Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Prescription for the futureop-ed snap

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

From UPSC perspective, the following things are important:

Prelims level: Attached stories and particulars of the NMC bill

Mains level: Complement this newscard with two of our recent newscards on the same bill, Medical panel Bill finalised, sent to Cabinet and [op-ed snap] Heed the patient


What is the issue?

  1. The National Medical Commission Bill, aimed at reforming Indian medical education and practice, is in trouble
  2. After protests, the Bill was referred by the Lok Sabha to a Parliamentary Standing Committee for a re-look
  3. Whatever be the outcome of this exercise, the altered Bill is unlikely to please everyone

Reasons behind these protests(against the bill)

  1. Because the questions it seeks to address are knotty, with no straightforward answers
  2. First, how can India produce enough competent doctors to meet its evolving health-care challenges?
  3. Second, how can it minimise opportunities for rent-seeking(the fact or practice of manipulating public policy or economic conditions as a strategy for increasing profits) in medical education and practice?

Issues with the Medical Council of India(MCI)

  1. The MCI’s failures are well known
  2. For years, it was mired in allegations of bribery and going soft on unethical doctors

National Medical Commission (NMC): A step in right direction

  1. The National Medical Commission (NMC), intended by policymakers to be a dynamic regulator responsive to India’s needs, unlike the opaque MCI
  2. In contrast with the MCI, which does everything from advising universities on curriculum to disciplining errant doctors
    the NMC distributes powers among four autonomous boards
    (1) those for undergraduate education,
    (2) postgraduate education,
    (3) medical assessment and rating, and
    (4) ethics and registration
  3. Also, unlike the MCI, the commission includes non-doctors like patient-rights advocates and ethicists, in line with the medical regulators of the U.K., Australia and Canada
  4. These are all steps in the right direction

Flawed electoral process of the MCI: Solution through NMC bill

  1. The committee headed by ex-vice chairman of Niti Aayog, argued that the electoral process through which MCI members were picked was fundamentally flawed, because conscientious doctors tended to avoid such elections
  2. Because there was no bar on re-elections, this had created a revolving door through which the same group of members controlled the MCI for years
  3. The NMC Bill’s solution to the flawed electoral process is that, under it, the central government will select most of the commission’s members
  4. But according to some experts, it will increase interference of the bureaucracy

The NMC Bill misses an opportunity to plan for India’s rural health- care

  1. The NMC eases regulations to set up private medical colleges, a move that will hopefully produce more doctors, this measure isn’t enough
  2. As of today, India has one doctor for 1,700 people, compared to the WHO norm of 1:1,000
  3. Most of these doctors are in urban regions, while close to 70% of Indians live in rural provinces. This gap isn’t going to close any time soon
  4. A 2015 Parliamentary Standing Committee report mentioned that even if India were to add 100 medical colleges per year for five years, it would take till 2029 to achieve the WHO prescribed ratio

Solution through non-doctors

  1. Several sub-Saharan countries have successfully addressed the problem by training non-doctors in basic medicine and even surgery
  2. Such non-doctors include nurses, or even informal health-care providers, often referred to as quacks
  3. Evidence from countries like Mozambique and Thailand shows that such training can be a safe, effective and cheap way to provide life-saving health care when no doctors are available
  4. This is why even Chhattisgarh attempted to create a cadre of rural doctors in 2001, through a three-year programme
  5. Even though the Indian Medical Association has strongly opposed such ideas, they cannot be off the table, given the evidence backing them
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