If 2018 was all about the launch of the government's flagship health scheme Ayushman Bharat, 2019 will be seen as one where the government initiated a major reform in the medical education sector. This year, the National Medical Commission Act, 2019, was passed in the Parliament. With it, the process of replacing the tainted Medical Council of India has officially begun. The challenge is huge—apart from setting up the core body, the Act also provides for four autonomous boards to regulate medical education and ethics, as well as conduct a national exit exam for MBBS students which will double up as an entrance test for PG courses. The Act also allows the NMC to regulate the fee structure for private medical colleges in the country. Sections of the medical fraternity and students were up in arms against the law, arguing particularly against the NMC's fee regulation for only 50 per cent of the seats, and the common exit exam. Protests against the law were quelled after negotiations, and “assurances” were given by Union Health Minister Dr Harsh Vardhan himself. However, conducting a common exit exam that includes both theoretical and practical aspects for around 70,000 students in the country will be a herculean task, health ministry officials concede.
This year, sections of medical fraternity and students also held agitations against the issue of violence against doctors. While the issue itself has been a recurring cause of concern among those in the fraternity, the scale of agitation and mobilisation was unprecedented this year. It all began with a violent attack on a junior doctor in Kolkata's NRS hospital, which snowballed into a nationwide agitation. The doctors demanded that the Centre pass a law to that would deal specifically with the issue of violence against health professionals. Many states already have a specific legislation, The Protection of Medical Service Persons and Medical Service Institutions (Prevention of Violence and Damage or Loss of Property) Act, 2017, which many doctors are not aware of. However, the doctors contended that the implementation of the law was faulty, and the punishment was not harsh enough to deter patients and their attendants from attacking doctors. While the Union health ministry responded with the promise of a legislation based on the doctors' demand, the draft law is reportedly caught in a tussle between the health ministry and the union home ministry. The underlying issue, however, remains—a breakdown of the doctor-patient relationship, and the abysmal state of healthcare in government hospitals, that often resulted in patients' ire being directed at the medical professionals.
Towards the later part of the year, the Union health ministry once again courted controversy on the issue of banning e-cigarettes. According to the ministry, e-cigarettes may act as gateway products for non-smokers, especially youth and adolescents, leading them to use conventional tobacco products. The safety and efficacy as a cessation aid has not been established, the government contended. Moreover, electronic cigarettes contain the highly addictive nicotine solution and flavouring agents and vaporisers that are harmful for health, the ministry said. The industry, however, contended that there was evidence to the contrary, and that if the government was serious about the health of young people, it should have banned cigarettes instead. A section of experts and vapers also said that a ban was not the answer, and the goverment ought to have regulated the industry instead. However, the goverment decided to go ahead with a law to ban their production, manufacture, sale, and distribution in the winter session of the Parliament.
Key regulations aside, each year, experts on public health have been demanding that the government increase the health budget, which stands at around 1 per cent of the GDP. While the Centre has been busy setting up AIIMS in different cities, as well as increasing the number of medical colleges, the existing state of healthcare, especially outside metros, remains a cause of concern. Nothing was more illustrative of the state of healthcare as the death of over a 100 children in an outbreak of encephalitis in Bihar's Muzaffarpur district. Doctors, researchers, and governments at both the state and the central level, couldn't even zero in on the cause of sudden deaths, let alone stop the spread of the disease, and plan a preventive strategy for next year.
In the coming year, as the discourse around Universal Health Coverage gains momentum, the government will face the tough task of balancing its priorities and putting its money where it matters—the health of the country's people.