With the passage of the National Medical Commission (NMC) Bill in the Rajya Sabha, the decks are now cleared to launch the new body in place of the much-maligned Medical Council of India (MCI).
The MCI served as the linchpin of the country’s medical education, profession and institution for more than seven decades with warts and all — but mostly warts.
Between the smooth passage of the Bill (in both the Houses within a month), there were widespread protests from the medical fraternity. The protests, triggered by aggrieved doctors, were aimed against one of the key features of the bill, which provides for grant of limited licence to practice medicine at mid-level. This licence would be issued to persons connected with modern scientific medical profession at the rudimentary level to be called community health providers (CHPs).
Given the paucity of trained professionals at primary health centres (PHCs), not to mention the pronounced bias of young graduate doctors against beginning their careers in rural areas minus basic amenities, the entry of CHP makes eminent sense.
It is akin to the old licentiate medical practitioners (LMPs), which did pioneering service in dealing with basic maladies in rural India through their limited, but well-honed knowledge of simple solutions to common ills that entail no elaborate procedures.
Global evidence conclusively demonstrates that countries that have robust primary healthcare systems have lower costs of care. As such, maximising the efficiency and effectiveness of PHCs will result in better health outcomes.
Given the grim ground situation of the doctor-patient ratio in the country, the means available to ensure successful running of the PHCs through the traditional five-year medicine course for trained doctors, would not do. There are a total 11, 59,309 allopathic doctors registered with the State Medical Council/MCI as on March 31, 2019. Assuming 80 per cent availability, it is estimated that around 9.27 lakh doctors may be actually available for active service in a country of one billion-plus people.
Hence, safe alternatives are being weighed to address the problem and reduce the gap in service delivery to the millions.
But, the return of this age-old practice in a modern garb as proposed in the Bill, has ignited the understandable ire of doctors, who feel that their services would be rendered futile and there would be a proliferation of sub-standard system of healthcare for a population that is vulnerable.
With medicine cost going up, even people with means might look for alternative care providers!
Yet another concern is that nurses, who are being converted into nurse practitioners or AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy) doctors, could be roped in for this mid-level career to work for the benefit of the under-served sections of society.
Former Health Secretary Sujatha Rao has a pertinent question: “Why on earth are we getting well-qualified AYUSH practitioners to practice allopathic medicine? Or is there a political angle where AYUSH doctors want to get into government services?”
Responding to the concerns expressed by MPs, Union Health Minister Harsh Vardhan has cleared doubts on the proposed issue of limited licence to CHPs to practice medicine, saying that the concept has already been implemented in developed nations.
The point is that like these countries, stringent measures to root out quacks from dispensing medicines, need to be replicated here by putting in place a thorough monitoring body to check lethal malpractices.
The Bill proposes the creation of a National Medical Commission (NMC) for development and regulation of all aspects pertaining to medical education, profession and institutions and a Medical Advisory Council to advise and make recommendations to the Commission.
As quality medical education holds the key to improved healthcare system in any country, the parliamentary standing committee on Health and Family Welfare in its 92nd report offered a critical appraisal of medical education, as well as a root and branch reform of the MCI in tune with modern times and changes needed to meet the healthcare requirements of an ever-burgeoning population.
The latest Bill passed by Parliament went by these suggestions, as also incorporating the views of an earlier Group of Experts headed by Ranjit Roy Chaudhary.
It has moved a crucial amendment to augment representation of states in the new body from five to nine members and the state university representatives from six to 10. The minister said the proposed new body would be in place in the next nine months.
The Indian Medical Association (IMA) is not too amused with the enhancement of more members to the regulatory NMC by the government, as this might open the charge of “regulatory capture” by the state to the detriment of fair and reasonable standards of quality in medical education, practices and institutions.
What is apprehended is the grave possibility of rent-seeking proclivities of deputed members if their selection is not transparent and based on their proven track record in the domain subject.
Even as the government’s avowed aim is to increase public health spending to 2.5 per cent of the gross domestic product (GDP), health spending now hovers somewhere between 1.15-1.5 per cent.
To reach its target, the government should step up funding for the health sector by 20 per cent to 25 per cent every year for the next five years or thereabouts.
The government is now in an unenviable position of not only channeling higher public investment to boost its health spend to make ample use of its demographic dividend, but also ensure that its proposed NMC is fairly constituted to deliver its mission with seriousness and result-oriented focus.