Doctoring the system

Health Minister Dr. Rajitha Senaratne has a new quest these days. He has declared war on an estimated 30,000 quacks purported to be working in Sri Lanka and wants them all drummed out of the system. However, the existence of these fake doctors indicates Sri Lanka does not have enough doctors and meeting demand will only grow stronger as the country ages. Focus is also necessary on evaluating all doctors to ensure that their knowledge and skills are up-to-date.   

Demand for doctors is growing with rising life expectancy and growth of non-communicable diseases among the reasons for stronger demand. The portion of over-60-year-olds in the population will rise to 17% in five years from 10% in 2016. By 2051, they will make up 29% or so of the total population.

Three decades ago, Sri Lanka had one doctor for every 6,000 people. The ratio has improved to a doctor for every 1,100 people by 2015. However, it is still lower than the world average of 670 people per doctor, according to Fitch Ratings Lanka. Many doctors with higher skills are concentrated in cities with many rural areas having fewer facilities and competent doctors. In a situation like this it is natural for unqualified people to start practicing and, in some instances, they can actually help patients.

When villagers fall ill, they turn to the “doctor” in their village, a person who seems to know how to treat routine ailments such as fever, diarrhoea, malaria, anaemia, hypertension, urinary tract infections and so on. They trust him. He is available at night, he charges very little and accepts payment in kind if villagers have no money. They know that he helps. What they don’t know is that, at times, by failing to recognise a serious condition, he can harm the patient. It is natural that such people form community bonds and hide that they are improperly qualified well.

But Sri Lanka also has a problem where qualified doctors who make mistakes are not punished. The prevalence of powerful unions mean that it is almost impossible for a doctor to be tried for malpractice and debarred in Sri Lanka, even where there is genuine need to do so to protect patients. All this could be averted if Sri Lanka could have a universal evaluation process for all doctors, which would provide a transparent system accessible to the public.

In the UK, the US and other countries, doctors are evaluated periodically to determine that their skills and knowledge are up-to-date and they are fit to practice. In the UK, doctors are subject to a revalidation process every five years. Revalidation builds the confidence of patients, employers and investors. The Sri Lanka Medical Council (SLMC) does not have a revalidation process for medical professionals practicing locally, leaving the regulatory door wide open.

In India an organisation has even started giving unlicensed doctors in rural areas some formal training, to help people in places where access to real health care is almost non-existent. After two years the West Bengal Government was so impressed that in January, it decided to throw its weight behind scaling up the project, which will train all of the estimated 170,000 quacks in West Bengal. They will be called village health workers and will provide much-needed services to the poor. 

Banning unqualified doctors alone will not solve Sri Lanka’s medical standards issue unless the underlying demand for quality, accessible and affordable care is met.