Old Wine In A New Bottle
But for the failure of the Modi government’s communications system, the National Medical Commission Bill could have brought healthcare reforms through landmark initiatives
The National Medical Commission Bill, 2017, introduced by the Central Government is – or rather was − a landmark legislation. Succumbing to a powerful lobby of doctors and associations, the Bill has now been diluted. The original Bill was drafted after deep thought, but not properly communicated to the stakeholders. This lack of communication led to the perception that the Bill was being foisted on doctors, medical associations and medical colleges.
This lack of communication and failure to take stakeholders into confidence through dialogues led to changes in the Bill through a series of amendments. This could have been avoided hadrobust and transparent communication lines been first established between the government and the stakeholders.
The lack of communication is best highlighted in the way the amendments dropped the progressive and intended provision of a “bridge course” for AYUSH practitioners. The thought behind this move was to address the woeful lack of medical practitioners in rural areas. But the perception among doctor communities was that these AYUSH practitioners would be a challenge to practitioners of modern medicine and would replace them or compete with them in medical practice!
The NMC Bill allows practitioners of homoeopathy and Indian systems of medicine to prescribe allopathic medicine on completion of a “bridge course”, to address the growing derthdoctors in rural areas. But the government could not communicate the intent behind this move properly. This `cross-pathy’ became a major sticking point, as a person trained in one stream of medicine practising another is specifically disallowed under the current rules.
The best of healthcare ideas just cannot take off if doctors are not available in rural areas. While allopathic doctors arereluctant to practise in rural areas, the lacunae could have been filled by AYUSH practitioners who pass the bridge course and are able to prescribe basic allopathic medicines, first aid, primary care and some treatment at the basic level in the secondary care space.
Let us look at some statistics. Doctors per every 1000 peoplewas just 0.7 in 2012 in India. The figure was 2.5 in the United States and 1.9 in China. If India has to cope with global challenges on the healthcare front by 2020, the number of physicians has to increase from 0.7 per 1000 of the population to 1.50 – an increase of 114 percentage points. How can this be done without innovative ideas like allowing AYUSH doctors to prescribe basic medicines? If China could introduce barefoot doctors, why can't India have AYUSH doctors who are not barefoot, but ‘booted’ with knowledge of medicine?
In fact, in its 92nd report (submitted in March 2016), the Parliamentary Standing Committee for Health and Family Welfare examined MCI’s (Medical Council of India)functioning, and identified the failure of IMA (Indian Medical Association) to produce adequate doctors. If the Modigovernment’s laudable idea of creating a Healthy India by 2020 under Ayushman Bharat has to succeed, more doctors are needed in rural areas and not hurdles or turf protection by vested interests.
The other objection to the Bill was the replacement of the MCI with NMC. The Parliamentary Standing Committee had said in its 92nd report that the MCI had failed to address the issues of shortage of teachers in medical colleges; poor regulation of undergraduate and postgraduate medical education; opacity and alleged corruption in the functioning of the regulator and its lack of accountability and failure to discharge mandated responsibilities; and the prevalence of capitation fees in private medical colleges in violation of the law.
The committee observed that “currently the MCI is an exclusive club of medical doctors as the IMC Act does not call for diversity of backgrounds in the members” and that “across the world, a perspective has gained ground that self-regulation alone does not work because medical associations have fiercely protected their turf and any group consisting entirely of members from the same profession is unlikely to promote and protect public interest over and above their own self-interest”. There was a need for “check-and-balance mechanisms”, the committee said, apart from “inputs from people with excellence and competence in other disciplines”.
Doctors managing doctors is clearly a case of conflict of interest. World over, medical bodies have been best managed by professionals from diverse administrative fields. India cannot be an exception if the ills plaguing the medical system have to be addressed. This should have been clearly and firmly put across through proper communication and dialogue.
Instead of succumbing to pulls and pressures, the government should have taken three steps in communication: opened dialogue and invited inputs in the pre-Bill stage; crystallised key features of the Bill and put it out for debate and dialogue and thirdly, presented the Bill as a consensus document by wiping out the sticky points through hard facts and figures.
An ‘effective communications mechanism’ to present the true perspective would have rendered the NMC Bill a ‘landmark’ Bill. Having been overlooked, the NMC Bill probably faces a big hindrance in transforming the healthcare sector in Indiaeffectively. The Bill in its current form, is like ‘old wine in a new bottle’. It is another big opportunity lost by the Modigovernment to bring in transformation in the true sense.
Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.
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