New Delhi: Clearing its stance on the provision of mid-level health providers in the National Medical Commission Bill, 2019, the union health ministry on Tuesday said that the provision is an interim arrangement till the doctor population is scaled up to the required level in India.
According to Clause 32 of the NMC Bill, there is a provision to issue limited licence to practice at mid-level as community health provider. As the medical students and medical body Indian Medical Association (IMA) have been largely opposing the provision, ministry of health and family welfare, the implementing ministry of the proposed legislation made it stance clear on the provision.
“India has a doctor-population ratio of 1:1456 as compared with the WHO standards of 1:1000. 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 is denied good quality care leaving them in the clutches of quacks. It is worth noting that at present 57.3% of personnel currently practicing allopathic medicine does not have a medical qualification,” said union health ministry, in an official statement.
“The ambitious Ayushman Bharat initiative announced by the government in this year’s Budget Speech needs 1,50,000mid-level providers within the next 3-5 years to provide comprehensive primary and preventive care.It will take 7-8 years to ramp up the supply of doctors, therefore, 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,” it said.
The government cited instances from other countries stating that there are international examples of Health Systems permitting such Community Health workers. Countries such as Thailand, United Kingdom, China, and even New York have permitted Community Health Workers/Nurse Practitioners into mainstream health services, with improved health outcomes.
“Since we have shortage of doctors and specialists, the task shifting to Mid- level Provider will relieve the overburdened specialists. This is merely an enabling provision to grant limited licence only in primary and preventive healthcare to practice medicine at mid-level to such persons, who qualify such criteria as may be specified by regulations which will have an overwhelming representation of Doctors,” the official statement said.
“Chhattisgarh and Assam have experimented with the Community Health Workers. As per independent evaluations (carried out by Harvard School of Public Health), they have performed very well and there is no ground of concern if the quality of personnel is regulated tightly,” it said.
Section 32 provides for licensing persons connected with modern scientific medical profession to practise medicine independently in primary and preventive healthcare.
IMA has been opposing the provision claiming that it will legalise quackery in India.
“ Such a person may prescribe medicine in secondary and tertiary care hospitals under a person of same qualification. This means that “such” a person who is “connected” to modern medicine can practise as a General Practitioner anywhere in India both urban and rural. S/He will be independent. S/He can be employed in emergencies, critical care, neonatal ICUs, Labour rooms operation theatres, ICUs inpatient wards and OPDs under similarly qualified persons providing cheap labour for the corporate hospitals,”’said R V Asokan, secretary general, IMA.