(Kuradi Chandrasekhara Kalkura)
The Indian Medical Association (IMA) has raised concerns over Section 32 of the National Medical Commission(NMC)bill which got presidential assent on August 9, 2019. The NMC, which has replaced 63-year-old Indian Medical Council Act, provides for licensing of 3.5 lakhs informal providers of healthcare to practice modern medicine.
According to the Bill, the Commission may grant limited license to practice medicine at mid-level as Community Health Provider if the informal medical practitioner who qualifies such criteria as may be specified by the regulators.
Earlier there was a proposal to start a bridge course clearing which allows informal providers to practice modern medicine legally. The provision was majorly opposed by doctors when the Bill was proposed.
The government made changes in the bill but proposed a similar idea of Community Health Providers to help tackle the disease burden in rural areas.
According to the Bill, the Community Health Provider may prescribe specified medicine independently, only in primary and preventive healthcare, but in cases other than primary and preventive healthcare, he may prescribe medicine only under the supervision of medical practitioners registered under sub-section (1) of section 32.
“The term Community Health Provider has been vaguely defined to allow anyone connected with modern medicine to get registered in NMC and is licensed to practice modern medicine,” said IMA in an official statement.
“This means persons without a medical background are becoming eligible to practice modern medicine and prescribe independently. This law legalizes quackery. This provision and the other controversial provisions can never be accepted by the medical fraternity of the country,” it said.
This apart the Bill makes many fundamental changes in the functioning of the Medical Profession and Medical Education.
It seeks to abolish the all-powerful Indian Medical Council. Since the Govt has not budged an inch, the Medical Profession, particularly the Junior Doctors (JUDAs) have struck work and boycotted duties, vigorously in A.P. and with a low key elsewhere in the country. It is good that the Strike and boycotting of duty has been called off.
Though they have resumed duty, and though only the JUDOs were in the fray, the mind of the entire medical fraternity is still agitating. Though the Govt’s anxiety to provide better medical services to the rural areas cannot be suspected, there is every responsibility on its part to ward off the genuine suspicion in the minds of the agitating Medical Fraternity all over the country.
Since the government has a road-roller majority in the Parliament, the Bill is passed and obliging President was eagerly waiting to give his assent.
In this regard, the considered opinions of the experts in the domain of Public Health must be obtained by the government before actually implementing the Law.
There is a wide gap between demand and supply in rural areas. Qualified Allopathic Doctors hesitate to serve in the Primary Health Centres.
Their reason cannot be easily brushed aside. To overcome the hurdle, the medical experts, both Social and Physical, have been stating “In terms of bridging this gap, yes, Chattisgarh and Assam did work on having a three-year-trained physician, something like the old LMPs (Licentiate Medical Practitioner and RMPs (Registered Medical Practitioners). They are really very good.”
This argument is backed with historical evidence. Almost for the whole of the 20th century these LMPs and RMPs monopolized the rural health services. There were a few private practitioners.
Most of them were serving in the Local Fund Dispensaries administered by the municipalities, district, and taluka Boards. They were Almighty incarnated. (Vaidyo Narayanoh Hari:). They were ‘specialists’ in treatment; gynecology, orthopedics, dentistry, medicine, ophthalmology, communicable diseases, infectious diseases, etc. etc. I gratefully remember, Dr. A.S.N.Hebbar, an L.M.P. of the Local Fund Dispensary at Barkur in the present Udupi Dist of Karnataka extracting my tooth in 1957. Since I had not taken my meal, and I had no money he paid two annas for my lunch. Private practitioners were charging four annas for extracting a tooth.
Such legend L.M.P.s are still gratefully remembered by the beneficiaries. Statues were erected for them. Community Halls and institutions were built to perpetuate their memories. Scholarships were instituted in their names.
And many more memorials are seen in the countryside and semi-urban areas. Many of them like Bhogaraju Pattabhi Sitaramayya plunged into the National Movement. There were philanthropists and social activists. They managed and help run Charitable and Religious Institutions. Some of them were heading the local bodies; Municipalities and Taluk Boards.
World Bank’s Lead Economist Jishnu Das argues in favor of training and availing the skills of rural informal health care providers. According to Das training, informal providers could vastly improve the quality of care for millions of rural Indians and there is no evidence that it would make matters worse.
It is said that the Medical profession became commercial only after the starting of a number of Medical Colleges in the Private Sector imparting Allopathic system. Will the present Law be able to contain the degeneration?
The profession too has an obligation to justify their demands regarding the apprehensions about the National Medical Commission Bill.
(picture courtesy International Growth Centre)