Can the NMC Bill help India overcome its lack of Primary Healthcare?
There is no doubt that India faces a shortage of doctors, with the doctor to population ratio being 1:1655 as compared with the WHO standards of 1:1000. There is also a disparity in this shortage, between the rural and urban areas, with the former being skewed negatively in a doctor to doctor ratio of 1: 3.8.
Quite ironically, although the aforementioned figures may imply otherwise, India is a booming centre for ‘medical tourism’, with the Ministry of Tourism predicting that this industry could grow by 200% by 2020 and hit the 9 billion mark! Thus, this contradictory situation owes itself to a nation which has given a greater preference for secondary and tertiary health care over the primary one. Firstly, what exactly is primary healthcare? There are two broad definitions for it. The first:-
Primary Healthcare is the first place to go when you need health advice, the first stop for symptoms and medical concerns.
The second:-
It is a whole of society health approach, where individuals, families, and communities are guided for their entire life, not just for a set of diseases.
The problems in India’s medical system can be summed up with the following two points:-
1. No Country for Non Specialists
India is a country where we run after specialists even if we just have a common cold. The family physician is mostly a fragment of the past in a society that sees doctors with just MBBS degrees as ineffectual. Even in specializations, radiology, cardiology and so on, are considered more lucrative than say, general or family medicine. In this sense, this is indeed a self-inflicted crisis as stated by the former Health Secretary Keshav Desiraju, in his article.
There is also no compulsory requirement of seeing a general practitioner first or requiring his or her reference for seeing a specialist, which is present in countries like the UAE and the UK.
2. An Alarming Yet Reasonable Rural Void
As mentioned above, there is a greater shortage of medical personnel in rural areas, with many doctors preferring to work instead in metros. Sadly, it is truly the rural areas that really need primary healthcare and a holistic approach to medicine, where societal, economic and environmental factors need to be assessed in planning the delivery of health. And when they finally have no other alternative, they turn to unqualified practitioners and quacks for their needs.
Now it is unfair to just put the blame on the doctors or pinpoint a lack of altruism. Doctors are ultimately human beings, and if the work environment is not too good then they, just like other professionals, prefer to work in one that is.
Instead of focusing only on steps like the compulsory rural service by MBBS graduates, the government should make sure the HR policies and infrastructure cater to the needs of doctors working in rural areas. Otherwise, it is unjust to expect things from just one side.
NMC- Finally a way forward?
In the new National Medical Commission(NMC) bill passed, the provision that has stirred the most controversy is Clause 32, which the critics say amounts to legalizing quackery. According to the clause, Community health providers (CHPs) will be given a restricted license to deliver preventive and primary health services.
What is important to note is that, even before this bill was passed, there was no shortage of quackery in India.
Although by the law until now, only a practitioner of allopathic medicine could administer the same, the Medical Commission of India(MCI, the regulatory medical body before the NMC) till now, has failed to reach out to the rural areas in practice, which turned to quackery due to no other alternative.
Previously, countries like Rwanda and Thailand have tried out Community Health Workers(CHW) and yielded good outcomes. In India, a similar result was obtained with CHWs in the states of Assam and Chhatisgarh. Additionally, the NMC will also determine the qualifications of CHPs through various steps, which should ensure their quality.
Interestingly, instead of increasing quackery, this might have the opposite effect and may finally give the people, especially in the rural areas, a worthy alternative to turn to.
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