Letters Corruption in medicine

Indian government must spend more on healthcare, salaries, and infrastructure

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4625 (Published 15 July 2014) Cite this as: BMJ 2014;349:g4625
  1. Dipankar Sircar, nephrologist1
  1. 1Institute of Postgraduate Medical Education and Research (IPGMER), Kolkata, India
  1. deepsircar{at}gmail.com

There are several reasons for this state of affairs in Indian healthcare.1

In the case of government hospitals, the government spends only 4% of its gross domestic product on health compared with 8% in Afghanistan, for instance. Facilities and salaries are abysmal; at best, a professor of medicine in Kolkata will earn the equivalent of $1400 (£820; €1028; Rs83 937) a month. A resident medical officer will earn $400.2 These salaries are completely inadequate—for example, an apartment in Kolkata costs $100 000 to buy and petrol is $1.20/L.

According to 2010 WHO statistics,3 India has 0.6 doctors per 1000 population—again, half of what is needed. Rural India lacks water, electricity, and sanitation facilities, let alone educational or recreational ones. The doctor-population ratio varies greatly between rural and urban areas, with large numbers of doctors in the cities. In rural areas, the population lacks the paying capacity to support doctors. An average GP’s fee in a rural area in West Bengal will be $1-2. In cities, competition between doctors reduces the fees they charge. The average fee of a gynaecologist in Kolkata is just $5.

The number of doctors continues to grow but the capacity of people to pay for treatment does not. Because doctors cannot increase fees directly, they consider secondary sources of income to be, if not legitimate, at least excusable.

If the government spent more on healthcare and improved salaries and infrastructure, things might improve. Crusades like the one by The BMJ might help, but until the reality on the ground improves, I am not holding my breath.


Cite this as: BMJ 2014;349:g4625



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