24 Feb, 15 | by BMJ
WHO estimates that the world is short of 12.9 million healthcare workers, and Devi Shetty, the cardiac surgeon and chairman and founder of Narayana Hrudayalaya Hospitals, thinks that radical steps are needed to provide these workers. Money for healthcare for all will come, he believes, but it cannot be achieved unless healthcare workers are available to provide the care.
India, for example, needs three million doctors and six million nurses in addition to millions of community health workers. The country needs 500 new medical colleges, and Shetty is keen that the very poorest who have “magic in their fingers and passion in the hearts” should be able to train as doctors.
The answer, he believes, is a virtual global university for healthcare workers. He has been developing the vision over three years.
His vision is for Asia, Africa, and Latin America not North America, Europe, and Australasia. Students will receive their hands on training in small hospitals, which will become “medical schools,” and their theoretical training will be delivered online. He believes that care is 80% standard and 20% local. The training will be very practical unlike the training received in most universities.
Medical students would be selected using a standardised test that didn’t depend on having lots of knowledge already. Instead of learning physiology, biochemistry, and anatomy students would spend their first two years working as assistants on the wards but also studying online courses.
Students would be tested monthly with the data being collected centrally. This would allow quality assurance of the different centres, and students who weren’t progressing would be thrown out. Shetty believes that people are resentful about never having a chance to study medicine but understand rejection if failing to progress. He observes that it’s getting into medical school that is difficult and that most of those who are admitted graduate.
Shetty doesn’t believe that it needs 14 years to train a surgeon. As he travels the world he sees nurses doing surgery, including hand and cataract operations and Caesarean sections.
It will be essential that the doctors, nurses, and community health workers produced from the global university are licensed to practice, and Shetty believes that they should be free to practice in all the countries that sign up to the university. Achieving this license is probably the biggest single barrier to Shetty’s vision being achieved. As he says bluntly, “The major hurdle to train medical manpower across the world is the attitude of the guild of professionals who like to keep the shortage to protect their income and their importance.”
Cuba shows what can be achieved with many health workers in a poor country. Its per capita income is $6000 compared with $48 000 for the US, yet with 67 doctors per 10 000 people compared with 24 per 100 000 in the US it has a life expectancy slightly higher than that of the US.
India will not, Shetty believes, be the first government to sign up, perhaps because it has more medical schools than any other country with medical education employing many and generating substantial revenues. But India might follow if others lead, and Shetty believes that Africa countries like Kenya and Nigeria, which have the biggest shortages of healthcare workers and fewest medical schools, will take the lead.
For change to happen there needs to be a “burning platform,” a vision of the future, and a plan for what will happen today. That combination needs to overcome the resistance to change that is always present—“better to bears the ills we have than fly to others we know not of.” The severe shortage of healthcare workers and the lack of access to care of many in the world mean that the platform is burning, although it may not feel like it to presidents of medical colleges. Shetty has supplied the vision, and the next step is to find partners, a leader, and make it happen.
Massive online open courses (MOOCs) provide an example of large scale online learning as does the Institute for Healthcare Improvement’s (IH) Open School. It was created in 2008 to respond to the problem that many health students received little or no training in the science of improvement and patient safety. So far some 220 000 students have enrolled on courses. The economics of education are changed dramatically by delivering online courses to large numbers, making expensive education much cheaper. Don Berwick, the founder of IHI, also spoke at the World Innovation Summit for Health, and is enthused by Shetty’s vision.
The resistance to be overcome is considerable, and the whole idea might seem a fantasy—but Shetty has already shown that he’d be capable of doing what looks “impossible.”
Competing interest: Like everybody else at the conference RS had a business class fare to the conference and three days in a posh hotel paid for by the Qatar Foundation, to which the WISH conference belongs.
Richard Smith was the editor of The BMJ until 2004. He is now chair of the board of trustees of icddr,b [formerly International Centre for Diarrhoeal Disease Research, Bangladesh], and chair of the board of Patients Know Best. He is also a trustee of C3 Collaborating for Health.