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Why Doctors Strike in Public Health Systems in India: Lessons for Medical Education and Addressing Migration of Healthcare Workforce

Author(s): A. Das1
Affiliation(s): 1Director, Centre for Health and Social Justice, New Delhi, India
Keywords: Medical ethics, health systems, workers rights, training, medical education, health policy, India
Background:

India is emerging as a global economic superpower but lags behind many nations in health related MDG indicators. India has a severe shortage of doctors in the public sector and huge public healthcare crisis. The new public health policy in India, the National Rural Health Mission promises an improvement in the public health system and in improvement in basic public health indicators. It is based on the principles of comprehensive primary healthcare. There have been a large number of strikes by young doctors and doctors in training in India over the last couple of years. These have taken place in tertiary teaching hospitals and across many states. The reasons have varied but there are strong links to young doctors wanting privileges and personal opportunities. These include refusal to undergo compulsory rural or public sector posting, or seeking opportunities to go abroad.

Summary/Objectives:

The paper is based on newspaper and other secondary reports of a range of strikes across various states in India over the period of the last three years since the National Rural Health Mission was announced. The reasons given for the strikes by young doctors or doctors in trainings, as well as the provocations are examined. The response from the health bureaucracy is examined in the context of the national constitution and health policy guidelines.

Results:

The paper provides a short historical summary of the growth of western medical training in the country over the last one hundred and fifty years. The paper examines the changing context of western medicine in providing healthcare to rural and poor citizens in India and the role of the public and private healthcare sector. The paper examines the strikes by young doctors in the context of the growing private sector medical industry and the phenomenon of ‘medical tourism’ that has come up in the country. The paper also examines the validity of strikes by doctors and doctors in training in the context of medical ethics and worker rights.

Lessons learned:

Medical education needs to be guided by a number of factors. While it is necessary to provide up-to-date medical information, and build adequate clinical skills, it is also essential to ground it in the constitutional character of the country and in medical ethics. Doctors are not technical agents in a market place selling healthcare innovations but agents responding to the social and political reality relating to health in the country in which they are trained. The application of these principles in designing medical education curriculum may prevent widespread migration of medical personnel from developing countries.

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