[op-ed snap] Heed the patient

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Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: National Medical Commission Bill 2017, Indian Medical Association (IMA), Medical Council of India, National Health Policy 2016

Mains level: Reforms required in health sector


National Medical Commission Bill 2017

  1. It has brought to the fore a disturbing aspect of an ongoing controversy — the activities of medical lobbies that have persistently thwarted efforts to put consumer interest above their own

Most medical practitioners do not possess educational qualification

  1. There are some 10.4 lakh private medical establishments with hospitals accounting for under 8 percent of them
  2. Most are lone practitioners running small nursing homes and clinics
  3. Most do not possess a medical qualification
  4. 2016 WHO study has brought out that only 58 percent of urban doctors had a medical degree and only 19 percent in rural areas
  5. Only 31.4 percent of allopathic doctors were educated to the secondary school level and 57.3 percent did not have any medical qualification
  6. NSSO reports show there are more unqualified practitioners than regular doctors

Role of IMA in quackery

  1. The interests of all allopathic doctors, regardless of their competence, are looked after by the Indian Medical Association (IMA)
  2. It is a voluntary registered society with state chapters which register doctors as members and lobby with the government, resorting to agitations and strikes whenever doctors’ interests are affected
  3. Many of the IMA’s members are single practitioners and they run their clinics with the assistance of young school dropouts engaged as helpers
  4. They train them to handle acute illnesses and treat acute medical conditions with antibiotics, IV fluids and steroid injections
  5. Once sufficiently skilled, these assistants set up independent practice using the prefix “doctor”
  6. They run a lucrative business charging a fraction of a qualified doctor’s fees
  7. The IMA and the Medical Council of India, both at the apex level and in their state units, are aware of what is happening

National Medical Commission Bill 2017 overlooks this problem

  1. The National Medical Commission Bill 2017 and the National Health Policy 2016 overlook this countrywide phenomenon altogether
  2. Under law, the Medical Council of India and the state medical councils are enjoined to take action against those who practise allopathic medicine without being enrolled on the allopathic medical register
  3. As consumer safety is at stake, this is a serious omission from a bill which seeks to replace the medical council

What is needed now?

  1. The new Bill must take stock of and address what the country actually needs
  2. Community-level accredited practitioners — not full-fledged doctors — after training should be equipped to provide the first line of care for acute conditions and to make referrals to a regular doctor within a GPS-supervised system
  3. A new system of community-based trained health workers (not government employees) who are enrolled in the state medical register is needed to take health benefits to village level
  4. The new Bill should promote integrative medicine enabling people to access multiple choices but available under one roof, particularly for chronic conditions or even as adjuvant therapy

Way forward

  1. The government has done well to bring forward new legislation to replace the medical council
  2. But unless the Bill confronts reality and addresses it, keeping consumer interest paramount, the new law will make little difference to people’s lives
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
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