World Health Organization recommends a ratio of one doctor for every 1,000 population, right? Wrong. WHO has denied ever making such a recommendation and cautions against using a metric used to facilitate inter-country comparison as a benchmark for health human resource planning at the national level.The head of WHO’s hea-lth workforce unit, Dr Giorgio Cometto, told TOI: “WHO does not have a blanket recommendation of 1 doctor/1,000 population. This is a factoid that is not backed up by any WHO document or reference, but unfortunately, it is quoted quite often.” Govts have used the 1:1000 doctor-population ratio to calculate doctor shortage and to push for increasing MBBS seats in existing medical colleges and opening new colleges, even if many of these are poorly equipped.Cometto pointed out that every country ought to consider its unique epidemiology, demography, finances and health system setup in planning for the workforce it will need to meet Sustainable Development Goals (SDGs) by 2030. Other public health experts, too, have said the same thing while pointing to the extreme skew in distribution of doctors among states and between rural and urban areas, none of which are being addressed by blanket expansion of medical colleges.WHO uses a threshold of 4.45 doctors, nurses and midwives per 1,000 population, based on the minimum density of health workers generally associated with attaining a median level of coverage of essential SDG services. But this does not reflect the heterogeneity of countries in terms of baseline conditions and health system needs, said Cometto. Medical historian Dr Kiran Kumbhar, who had published an essay on his quest to track the root of this “invented figure”, found that the earliest official reference was in Medical Council of India’s “Vision 2015” report in March 2011. It doesn’t cite WHO, merely says “after detailed inputs from various working groups”, there was consensus that “targeted doctor-population ratio would be 1:1000”.According to Kumbhar, it is the 14-member High Level Expert Group on Universal Health Coverage for India that called 1:1000 a “WHO norm” in its report released in Oct 2011. it is citing data from a WHO report, which in turn is citing data from a 2004 report put together by a group of global health experts. The 2004 report observed that countries with fewer than 2.5 healthcare professionals per 1,000 population failed to achieve 80% coverage rate for deliveries by skilled birth attendants or for measles immunisation.
