Under Operation Ganga, India evacuated its stranded citizens from Ukraine along with around 20,000 medical students who traveled to Eastern European countries aspiring to become doctors. What attracts these aspirants to Ukrainian medical colleges? The answer lies in the fact that they are affordable for middle-class families, offer quality education and licensure abroad.
Ukraine, like Romania and Bulgaria, is a popular destination for medical students due to lower costs. A student taking a six-year medical course has to spend around Rs 20 lakh. Indian medical students are not required to pass a national medical examination; all they have to do is declare NEET in India and they are eligible to get admission into Ukrainian colleges. Before 2019, even NEET compensation was not mandatory.
Most colleges provide education in English, making the country a preferred destination for Indians. To elaborate, some countries like Ukraine, Belarus, Georgia, Russia, Armenia, China, Philippines, Trinidad, etc. serve as a refuge for several thousand students each year. They offer relatively good quality medical education at almost a third of the cost of private medical colleges in India. Ukraine has the fourth largest number of higher and postgraduate specializations in the field of medicine in Europe.
Universities there are cheaper ~ MBBS costs range from $3,000 to $5,000 per year which is quite affordable for many Indian students. Apart from low tuition fees, Ukraine offers various benefits such as food and accommodation. The institutions are generally accredited by the WHO, UNESCO and various European countries. The medical degrees offered by these universities are also recognized by the European Medical Council, the General Medical Council of UK and the Medical and Dental Council of Pakistan.
According to the Ukrainian Ministry of Education and Science, 24% of its foreign students come from India. Back home, the National Medical Commission website shows that there are 605 medical colleges in India with a total of 90,825 MBBS seats per year. However, this is not encouraging when you look at the fact that around 1.6 million students wrote the NEET in 2021. Aspirants who failed to secure a seat by dint of merit are willing to spend considerable sums.
Some private medical schools come to their rescue by charging them large sums. According to data from the National Medical Commission, in 2021-2022 there were 596 medical schools with a total of 88,120 MBBS seats. More than the unbalanced situation of demand and supply, it is the failure of regulatory structures that results in the exodus of medical candidates.
There are many medical colleges without proper facilities or qualified professors. It is concerning that no medical college in India is in the list of top 100, according to the QS World Rankings in 2021. WHO has recommended a doctor to population ratio of 1 per thousand while in India it is 0.9 per thousand. There is a great disparity between rural and urban areas. Currently, India has one doctor per 1456 people against the WHO recommendation of one doctor per 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 medical system to provide health care to the people. Soon, the country embarked on a massive expansion of medical and paraprofessional training so that the health workforce needs for the proposed expansion of health system institutions would be met through in-country training.
The country has managed to train a large number of qualified professionals to equip the main hospitals and educational institutions in the country and abroad. But even after more than seven decades of independence, there are huge gaps in essential health personnel in primary health care facilities in remote rural and tribal areas. Initially, most medical schools were funded by state or central government.
The Indian Medical Council Act was amended in 1993 stating that no person shall establish a medical college, open a new or higher course of study or training or increase its capacity for admission without the prior permission of the government central, as it was assumed that we had a number of doctors to meet the health needs of our population. Over the decades, several medical schools have been established in the private sector. There were many disparities in admission criteria and fee structure between private and government-funded medical schools.
Judicial intervention has, to some extent, mitigated the differences in admission criteria and fee structure. However, even today, large sums of money are spent on admission to many medical schools, indicating that the demand continues. It is important to meet the demand for medical education in a way that would enable the country to meet the growing health needs of the vast population.
The rationale for investing in health workforce development is to provide good quality health care to citizens and to improve population health indices. The outcome and impact of all efforts to improve the health status of the population depend on the knowledge, skills, abilities, abilities and commitments of the people who provide health care. We have to recognize that some of the smaller countries like Ukraine, which invest much less in health workforce development, have better health indices.
Over the years, it felt like the quality of medical education in India had declined. This could be partly due to the difficulties faced by teachers and students in coping with the explosive expansion of medical knowledge and technology over the past two decades. The proliferation of medical institutions with inadequate staff and infrastructure has undoubtedly contributed to the decline in quality.
All the committees set up by the Ministry of Health and by the Planning Commission for Health Manpower Development have recommended that medical education be reoriented to meet the needs of the population. The National Medical Commission Act 2019 is indeed a welcome step in this regard. Creating more medical schools will only be beneficial if access and availability can be assured. This may not be possible using private enterprise alone.
State and central governments can establish medical colleges, as recommended by NITI Aayog, using district headquarters hospitals and developing infrastructure. India, with its excellent faculties and abundant clinical equipment, can become a global player in medical education.
(The author, former Associate Professor, Department of English, Gurudas College, Kolkata, is currently at Rabindra Bharati University)