Kerala, Karnataka and Tamil Nadu each have one medical college for a population of 1.5 million, 1.6 million and 1.9 million, respectively.

The HLEG has proposed a phased addition of 187 colleges. It expects that by 2015 under phase A, 59 new medical colleges will admit students in 15 states like Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jammu and Kashmir, Jharkhand, Madhya Pradesh, Maharashtra, Meghalaya, Orissa, Punjab, Rajasthan, Uttar Pradesh and West Bengal. By 2017, 13 of these states will have an additional 70 medical colleges, and by 2022, another 58 institutes will be built in two additional phases (2017-2020 and 2020-2022).

By 2022, India will have one medical college per 2.5 million population in all states except Bihar, Uttar Pradesh and West Bengal. The implementation of HLEG’s recommendations will enable the additional availability of 102,000 doctors by 2017, and another 190,000 doctors between 2017 and 2022. “With this rate of growth, it is expected that the HLEG target of one doctor per 1,000 will be achieved by 2028,” the report says.

It recommends that along with establishment of new medical colleges, the admission capacities of existing colleges in the public sector should also be increased. Partnerships with the private sector should be encouraged, with conditional reservation of 50% of seats for local candidates, fixed admission fees and government reimbursement of fees for local candidates. The revised MBBS curriculum proposed by the MCI (Medical Council of India) should be refined to put greater focus on preventive, promotive and rehabilitative healthcare.

“Measures such as a compulsory posting of one year for all MBBS graduates immediately after internship, with 10% extra marks weightage for one year of rural service and 20% extra marks for two years of rural service in the post-graduate entrance examination should be included,” the report suggests.

The World Health Statistics Report (2011) says, the density of doctors in India is six for a population of 10,000. India is ranked 52 among 57 countries facing human resource crunch in healthcare. Between 2001 and 2005, India had a doctor: population ratio of 0.5 per 1,000 population in comparison to 0.3 in Thailand, Sri Lanka (0.4), China (1.6), the UK (5.4), the US (5.5) and Cuba (5.9).

The nation has the largest number of medical colleges in the world, with an annual churning rate of over 30,000 doctors and 18,000 specialists. However, the average annual output is 100 graduates per medical college in comparison to 110 in North America, Central Europe (125), Western Europe (149) and Eastern Europe (220). China, which has 188 colleges, produces 1,75, 000 doctors annually, with an average of 930 graduates per institute.

Source: The Times of India, September 27, 2011

India tops with 56,000 migrant doctors in OECD countries

India is the top country of origin of migrant doctors in OECD countries with over 56000 Indian doctors in these countries, which include the UK, the US, Canada, and Australia. India also figures at sixth place in the expatriation of nurses to OECD countries (about 23000). In terms of percentages, however, these figures constitute just 8% and 3% respectively of the doctor and nurse population in India, comfortingly low compared to some of the smaller countries severely affected by emigration of doctors such as Mozambique (75%) and Angola (70%). These numbers, revealed by the recently released World Migration Report 2010, however, do not include the large number of Indian doctors and nurses working in the Gulf.

It is estimated that at any given time there are over 100,000 Indian nurses in the GCC (Gulf Coordination Council) countries. “The poor working conditions in India coupled with low salary and the lack of respect at the work place are the top reasons for nurses migrating abroad,” said Sreelekha Nair, of the Centre for Women’s Development Studies at a recently organized seminar on Indian Nursing in the New Era of Healthcare.

The World Migration Report talks about the problem of medical brain drain, especially in African countries. According to the World Health Organisation (WHO), the number of physicians per 100,000 population for India is 70, which is at par with low-income countries, and for the public sector, the figure is a paltry 20. In the European Union (EU), the figure is 310 physicians per 100,000 population and in the US 240 physicians per 100,000. Similarly, the number of nurses per 100,000 population in India is 80, while it is 330 for the world and 160 for low-income countries.

The WHO threshold for a health workforce crisis is 230 health workers per 100,000 population. For example, India, an origin country, with only 190 health workers per 100,000 persons, is in a crisis state. As destination countries, the UK and the US have ratios of 750 and 1250 health workers per 100,000 persons respectively, which are far above the benchmark. However, there is still a demand for doctors and nurses in these countries. This was pointed out in a background paper, “The Future of Health Worker Migration”, by Professor Binod Khadria of the Zakir Hussain Centre for Educational Studies in JNU. In OECD countries, there is an increasing demand for health workers because of rising incomes, new technology, and an aging population.

In terms of nurses, the Philippines is the main country of origin for nurses, with over 110,000 Filipino nurses working in OECD countries, followed by the UK (just under 46000), Germany (under 32000). According to the OECD data of 2007, the top five countries in terms of emigration rates of nurses are all from the Caribbean Haiti leads with an expatriation rate of 94%, followed by Jamaica (87.7%), Grenada (87.6%), St. Vincent and the Grenadines (81.6%) and Guyana (81.1%).

A lot of the data on migrating health workers could be outdated and also fluctuates a lot depending on the demand around the world. But it is a given that there is no stopping the migration of health workers. “Migration for employment abroad is the basic human right of every health worker — or any skilled worker,” said professor Khadria.

Source: The Times of India, December 24, 2010

India will need 2.4 million nurses by 2012: WHO

According to the World Health Organisation (WHO), India will need 2.4 million nurses by the year 2012 to achieve the governments aim of a nurse-patient ratio of one nurse per 500 population. On the eve of International Nursing Day on May 11, 2010) WHO said, “In most countries, there is a shortage of nurses but nowhere is it so acute as in the developing world. The developed world fills its vacancies by enticing nurses from other countries, while developing countries are unable to compete with better pay and better professional development.

In India, nurse shortages occur at every level of the healthcare system. The states with the worst healthcare human resource shortages are also the ones with the worst health indicators and highest infant and child mortality, Nidhi Chaudhary from the WHO’s New Delhi office said.

Source: The Times of India, May 12, 2010

India will need 2.4 million nurses by 2012: WHO

According to the World Health Organisation (WHO), India will need 2.4 million nurses by the year 2012 to achieve the governments aim of a nurse-patient ratio of one nurse per 500 population. On the eve of International Nursing Day on May 11, 2010) WHO said, “In most countries, there is a shortage of nurses but nowhere is it so acute as in the developing world. The developed world fills its vacancies by enticing nurses from other countries, while developing countries are unable to compete with better pay and better professional development.

In India, nurse shortages occur at every level of the healthcare system. The states with the worst healthcare human resource shortages are also the ones with the worst health indicators and highest infant and child mortality, Nidhi Chaudhary from the WHO’s New Delhi office said.

Source: The Times of India, May 12, 2010