The National Medical Commission Bill was passed by the Rajya Sabha on Thursday, 1 August, amidst much furor across the medical fraternity. However, it will be sent back to the Lok Sabha following amendments by the upper house.
Hailed by Health Minister Harsh Vardhan as one of the “biggest reforms for medical education in the country by the Modi government,” the Bill's near passing resulted in protests, marches and boycotting of healthcare services across the country.
Union Minister Dr Harsh Vardhan on National Medical Commission (NMC) Bill, 2019 passed in Rajya Sabha: This Bill will benefit the MBBS students and doctors. It will be listed as a major reform of the Narendra Modi government. pic.twitter.com/4nKnvmXSl3— ANI (@ANI) August 1, 2019
Unfortunately, the strike adversely impacted patients of government hospitals the most.
There has been a lot of confusion over the vagueness of certain aspects of the bill, with The Indian Medical Association (IMA) also raising concern. In fact, the IMA asked medical students to boycott medical classes and withdraw non-emergency services on Wednesday, in solidarity with the movement.
So, why is there so much worry in the air and why are doctor’s protesting and calling the Bill “anti-poor, anti-student and undemocratic?”
Explaining the NMC
The NMC was introduced to repeal the Indian Medical Council Act, 1956 and effectively replace the Medical Council of India (MCI), which has been plagued with corruption charges.
The MCI was disbanded in 2010 when the CBI charged MCI president Ketan Desai with corruption.
One of the biggest changes the NMC will introduce is that of a common MBBS entrance and exit exam. Other new additions include setting up a new commission that will set course fees and assess medical colleges.
According to legal site PRS Legislative Research, the bill aims to create a medical education system that ensure an increased “availability of adequate and high quality medical professionals.”
So, What’s the Problem?
One of the biggest and most surprising changes the Bill is set to introduce is on the issue of community health providers (CHP).
The wording of the Bill is vague, but the NMC might grant a limited license to mid-level practitioners “connected with the modern medical profession to practice medicine.” What this could mean is that healthcare practitioners who have not undergone rigorous medical college training could be allowed to practice and prescribe medication in primary and preventive healthcare.
Now that is a really scary thought. Of course, in certain cases the health workers are allowed to prescribe medication, but only under supervision from a registered medical practitioner.
However, this new bill has thrown the term “medical practitioner” into disarray with little distinction, from the perspective of the patient, between an allopathic medical professional and other practitioners.
In our country, we have varied options for our healthcare - from allopathy to homeopathy to Ayurveda and many more.
Now although terms like “mid-level practitioner” and “limited license” are not clearly defined, it seems that the Bill seeks to conflate all types of practitioners and allow all to prescrible modern medicine, something that was previously only allowed to those who had done an MBBS.
Another concern this raises is on how these practitioners will be regulated as no clear solution has been offered so far.
Can This Help Bridge the Low Doctor-Patient Ratio?
The rationale behind the Bill was apparently to create more doctors to solve the severe doctor shortage in our country that has exacerbated recent epidemics like encephalitis.
MBBS doctors say that creating Community Healthcare Providers would not solve this issue as there would be an increased lack of credibility in the medical profession.
However, the counter argument is that this step could boost rural healthcare. News18 reported that Chhattisgarh and Assam introduced the idea of CHPs who would complete three-year diploma courses (focusing on primary healthcare) and the result was an increase in overall state health.
"“When Chhattisgarh introduced this diploma, it ensured that the graduates only remain and serve in the public health sector and do not move to the private sector. This was needed for the public health system to grow.”" - Samir Garg, Senior Programme Coordinator, State Health Resource Centre, Chhattisgargh said to News18.
The Rural Medical Assistants (RMAs) were posted in goverment health centers and filled nearly 1,400 vacant posts. WHO has long proclaimed the dangers of a low doctor:patient ration, and the NMC proposes to help balance the shortage.
However, question remains over how the Bill proposes to regulate CHPs and the power they are getting.
If these issues are clarified, is there any merit in licensing local health workers to help cater to lower-level healthcare issues in areas with lesser access to doctors?
While medical bodies debate this, there is evidence across the world, from China to Cuba to pre-independence India, that this practice works. However the limits need to be set clearly.
Other Issues with the Bill
The Bill seeks to create uniformity in medical education standards in India by having a common final-year MBBS exam called National Exit Test (NEXT), for admission to PG courses and also for obtaining a practice licence.
However, the medical student fraternity argues that this would be anti-democratic, and the merit debate has popped up again - albeit in a new form.
“Merit should be the determining factor in securing a PG seat and the current NEET-PG should not be scrapped," said the All India Institutes of Medical Sciences (AIIMS) Resident Doctors Association (RDA) the Federation of Resident Doctors Association (FORDA) and the United-RDA in a joint statement opposing the NMC Bill in its current form.
Critics of the bill also said the regulation of 50% of the fees would be problematic, as would the fact that now states can only advise the NMC but the council will not be obligated to take up the state’s concerns.
NMC is clearly a hot-button, developing issue but it’s essential to be aware of changes in India’s healthcare landscape and be proactive about our own healthcare rights.
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