Essay On Population Of India In 2010

15th Census
of India
General information
Country India
Date taken2010-2011
Total population1,210,193,422
Percent change 17.70%[1]
Most populous stateUttar Pradesh (199,812,341)
Least populous stateSikkim (610,577)

The 15th Indian Census was conducted in two phases, house listing and population enumeration. House listing phase began on 1 April 2010 and involved collection of information about all the state buildings.bomb Information for National Population Register was also collected in the first phase, which will be used to issue a 12-digit unique identification number to all registered Indian residents by Unique Identification Authority of India (UIDAI). The second population enumeration phase was conducted between 9 and 28 February 2011. Census has been conducted in India since 1872 and 2011 marks the first time biometric information was collected. According to the provisional reports released on 31 March 2011, the Indian population increased to 121 crore with a decadal growth of 17.64%.[2] Adult literacy rate increased to 74.04% with a decadal growth of 9.21%. The motto of census 2011 was 'Our Census, Our future'.

Spread across 28 statesTemplate:Efnbr and 7 union territories, the census covered 640 districts, 5,924 sub-districts, 7,935 towns and more than 6 lakh villages. A total of 27 lakh officials visited households in 7,935 towns and 6 lakh villages, classifying the population according to gender, religion, education and occupation.[3] The cost of the exercise was approximately ₹2,200 crore (US$340 million)[4] – this comes to less than $0.50 per person, well below the estimated world average of $4.60 per person.[3] Conducted every 10 years, this census faced big challenges considering India's vast area and diversity of cultures and opposition from the manpower involved.

Information on castes was included in the census following demands from several ruling coalition leaders including Lalu Prasad Yadav, Sharad Yadav and SP suprimo Mulayam Singh Yadav supported by opposition parties Bharatiya Janata Party, Akali Dal, Shiv Sena and Anna Dravida Munnetra Kazhagam.[5] Information on caste was last collected during the British Raj in 1931. During the early census, people often exaggerated their caste status to garner social status and it is expected that people downgrade it now in the expectation of gaining government benefits.[6] There was speculation that there would be a caste-based census conduced in 2011, the first time for 80 years (last was in 1931), to find the exact population of the "Other Backward Classes" (OBCs) in India.[7][8][9][10] This was later accepted and the Socio Economic and Caste Census 2011 was conducted whose first findings were revealed on 3 July 2015 by Union Finance Minister Arun Jaitley.[11] Mandal Commission report of 1980 quoted OBC population at 52%, though National Sample Survey Organisation (NSSO) survey of 2006 quoted OBC population at 41%[12]

There is only one instance of a caste-count in post-independence India. It was conducted in Kerala in 1968 by the Communist government under E M S Namboodiripad to assess the social and economic backwardness of various lower castes. The census was termed Socio-Economic Survey of 1968 and the results were published in the Gazetteer of Kerala, 1971.[13]

Census[edit]

C Chandramauli was the Register General and Census Commissioner of India for the 2011 Indian Census. Census data was collected in 16 languages and the training manual was prepared in 18 languages. In 2011, India and Bangladesh also conducted their first-ever joint census of areas along their border.[14][15] The census was conducted in two phases. The first, the house-listing phase, began on 1 April 2010 and involved collection of data about all the buildings and census houses.[16] Information for the National Population Register was also collected in the first phase. The second, the population enumeration phase, was conducted from 9 – 28 February 2011 all over the country. The eradication of epidemics, the availability of more effective medicines for the treatment of various types of diseases and the improvement in the standard of living were the main reasons for the high decadal growth of population in India.

Information[edit]

House-listings[edit]

The House-listing schedule contained 35 questions.[17]

Building number
Census house number
Predominant material of floor, wall and roof of the census house
Ascertain use of actual house
Condition of the census house
Household number
Total number of persons in the household
Name of the head of the household
Sex of the head
Caste status (SC or ST or others)
Ownership status of the house
Number of dwelling rooms
Number of married couple the household
Main source of drinking water
Availability of drinking water source
Main source of lighting
Latrine within the premises
Type of latrine facility
Waste water outlet connection
Bathing facility within the premises
Availability of kitchen
Fuel used for cooking
Radio/Transistor
Television
Computer/Laptop
Telephone/Mobile phone
Bicycle
Scooter/Motor cycle/Moped
Car/Jeep/Van
Availing Banking services.

Population enumeration[edit]

The Population enumeration schedule contained 30 questions.[18][19]

Name of the person
Relationship to head
Sex
Date of birth and age
Current marital status
Age at marriage
Religion
Scheduled Caste/Scheduled Tribe
Disability
Mother tongue
Other languages known
Literacy status
Status of attendance (Education)
Highest educational level attained
Working any time during last year
Category of economic activity
Occupation Nature of industry
Trade or service
Class of worker
Non economic activity
Seeking or available for work
Travel to place of work
Birthplace
Place of last residence
Reason for migration
Duration of stay in the place of migration
Children surviving
Children ever born
Number of children born alive during last one year

National Population Register[edit]

The National Population Register household schedule contained 9 questions.[20]

Name of the person and resident status
Name of the person as should appear in the population register
Relationship to head
gender
Date of birth
Marital status
Educational qualification
Occupation/Activity
Names of father, mother and spouse

Once the information was collected and digitised, fingerprints were taken and photos collected. Unique Identification Authority of India was to issue a 12-digit identification number to all individuals and the first ID was to have been issued in 2011.[21][22][23]

Census report[edit]

Provisional data from the census was released on 31 March 2011 (and was updated on 20 May 2013).[24][25][26][27][28]Transgender population was counted in population census in India for first time in 2011.[29][30] The official count of the third gender in India is 4.9 lakh[31]

PopulationTotal1,210,854,977
Males623,724,568
Females586,469,294
LiteracyTotal74%
Males82.10%
Females65.50%
Density of populationper km2382
Sex ratioper 1000 males943 females
Child sex ratio (0–6 age group)per 1000 males919

Population[edit]

The population of India as per 2011 census was 1,210,193,422.[32] India added 181.5 million to its population since 2001, slightly lower than the population of Brazil. India, with 2.4% of the world's surface area, accounts for 17.5% of its population. Uttar Pradesh is the most populous state with roughly 200 million people. Over half the population resided in the six most populous states of Uttar Pradesh, Maharashtra, Bihar, West Bengal, Andhra Pradesh and Madhya Pradesh.[33] Of the 121 crore Indians, 83.3 crore (68.84%) live in rural areas while 37.7 crore stay in urban areas.[34][35] 45.36 crore people in India are migrants, which is 37.8% of total population.[36][37][38]

India is the homeland of major belief systems such as Hinduism, Buddhism, Sikhism and Jainism, while also being home to several indigenous faiths and tribal religions which have survived the influence of major religions for centuries.

Ever since its inception, the Census of India has been collecting and publishing information about the religious affiliations as expressed by the people of India. In fact, population census has the rare distinction of being the only instrument that collects this diverse and important characteristic of the Indian population.

RankState /
Union Territory (UT)
TypePopulation[39] % of total population[40]MalesFemalesSex Ratio
[41]
Literacy rate (%)Rural[42]
Population
Urban[42]
Population
Area[43]
(km²)
Density
(/km²)
Decadal Growth% (2001-2011)
1Uttar PradeshState199,812,34116.5104,480,51095,331,83193067.68155,111,02244,470,455240,92882820.1%
2MaharashtraState112,374,3339.2858,243,05654,131,27792982.3461,545,44150,827,531307,71336516.0%
3BiharState104,099,4528.654,278,15749,821,29591861.8092,075,02811,729,60994,1631,10225.1%
4West BengalState91,276,1157.5446,809,02744,467,08895076.2662,213,67629,134,06088,7521,03013.9%
5Andhra Pradesh[a]State84,580,7776.9942,442,14642,138,63199367.0256,361,70228,219,075275,04530811.1%
6Madhya PradeshState72,626,8096.0037,612,30635,014,50393169.3252,537,89920,059,666308,24523620.3%
7Tamil NaduState72,147,0305.9636,137,97536,009,05599680.0937,189,22934,949,729130,05855515.6%
8RajasthanState68,548,4375.6635,550,99732,997,44092866.1151,540,23617,080,776342,23920121.4%
9KarnatakaState61,095,2975.0530,966,65730,128,64097375.3637,552,52923,578,175191,79131915.7%
10GujaratState60,439,6924.9931,491,26028,948,43291978.0334,670,81725,712,811196,02430819.2%
11OdishaState41,974,2183.4721,212,13620,762,08297972.8734,951,2346,996,124155,70726914.0%
12KeralaState33,406,0612.7616,027,41217,378,6491,08494.0017,445,50615,932,17138,8638594.9%
13JharkhandState32,988,1342.7216,930,31516,057,81994866.4125,036,9467,929,29279,71441422.3%
14AssamState31,205,5762.5815,939,44315,266,13395872.1926,780,5264,388,75678,43839716.9%
15PunjabState27,743,3382.2914,639,46513,103,87389575.8417,316,80010,387,43650,36255013.7%
16ChhattisgarhState25,545,1982.1112,832,89512,712,30399170.2819,603,6585,936,538135,19118922.6%
17HaryanaState25,351,4622.0913,494,73411,856,72887975.5516,531,4938,821,58844,21257319.9%
18DelhiUT16,787,9411.398,887,3267,800,61586886.21944,72712,905,7801,48411,29721%
19Jammu and KashmirState12,541,3021.046,640,6625,900,64088967.169,134,8203,414,106222,2365623.7%
20UttarakhandState10,086,2920.835,137,7734,948,51996379.637,025,5833,091,16953,48318919.2%
21Himachal PradeshState6,864,6020.573,481,8733,382,72997282.806,167,805688,70455,67312312.8%
22TripuraState3,673,9170.301,874,3761,799,54196087.222,710,051960,98110,48635014.7%
23MeghalayaState2,966,8890.251,491,8321,475,05798974.432,368,971595,03622,42913227.8%
24ManipurState2,721,7560.211,290,1711,280,21999279.211,899,624822,13222,32712218.7%
25NagalandState1,978,5020.161,024,649953,85393179.551,406,861573,74116,579119-0.5%
26GoaState1,458,5450.12739,140719,40597388.70551,414906,3093,7023948.2%
27Arunachal PradeshState1,383,7270.11713,912669,81593865.381,069,165313,44683,7431725.9%
28PuducherryUT1,247,9530.10612,511635,4421,03785.85394,341850,1234792,59827.7%
29MizoramState1,097,2060.09555,339541,86797691.33529,037561,99721,0815222.8%
30ChandigarhUT1,055,4500.09580,663474,78781886.0529,0041,025,6821149,25217.1%
31SikkimState610,5770.05323,070287,50789081.42455,962151,7267,0968612.4%
32Andaman and Nicobar IslandsUT380,5810.03202,871177,71087686.63244,411135,5338,249466.7%
33Dadra and Nagar HaveliUT343,7090.03193,760149,94977476.24183,024159,82949169855.5%
34Daman and DiuUT243,2470.02150,30192,94661887.1060,331182,5801122,16953.5%
35LakshadweepUT64,4730.0133,12331,35094691.8514,12150,308322,0136.2%
TOTALIndia351,210,854,977100623,724,248586,469,17494373.00833,087,662377,105,7603,287,24038217.64%

Religious demographics[edit]

The religious data on India Census 2011 was released by the Government of India on 25 August 2015.[44][45][46] Hindus are 79.8% (966.3 million),[47] while Muslims are 14.23% (172.2 million) in India.[48][48][49][50] and Christians are 2.30% (28.7 million). According to the 2011 Census of India, there are 57,264 Parsis in India.[51][52] For the first time, a "No religion" category was added in the 2011 census.[53][54] 2.87 million were classified as people belonging to "No Religion" in India in the 2011 census.[55][56] - 0.24% of India's population of 1.21 billion.[57][58] Given below is the decade-by-decade religious composition of India till the 2011 census.[59][60][61] There are six religions in India that have been awarded "National Minority" status - Muslims, Christians, Sikhs, Jains, Buddhists and Parsis.[62][63] Sunnis, Shias, Bohras, Agakhanis and Ahmadiyyas were identified as sects of Islam in India.[64][65][66] As per 2011 census, six major faiths- Hindus, Muslims, Christians, Sikhs, Buddhists, Jains make up over 99.4% of India’s 121 crore population, while “other religions, persuasions” (ORP) count is 82. Among the ORP faiths, six faiths- 49.57 lakh-strong Sarna, 10.26 lakh-strong Gond, 5.06 lakh-strong Sari, Doni Polo (3.02 lakh) in Arunachal Pradesh, Sanamahi (2.22 lakh) in Manipur, Khasi (1.38 lakh) in Meghalaya dominate.[67] Maharashtra is having the highest number of atheists in the country with 9,652 such people, followed by Meghalaya (9,089) and Kerala.[68]

Population trends for major religious groups in India (1951–2011)
Religious
group
Population
% 1951
Population
% 1961
Population
% 1971
Population
% 1981
Population
% 1991
Population
% 2001
Population
% 2011[69]
Hinduism84.1%83.45%82.73%82.30%81.53%80.46%79.80%
Islam9.8%10.69%11.21%11.75%12.61%13.43%14.23%
Christianity2.3%2.44%2.60%2.44%2.32%2.34%2.30%
Sikhism1.79%1.79%1.89%1.92%1.94%1.87%1.72%
Buddhism0.74%0.74%0.70%0.70%0.77%0.77%0.70%
Jainism0.46%0.46%0.48%0.47%0.40%0.41%0.37%
Zoroastrianism0.13%0.09%0.09%0.09%0.08%0.06%n/a
Other religions / No religion0.43%0.43%0.41%0.42%0.44%0.72%0.9%

Literacy[edit]

Any one above age 7 who can read and write in any language with an ability to understand was considered a literate. In censuses before 1991, children below the age 5 were treated as illiterates. The literacy rate taking the entire population into account is termed as "crude literacy rate", and taking the population from age 7 and above into account is termed as "effective literacy rate". Effective literacy rate increased to a total of 74.04% with 82.14% of the males and 65.46% of the females being literate.[70]

S.No.Census yearTotal (%)Male (%)Female (%)
119015.359.830.60
219115.9210.561.05
319217.1612.211.81
419319.5015.592.93
5194116.1024.907.30
6195116.6724.959.45
7196124.0234.4412.95
8197129.4539.4518.69
9198136.2346.8924.82
10199142.8452.7432.17
11200164.8375.2653.67
12201174.0482.1465.46
  • The table lists the "crude literacy rate" in India from 1901 to 2011.[citation needed]

See also[edit]

Notes[edit]

References[edit]

  1. ^"Decadal Growth :www.censusindia.gov.in"(PDF). 
  2. ^"India's population — 127,42,39,769 and growing". 
  3. ^ abC Chandramouli (23 August 2011). "Census of India 2011 – A Story of Innovations". Press Information Bureau, Government of India. 
  4. ^"Do we really need the census?". 
  5. ^Demand for caste census rocks Lok Sabha
  6. ^"Login". 
  7. ^"OBC data not in 2011 Census, says Moily". Indian Express. 18 December 2009. Retrieved 24 July 2016. 
  8. ^"No data since 1931, will 2011 Census be all-caste inclusive? – The Times of India". The Times Of India. 11 March 2010. 
  9. ^"Caste in Census 2011: Is it necessary?". The Times Of India. 28 May 2010. 
  10. ^"OBCs form 41% of population: Survey – The Times of India". The Times Of India. 1 September 2007. 
  11. ^"Govt releases socio-economic and caste census for better policy-making". 
  12. ^"OBc count: 52 or 41%? – The Times of India". The Times Of India. 1 November 2006. 
  13. ^G.O.K 1971: Appendix XVIII
  14. ^"Bangladesh and India begin joint census of border areas". 
  15. ^"Census in Indian and Bangladesh enclaves ends". 
  16. ^Kumar, Vinay (4 April 2010). "House listing operations for Census 2011 progressing well". The Hindu. Chennai, India. Retrieved 16 April 2011. 
  17. ^"Census of India 2011; Houselisting and Housing Census Schedule"(PDF). Government of India. Retrieved 22 January 2011. 
  18. ^"Census of India 2011; Household Schedule-Side A"(PDF). Government of India. Retrieved 22 January 2011. 
  19. ^"Census of India 2011; Household Schedule-Side B"(PDF). Government of India. Retrieved 22 January 2011. 
  20. ^"National population register; Household Schedule"(PDF). Government of India. Retrieved 22 January 2011. 
  21. ^"Census operation in history kicks off". The Hindu. 1 April 2010. Retrieved 1 April 2010. 
  22. ^"India launches new biometric census". Yahoo news. 1 April 2010. Retrieved 1 April 2010. [dead link]
  23. ^"India launches biometric census". BBC. 1 April 2010. Archived from the original on 1 April 2010. Retrieved 1 April 2010. 
  24. ^"India's total population is now 121 crore". LiveMint. Retrieved 30 April 2013. 
  25. ^"India at Glance – Population Census 2011". Census Organisation of India. 2011. Retrieved 1 January 2014. 
  26. ^"It's official. We are the second most populous nation in the world at 1.2 billion". 
  27. ^"India's total population is now 1.21 billion". 
  28. ^"India's total population is 1.21 billion, final census reveals". 
  29. ^"Pakistan counts transgender people in national census for first time". 
  30. ^Over 70,000 transgenders in rural India, UP tops list: Census 2011
  31. ^"First count of third gender in census: 4.9 lakh". 
  32. ^"Why activists are upset with Census disability numbers". 
  33. ^"Indian States Census 2011". Census Organization of India. 2011. Retrieved 1 January 2014. 
  34. ^"About 68.84 per cent Indians live in rural areas: Census report". 
  35. ^"Rural Urban". 
  36. ^"Every 3rd Indian migrant, most headed south". 
  37. ^http://blogs.timesofindia.indiatimes.com/minorityview/migration-in-india-is-still-largely-remains-a-social-rather-than-an-economic-phenomenon/
  38. ^http://blogs.timesofindia.indiatimes.com/minorityview/migration-in-india-is-slowly-becoming-more-urban-and-driven-by-economic-factors/
  39. ^"List of states with Population, Sex Ratio and Literacy Census 2011". 2011 Census of India. Retrieved 23 January 2013. 
  40. ^"Ranking of States and Union territories by population size: 1991 and 2001"(PDF). Government of India (2001). Census of India. pp. 5–6. Retrieved 12 December 2008. 
  41. ^"Population"(PDF). Government of India (2011). Census of India. Archived from the original(PDF) on 12 January 2012. 
  42. ^ ab"Provisional Population Totals". Government of India (2011). Census of India. Retrieved 23 July 2011. 
  43. ^"Area of India/state/district". Government of India (2001). Census of India. Retrieved 27 October 2008. 
  44. ^Abantika Ghosh, Vijaita Singh (24 January 2015). "Census 2011: Muslims record decadal growth of 24.6 pc, Hindus 16.8 pc". Indian Express. Indian Express. Retrieved 27 January 2015. 
  45. ^"Hindus 79.8%, Muslims 14.2% of population: census data". 
  46. ^"India Census 2011". Censusindia.gov.in. Retrieved 25 August 2015. 
  47. ^"India's religions by numbers". 
  48. ^ ab"Muslim population growth slows". 
  49. ^"Muslim representation on decline". The Times of India. 31 August 2015. Retrieved 31 August 2015. 
  50. ^Share on Twitter (26 August 2015). "Muslim share of population up 0.8%, Hindus' down 0.7% between 2001 and 2011 - Times of India". Timesofindia.indiatimes.com. Retrieved 24 July 2016. 
  51. ^"Where we belong: The fight of Parsi women in interfaith marriages". 
  52. ^"Parsi population dips by 22 per cent between 2001-2011: study". 
  53. ^"The tradition of atheism in India goes back 2,000 years. I'm proud to be a part of that". 
  54. ^"Why a Tinder date is better than 72 virgins in paradise". 
  55. ^"Against All Gods: Meet the league of atheists from rural Uttar Pradesh". 
  56. ^"People without religion have risen in Census 2011, but atheists have nothing to cheer about". 
  57. ^"2.87 million Indians have no faith, census reveals for first time". 
  58. ^"1.88 lakh people in Tamil Nadu state 'no religion' in 2011 census". 
  59. ^"Muslim politics:At a crossroads". livemint.com. Livemint. Retrieved 28 October 2014. 
  60. ^Aariz Mohammed (1–15 May 2013). "Demographic Dividend and Indian Muslims - i". Milli Gazette. Milli Gazette. Retrieved 15 May 2013. 
  61. ^Aariz Mohammed (1–15 May 2013). "Demographic Dividend and Indian Muslims - i"(PDF). Milli Gazette. Milli Gazette. Retrieved 15 May 2013.
Decadal growth of Indian population (1901–2011).
  1. ^Cite error: The named reference was invoked but never defined (see the help page).

Public health scenario

In India, in the health sector the progress has been very impressive since independence - infant mortality rate (IMR) has dropped from 150 to 50 (a three-fold reduction), the maternal mortality ratio (MMR) declined 10 folds from 2000 to 200 per 100,000 live births and the life expectancy at birth has gone up from 31 to 65 yr6,7. Sixty years ago the total number of physicians was 47,524, with doctor population ratio of 1 to 63007. Today, the number of registered medical practitioners is 840,130 (a 17-fold increase)8. Despite the population explosion (population has tripled) the overall doctor population ratio is now 1:1800 which reflects a 3·5 fold improvement. Primary Health Centres (PHCs) are the cornerstone of rural health delivery system. The number of PHCs has increased from 77 in the first plan (1955) to 23,887 in 20116,7, a 300 fold increase.

Each PHC is manned by at least one allopathic doctor. As against the common perception of gross shortage, the actual shortage of basic doctors is only 12 per cent (2900) to man PHCs, that too mostly in the northern States6. Shortage of basic doctors is not a national phenomenon. On the brighter side, 30 per cent PHCs have two or more doctors and equal number provides 24 × 7 h services. The number of doctors at the PHCs has increased from 20308 to 26329 (addition of 1,200 doctors per year) in the period 2006-20116. If the trend continues, the shortage of doctors in the PHCs could be met in the next few years within the existing system without increasing the number of medical colleges.

It cannot be denied that rural health services are far from satisfactory. But much of the ills of the rural sector are due to poor management and rampant corruption. Not very long ago the Uttar Pradesh government was accused of fraud to the tune of 10,000 crores in India's flagship health programme, the National Rural Health Mission9. However, it is a fact that the doctors are reluctant to serve in villages. But this is a global phenomenon. There is no doubt that medical students should be exposed to challenges of rural health care. This could be easily done through proper implementation of the current undergraduate medical curriculum and not through coercive tactics such as extending the 5.5 year-MBBS course to 6.5 years by making one year rural service mandatory and banning doctors from settling abroad10.

In ideal situation both basic health and education needs of a citizen should be public sector programmes. But this has not been possible even in the most advanced nations such as US where the healthcare is a mix of public and private providers. In urban India, the private sector accounted for only eight per cent of health services sixty years ago. The urban health scenario only changed with the growth of the private sector, which now accounts for more than 80 per cent of urban health care5. Allopathic private sector is almost non-existent in villages11. India now has a flourishing rural economy and a large number of villagers would want and be able to pay for quality private consultations12. The government has to be more proactive. Rural health care should be a part of a comprehensive socio-cultural, educational, economic and health care developmental package that will be also conducive for participation of private sector and not treated as a standalone commodity requiring only more number of doctors. Indian States, which have performed poorly, also show low level of literacy, especially women literacy, poor road connectivity and high level of poverty.

Need for high skilled doctors

Though shortage of primary health providers has been hyped, India faces severe shortage of specialists both for its rural and urban services and also to strengthen its position in the medical world. Rural India today needs specialists on a priority basis. Seventy per cent posts of specialists (surgeons, physicians, paediatrics, gynaecologists, etc.) at the Community Health Centers (CHCs), which provide minimum specialist services to villagers, are lying vacant6.

India's middle class population, which can pay for sophisticated medical procedures, is around 250 million13. They expect nation to develop on priority basis high tech medicine such as well equipped ICU, cardiac bypass surgery, organ transplant, advanced imaging technologies (MRI, PET), prenatal diagnosis, neonatal screening, in vitro fertilization (IVF), etc. India is witnessing fast demographic changes which will soon result in deluge of lifestyle disorders (cardiovascular and neurological disorders, diabetes and cancer, etc.). By 2025, India may become world's diabetic capital14. Management of lifestyle disorders needs continuous long term interaction of patients with highly skilled trained doctors and not just a primary health worker.

Repeated reference is made to low position of India in the global context in IMR and MMR where India's position is 151 and 130, respectively in the world5. But the fact that it is also one of the most favoured destinations for medical tourism, currently estimated to be US $ 2 billion industry, has been totally ignored15. Medical tourism, which needs highly skilled specialists and super-specialists, could be easily a $ 5 billion-industry in the next decade. With changes in patent laws several foreign companies are coming to India for clinical trials of drugs. A strong base of physician-scientists will not only promote international collaborative research but could also make India, which is a major manufacturer of generic drugs, a site for new drug development.

The two streams: Flexner and Welch-Rose

India today faces dual challenges: (i) It must improve its health services, and (ii) simultaneously, develop high tech interventional/curative medical services both for its own people and also for its international programmes such as medical tourism and drug trials. The former needs health workers, not necessarily physicians, but the latter needs highly skilled physicians and physician-scientists. Though conventionally the term “Health Workforce” includes both curative and preventive medicine, historically these started as two streams. The former is governed by “Flexnernonian” notions which put high quality science and research at the center of medical education16. On the other hand, creation of separate schools for ‘Health Sciences’ has its origin in the 1915 Report of Welch-Rose17. Knowledge of medicine is an asset but not a mandatory requirement for training in public health. Only 38 per cent of the full-time MPH students at the John Hopkins are physicians18. Obviously, quality of doctors would grossly differ for the two streams. A single recommendation on doctor population ratio for the two streams is just like putting apples and oranges in the same basket. More than 95 per cent members and consultants of HELG were health scientists5. More balanced comprehensive recommendations specifying requirements for individual streams would have emerged if hardcore medical scientists were present in much larger proportion in HELG especially when at the core of the debate is the issue whether India needs just more doctors or more good quality doctors.

Medical education in India

Growth of medical colleges in independent India has been very rapid. At the time of independence there were only 20 medical colleges admitting about 1500 students. Today, there are some 350 colleges admitting 45,000 students (30-fold increase in enrolment)19. This fast expansion of medical colleges has resulted in gross shortage of teachers estimated to be currently 40 per cent4. Private sector, which owns 190 of 350 medical colleges, is now the dominant player in medical education. Establishment of a private medical college is a huge money making business. Acceptance of the recommendation to create huge number of medical colleges in the next decade will only legitimize the unscrupulous trade of “private medical colleges”.

There is a need to be innovative and urgently evolve strategies to deal with acute shortages of specialists and super-specialists especially for rural health services. In the present system of medical education it takes about 10 years to produce a specialist. One approach may be to make posting at the CHCs, which are expected to provide minimum specialist services to villagers, a part of MD/MS courses. Each postgraduate student should spend a fix time (e.g. six months) at a CHC in the second year of his/her training. Also the concept of a ‘special paper’, which is followed in science faculties in universities, may be introduced. For example, a postgraduate (MD) student could opt for a ‘special paper’ in Gastroenterology, Nephrology, Radiotherapy, Medical oncology, etc. For this purpose the student will spend fixed time in the specialty of his/her choice that is available at the host medical college or even at a private tertiary specialty institution approved by the Medical Council of India (MCI). In the process the postgraduate would be trained to perform simple procedures in the ‘special paper’ related discipline. This could substantially reduce burden on super-specialists. Similar programme could be developed for postgraduates (MS) in surgical disciplines. To accommodate these changes, if necessary, MD/MS course duration (residency programme), which is currently of three year duration, may be extended by six months. Similarly, rural health service could be made a part of the super-specialty (DM) courses. There is obviously a need to appoint a task force/commission to reconsider all aspects of postgraduate medical education in India to make specialty and super-specialty services available to rural India.

Foundation of our rural health services was laid by Bhore committee4 about 60 years ago when acute infections dominated the health scenario. In view of the changing health scenario, it is time to review the structure of rural health services and tailor medical education to meet their needs.

The Government should desist from implementing its decision to create huge number of medical colleges. Just as no battle has been won in human history by ill trained armies, woes of the health sector cannot be solved by ill trained doctors.

Views expressed in the article are those of the author and not the the MCI.

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