More than half of allopathic practitioners don't have medical qualification

Health ministry clarifies its position on three main contentions of NMC Bill

Doctors hold placards during their strike in protest against an attack on an intern doctor, in Kolkata | Salil Bera [File] Doctors hold placards during their strike in protest against an attack on an intern doctor, in Kolkata | Salil Bera

Ahead of the Indian Medical Association's (IMA's) call for a strike against NMC Bill, 2019, on Thursday, the Union health ministry has clarified its position on three main contentions of the bill—the clause allowing limited license for mid-level health practitioners, the issue of fee regulation, and the National Exit Test (NEXT).

On Section 32 of the bill that allows for a limited license for mid-level practitioners as Community Health Providers (CHP), the health ministry has said that it is “merely an enabling provision” to grant limited licence “only in primary and preventive healthcare” to practice medicine at mid-level to persons who qualify a set criteria that will be specified by regulations.

According to the ministry, states such as Chhattisgarh and Assam have experimented with the concept of CHP, and independent evaluations such as the one carried out by Harvard School of Public Health have concluded that they have performed very well. “There is no ground of concern if the quality of personnel is regulated tightly,” the ministry said in a statement.

It may be noted that on Sunday, the residents doctors called off their strike after receiving assurances from the Union health minister Dr Harsh Vardhan that representatives of the association of residents doctors from AIIMS and Safdarjung would be included in the drafting of the regulations. The issue of Section 32 is one of the more vehemently opposed clauses in the bill by doctors.

However, the doctors in Delhi have been divided over the issue. While the IMA members have been vehemently opposing the bill, along with resident doctors and medical students from AIIMS and Safdarjung, the Delhi Medical Association has thrown its weight behind Dr Harsh Vardhan (who has been a prominent member of the DMA) in supporting the bill.

In its latest “FAQ on the NMC, Bill, 2019”, the ministry has said that there are international examples of health systems in countries such as Thailand, United Kingdom, China, and cities such as New York, where community health workers or nurse practitioners were allowed into mainstream health services, with improved health outcomes.

“Since we have an acute shortage of doctors (1:1,456) and specialists, the task shifting to mid-level provider will relieve the overburdened specialists,” the ministry said. In addition, there is a huge skew in the distribution of doctors working in the urban and rural areas with the urban to rural doctor density ratio being 3.8:1. “Consequently, most of our rural and poor population are denied good quality care leaving them in the clutches of quacks. It is worth noting that at present 57.3 per cent of personnel currently practicing allopathic medicine do not have a medical qualification,” the statement read.

According to the Centre, the demand for trained healthcare workers is huge—the ambitious Ayushman Bharat initiative needs 1,50,000 mid-level providers in the next three-five years to provide comprehensive primary and preventive care. “It will take 7-8 years to ramp up the supply of doctors... in the interim we have no option but to rely upon a cadre of specially trained mid-level providers who can lead the health and wellness centres,” the ministry has said.

On the issue of the NEXT exam, a common final year undergraduate exam and licentiate exam for MBBS students, the ministry has said that it is an “enabling provision” to ensure “common standards”. Regulations for operationalising the NEXT would be made in due course keeping in mind the importance of both theoretical as well as clinical skill sets required at the level of undergraduation, the ministry has claimed. The composition of NMC that includes 75 per cent doctors representing central and states institutions/councils and health universities will ensure that “due weightage” is given to theoretical as well as clinical skill sets.

The ministry has also said that nearly 50 per cent of the total MBBS seats in the country are in government colleges, and have nominal fees. Of the remaining seats, 50 per cent would be regulated by the NMC, which implies that almost 75 per cent of the total seats in the country would be available at a reasonable fee. The rest would be in the domain of the state to regulate. This is in contrast to what the IMA has been arguing—since states are regulating fees already (85 per cent) there was no need to have this regulation.

“We need to balance the interests of the poor, but meritorious students and the promoters of the private medical colleges in order to expand the number of seats on offer. It is not correct to assume that colleges would be free to arbitrarily raise the fees for unregulated seats. The transparency provided by NEXT results would lead to regulation of fees through market forces,” the ministry has said.

Colleges would have to provide quality of education commensurate to the fees charged by them; otherwise, there would be no takers for their management quota seats, according to the health ministry. Sections of doctors have argued against this clause and said that this is rampant “commercialisation” of medical education. “We have invested more than Rs 10,000 crore in creating government seats in the past five years, and are also setting up 21 new AIIMS at a cost of over Rs 30,000 crore to boost the medical education sector. This trend of creating government seats will continue in future,” the ministry has claimed.  

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