Surgery over healthcare: Does National Medical Commission go in haste?
India’s healthcare is one of the fastest growing sectors but the serious drawback is the neglect of rural population. After independence, there has been a significant improvement but the situation isn’t much better. The problem has further added by urbanised trend, inadequate outlay, social inequality, shortage of doctors/nurses, limited medical research and expensive health services. The industry is making progress, albeit rather difficulties. India has more than ten lakh doctors registered with MCI. It faces deficiency of qualified doctors available to serve the vast population of 14 billion. The current doctor-population ratio soars to 1:1596. There is a need to access quality and affordable healthcare to promote universal healthcare to all citizens. In order to address lack of medical coverage in rural areas, the govt launched National Rural Health Mission in 2005. There is a great discrepancy in quality and the coverage of medical treatment. Rural health care is a lack between need and feed. They often suffer from physician shortages. Grass root level health workers such as ASHA / Auxiliary Nurse / Midwives are engaged for serving the rural need. Should India emphasise on inexpensive alternative medicine AYUSH (Ayurveda, Unani, and Homeopathy) or go with paramedical for wider access? On the other hand, private hospitals offer world class quality. Surprisingly India is a popular destination for medical tourists seeking ayurvedic medicine.
To curb such disparities, the government has taken a historical step to constitute National Medical Commission Bill 2019. President of India already gave assent for legislation aiming for mega reforms that replaced old Indian Medical Council Act 1956. It dissolved scam-tainted Medical Council of India (MCI) to regulate reforms. The bill projected for probity, quality education and brings down costs of medical education and will prove to be a blessing in better health services to India.
As per the Bill, NMC will have responsibilities such as approving and assessing medical colleges, conducting common MBBS entrance and exit examinations and regulating medical course fees. To set up medical education affordable, 75% seats would be available at reasonable fees for MBBS-PG level in private/deemed universities. Also it plans to increase MBBS seats from 150 to 250 per college. It also takes various administrative measures to the Autonomous Board. Thus 19 out of 33 members would be from Vice Chancellors of state health universities (10) and state medical councils (9), rest 14 will have eminent medical personalities.
It proposes to set National Exit Test - NEXT for eligibility in PG and licence to practice for Indians / foreign students. NEET and NEXT will be a basis for all admissions in medical including AIIMS, JIMPER and PGI. Resident doctors allege the fear of compromising independence of premier institutes. However the provision will eliminate multiple counselling processes for admission. There are protests from students to resident doctors against empowering 2.5 lakh Community Health Providers (CHP) entrusted to prescribe drugs with medicine professionals. Protesting doctors oppose authorising quacks to play with the life of patients. The ministry promised doctors’ concerns that will be addressed within six months. NMC will frame the regulations and decide qualification after extensive public consultation and debate.
I was sweetly remembered of my arrival at Detachment Camp somewhere at the border of Rann of Kutch. There were no doctors available in that Restricted Area due to its proximity to the enemy. The only Medical Assistant of Air Force reminded of staying healthy & safe and also prescribed some medicine. The healthcare crisis at the border is worrisome for a while. UN, WHO and other agencies have mooted the idea of formally training and recognising CHP to improve primary healthcare delivery.
Like armed forces, can there be a game changer after proper registration process? India has 7.6 lakh AUH (Ayurveda, Unani and Homeopathy) practitioners. With these, India can go ahead (1:921) of the WHO standard 1:1000. New cadre of mid-level practitioners can easily fill the healthcare resource gap in areas which remain un-served by doctors. Is there a need to engage AUH doctors in promotion of preventive healthcare by encouraging alternative medicine? Various states have already lifted the quality of medical healthcare in villages by introducing CHP through diploma courses and have succeeded drastically improving health report cards.
But there are voices of dissent from Doctors. NMC decided to include pharmacology and knowledge of 47 basic drugs of allopathic with alternative medicine stream for Ayush doctors. Ironically trained midwives are still conducing deliveries in rural India. Will this benefit primary health centres across the country? The government must work to get public to have faith in alternative medicine instead of pushing them to prescribe allopathic drugs. At the same time AUH doctors must practice the system of medicine they have learnt.
However the bill is silent over health insurance where only 15% of India’s population are covered. India spends the least on health per capita among the BRICS nation. There is public outcry for demand of fair treatment at government hospitals. People fall victim from the exurban fee at ICU. Drugs are not in generic names. Specialist hospitals are overburdened. Ambitious students have to go foreign universities for study. India has shortage of specialist doctors as the causes of death can’t be cured by an MBBS doctor. PG Medical seats are limited. Facing such dilemmas by a large number of doctors has opted out for administrative jobs.
Are doctors not responsible for people’s happiness? At the same time, people expect fair medical treatment. It generates revenue when patient volume increases. Our healthcare must improve health (value) of our nation instead of sending people in large (volume) to emergency room. Will this mega reforms change India’s health sector? Health Ministry is aiming for a win-win situation for the incoming notification. The reality of a doctor is different beyond clinical skills at surgery. Those nerve-wracking duties are over life and death. Hope NMC won’t undermine doctor’s years of hard work over healthcare for the benefit of all mankind. The writer is based in Guwahati