Quacks or jhola chaps are usually known to operate in rural areas or outskirts of towns. That an Unlicensed Medical Practitioner (UMP) could practise as a cardiologist in a large, reputed hospital is unthinkable.
Narendra John Camm, a "cardiologist" at a Missionary Hospital in Madhya Pradesh's Damoh district, was arrested recently for the deaths of seven patients who allegedly died after being treated by him. This fake 'doctor' had performed angioplasty on 15 heart patients in January-February 2025.
Hundreds of lives are lost in India at the hands of UMPs every year. In September last, there were reports of three lives lost back-to-back in Bihar due to quacks. Mohi Yadav, a middle-aged man, died after a surgery for piles by a 'fake surgeon' in Jehanabad, Bihar.
Krishna Kumar, 15, died after a failed gallbladder surgery performed by a fake doctor who allegedly learned the procedure from YouTube videos. Lakshmi Devi, a resident of Bihar's Saharsa district, died after being administered the wrong injection by a so-called doctor operating out of a pharmacy in her neighbourhood.
In 2023, 33 people tested positive for HIV in Uttar Pradesh's Unnao district after a fake 'doctor' injected what he called 'magic treatment' for Rs 10 to all 33 with the same syringe.
The list, unfortunately, is endless.
There are two issues facing the public healthcare system across India. First, the lack of doctors or reliable and affordable healthcare. Second, the flourishing business of quacks or UMPs, who have exploited ignorant patients and continue to fill the gaps in healthcare.
Healthcare In Shambles
The dearth of doctors, both in the urban and rural areas, push people towards UMPs. It is more rampant in small towns and rural areas where these imposters are readily available, respond quickly and charge nominal fees. The UMPs exploit the ignorant and the impoverished, who cannot afford treatment in urban centres. Some operate from pharmacies or small clinics. Some establish fake hospitals operating out of large buildings, which pretend to be reputable institutions but often turn fatal for those seeking treatment.
The strange case of Narendra John Camm now raises the question about unqualified Registered Medical Practitioners (RMPs) in established hospitals.
"People like Narendra John Camm infiltrate big hospitals by exploiting lax verification systems, forged credentials, and the desperation of patients. Unlike unqualified RMPs, these imposters operate under the guise of legitimacy, leveraging hospital reputations," says Amulya Nidhi, the National Convenor of the Jan Swasthya Abhiyan India based in Madhya Pradesh.
"This trend now extends to urban hospitals due to unchecked private sector growth and doctor shortage. The government must enforce the Clinical Establishment Act, mandate rigorous credential checks, and set uniform treatment rates," he adds.
In healthcare, the doctor-patient ratio is a key indicator of medical access, quality of care, and system efficiency. According to the National Medical Commission (NMC), the doctor to patient ratio in the country is around 1:836, which, though better than the WHO standard of 1:1,000, is deplorable.
The distribution of healthcare professionals in India is extremely lopsided - mostly urban centred.
The report 'Health Dynamics of India 2022-23' put out by the Union health ministry in September flags a nearly 80% shortage of specialist doctors at community health centres across rural India. The Comptroller and Auditor General (CAG) reports of various states have also consistently highlighted the crisis in public health infrastructure.
A CAG report on public health infrastructure and management of health services in Madhya Pradesh - where Narendra John Camm operated - exposed several failings. It was based on an audit done from 2017-18 to 2021-22.
Among others, the CAG report pointed at a shortage of 22,845 healthcare workers due to unfilled sanctioned posts across public health centres.
Such a shortfall leaves a wide chasm in healthcare services, particularly in the poorer, interior regions of the country where primary health centres continue to be short of doctors, medical staff and resources. Specialists are even more scarce.
General Practitioners and specialists in private hospitals in towns and cities are unaffordable, not just for the rural population but also for many in urban areas.
The quacks end up filling a considerable gap in the healthcare system.
Why Do Quacks Exist?
Throughout the country, there have been numerous cases of unqualified individuals registered as doctors with State Medical Councils using forged documents and certificates of doctors from other states. Many are practising, undetected. That quacks only thrive in rural areas because of the lack of qualified doctors is belied by ground realities. In Telangana, according to a report, 75 per cent fake doctors operate in urban centres like Hyderabad, which have top government and private hospitals.
There is a complex symbiotic relationship between unregistered medical practitioners, the community they operate in, and public health services in rural areas. Any plan to improve healthcare in these areas will need to factor this in.
In states like Madhya Pradesh, Chhattisgarh, Jharkhand, Odisha and Bihar, the shortage of qualified health professionals, coupled with poor road connectivity, dense jungles, and the palpable fear of attacks by the Naxals and anti-social elements, prevent people from leaving the safety of their villages. Here too, unqualified RMPs fill the gap.
Some state governments have trained these unregistered medical practitioners, instead of checking them. They believe incorporating them into the health system would help bridge the healthcare gap in rural areas. But without much positive outcome.
"In my experience with Madhya Pradesh's Jan Swasthya Rakshak scheme launched in 1997 intended to train unqualified RMPs, many continued irrational practices despite training, highlighting enforcement gaps," says Mr Amulya.
The Way Ahead
Increasing the number of seats in medical colleges has hardly resulted in desired specialised healthcare facilities beyond cities. Suggesting some of the measures to fill shortage of doctors in rural areas, Mr Amulya says, "The government can leverage MBBS graduates awaiting exams by offering them short-term training and deploying them in underserved areas, easing doctor shortages."
"Lakhs of foreign medical graduates are waiting for approval to practise in our country. They should be allowed to practise with three-month training and a bond for a few years to work in rural public health centres and hospitals. It will be an important move by the government to fill the deficiency of doctors in rural areas as well as control unqualified RMPs."
"Private hospitals must display verified doctor profiles publicly. Health education in schools and community health drives can empower citizens to question credentials," says Mr Amulya.
(The author is Contributing Editor, NDTV)
Disclaimer: These are the personal opinions of the author
