India Faces Acute Shortage of Doctors, Technicians for Dialysis and Other Kidney Disease Treatments

Rewa: The management of kidney disease in India is marred by severe shortage of manpower across India. 

There is not a single nephrologist in any district hospital of at least 29 states and Union Territories in India. Similarly, there is not a single dialysis technician in any district hospital of 20 states and Union Territories in the country, a standing parliamentary committee report released this month has revealed. 

What is even more surprising is that many of these states have not even sanctioned the posts of human resources for managing kidney diseases – let alone to have them in-position – in their district hospitals. 

A state government runs district hospitals. The funding for its operations and human resources is borne mainly by the state government and the rest by the Union government. 

The absence of critical human resources is a pointer towards severely compromised treatment of chronic kidney diseases (CKD) at the level of districts, and at lower levels. 

Although the medical colleges, which are run by state governments, mostly do have these specialists, they are also overburdened with patients, and remain understaffed vis-a-vis the workload.

Nephrologists specialise in treatment of CKD. They usually do not perform surgeries. Urologists perform surgery for different kidney-related issues. The other important cog is a dialysis technician. There is a shortage across all these categories.

While there are no nephrologists in any district in 29 states, one each exists in the district hospitals of Meghalaya, Gujarat and Puducherry. 

There are 29 states where none of the district hospitals have a urologist. West Bengal has 31 urologists in total in government hospitals across the state. 

To manage CKD, dialysis is one of the key processes. Even for that there’s an acute shortage of healthcare professionals across the country. Twenty states have no dialysis technicians in any of their district hospitals.

 “The committee takes into account that the nephrologist's non-availability at district hospitals reflects a serious disconnect between infrastructure creation and the availability of specialised human resources,” the report says. 

This leads to compromised “quality, safety and continuity of CKD care, delays clinical decision-making, limits the management of complications and reduces the effectiveness of dialysis services, particularly in rural and underserved regions,” it adds. 

The onus to improve this situation lies more on state governments. Therefore the committee recommends that the Union health ministry must coordinate with the state governments and undertake a time-bound exercise to fill all vacant posts “with priority accorded to states reporting nil or severely inadequate availability of such specialists especially in Bihar, Rajasthan, Odisha, Assam, Chhattisgarh etc.”

Pradhan Mantri National Dialysis Programme and Ayushman Bharat

The Pradhan Mantri National Dialysis Programme (PMNDP) was launched in 2016. 

The health ministry, through its secretary, told the committee members that annual haemodialysis sessions increased from about 25 lakh in 2019-20 to around 70 lakh in 2024-25. 

The committee acknowledged this but flagged several operational challenges like inadequate supervision, maintenance of dialysis equipment, delay in availability of consumables and release of funds.

It said, “Merely augmenting dialysis infrastructure without ensuring adequate skilled manpower, quality assurance, timely maintenance and uninterrupted supply of consumables may compromise the quality, continuity and accessibility of dialysis services.” 

The financial challenges in treating CKD remain significant despite progress achieved through PMNDP and Ayushman Bharat scheme (which provides insurance cover for hospitalised patients). 

The panel reckons that these two schemes provide assistance only for end-stage interventions like dialysis (through PMNDP) and kidney transplantation (through Ayushman Bharat).

“The costs incurred during the earlier stages of the disease including screening of high-risk individuals, regular diagnostic investigations, outpatient consultations, essential medicines and management of complications are generally excluded or inadequately covered,” it noted.Therefore, the patients have to bear high out-of-pocket expenditure (OOPE) in availing these early-management measures.

The OOPE comprises spending that patients incur out of their pockets. The high OOPE leads to delayed diagnosis, poor treatment adherence, catastrophic health expenditure and faster progression to kidney failure.

Gaps in diagnosis

Much of the CKD burden is also attributed to diseases like hypertension, diabetes and cardiovascular problems. The committee says that much more is needed to be done on preventing and managing these diseases.

However, currently a substantial chunk of resources are being diverted to dialysis and kidney replacement therapies and preventive nephrology, which can reduce long-term healthcare costs – an issue that largely remains ignored. 

The other way to prevent progression to a serious form of this illness is early identification. Among other things, it requires pre-emptive screening of what are known as ‘high-risk individuals’. 

These are people who may have a family history of CKD and/or are suffering from ailments like diabetes, hypertension and other conditions which are linked with CKD. 

The panel warns that CKD continues to be detected “pre-dominantly” in advanced stages because kidney health assessment is not uniformly integrated in policies targeted to manage diseases linked with it.

Screening for kidney-related ailments is a part of the non-communicable diseases programme of the government. Under it, screening of hypertension, diabetes and cardiovascular diseases is carried out. But the committee said this programme caters to only that section of population which goes to Arogya Mandirs (or health and wellness centres) in rural areas, or in other health facilities. And, therefore, community screening is restricted to "opportunistic screening” as it largely depends on patient attendance. 

It stresses that to prevent delay in diagnosis, screening of all high-risk individuals on an annual basis must be “institutionalised” along with introduction of mandatory and free-of-cost biannual kidney function tests (a blood marker) for people below poverty line. 

Transplant and other medical interventions

The Union government launched the National Organ Transplant Programme (NOTP) to increase awareness among people for organ donation. Transplantation is necessary in many severe cases of kidney diseases. 

The committee appreciated the government's NOTP but also put on record that India's deceased organ donation rate continues to remain significantly lower than global benchmarks. It is a result of persistent social misconceptions, inadequate public awareness, limited organ retrieval infrastructure and procedural bottlenecks.

Post-transplant care is equally important. Among other things, a patient, who has received a donated organ, needs to take immunosuppressive drugs lifelong. These drugs suppress the immune system from attacking the organ received by the patient. 

The panel observed that the recurring cost of these drugs "places a considerable financial burden on patients who have already incurred substantial expenditure on dialysis and transplantation.” 

Another critical issue that the lawmakers’ panel flagged is unsupervised sale and consumption of Non-steroidal Anti-inflammatory Drugs (NSAIDs) which people buy over-the-counter for pain relief. Their long-term use can cause nephrotoxicity (toxicity for the kidney).

The committee recommended that the country’s drug regulator – Central Drugs Standard Control Organisation – should do more to enhance regulatory oversight and public awareness. 

One of the peculiar lacunae that affects many health programmes of the country is lack of data, and CKD prevalence is not an exception. 

The committee says approximately 13–16% of the adult population in India suffers from this disease, but there is no real-time or updated database.

All the policymaking on this front is happening without capturing “patient-level data on disease occurrence, progression, treatment modalities, clinical outcomes and mortality”. The committee, therefore, strongly recommended the government to create a national kidney registry.

Banjot Kaur is an independent health journalist.

The Wire is now on WhatsApp. Follow our channel for sharp analysis and opinions on the latest developments.