Section 32 of the National Medical Commission Bill, 2019: A License to Growth or Glory?

The esteemed legislative houses of the largest democracy in the world have recently passed the National Medical Commission Bill on 31st July 2019. This Bill, in effect will repeal the Indian Medical Council Act, 1956 which previously governed the functioning of the now defunct Medical Council of India. The Medical Council of India had failed to fulfil its mandated responsibilities of the establishment and maintenance of uniform standards in the field of medicine, in the wake of corruption and the National Medical Commission seeks to remedy these sins of the past. 

The doctor-patient ratio in India has reached an alarming 1:1655 in contrast to the WHO Standards of 1:1000 and the aforesaid Bill proposes to upgrade the quality of healthcare and the quantity of professionals administering it. Many provisions have been included in the said Bill that intend to improve the standards of healthcare in India, after giving due consideration to this derth of qualified medical professionals. Though the aspect of improving healthcare is a relentless endeavour with the ever increasing population and poverty, but what is bizarre is the way the legislative wing of the nation has dealt with it through this Bill. 

Section 32 under the NMC Bill, 2019 seeks to provide a license to the mid-level practitioners, connected to the field of medical science (specified in the previous draft as only including AYUSH) to practice medicine for primary and preventive medical care under the name of being ‘Community Health Providers’. The intended purpose of this provision was to provide opportunity to the more than 7,71,468 AYUSH and other mid-level medical practitioners, who can leverage to improve the situation of better access to health once they hold a license to practice allopathy.  Many individuals in the rural villages and townships refer to these ancillary yet unqualified medical professionals as their first line of treatment. But the existence of malpractices cannot go unnoticed. More dangerous than these professionals who don’t possess the necessary wisdom and the requisite qualification to practice formal medicine are the completely uncertified and unidentified individuals who carry out medical practice without being authorised to do so. These are the quacks that are often consulted by the patients as being bona fide doctors. This makes the tool of allopathy, dangerous in the hands of these untrained individuals. The Supreme Court in its leading judgment on Quackery in India took the view that a number of these unqualified and untrained quacks are posing a great risk on the society and playing with the lives of many people. They possess very little knowledge of the indigenous medicines and often commit blunders where precious lives are lost. The Indian Healthcare System is a hostage to practically over a million Quacks and with this uncapped privilege to prescribe and practice medicine, the number is only going to increase. 

In addition to the aforesaid section, another provision under this Bill entails the option of a ‘Bridge Course’ for these mid-level practitioners that makes the Community Health Providers, a separate and sanctioned entity to practice medicine in the eyes of the law. This Bridge Course needs the approval of the Commission and Councils at the National and State level, depending on the necessity of medical personnel respectively. 

Both the aforementioned provisions met with wide spread criticism from doctors all over the country. Expressing their dissent, doctors from all across the country gathered in protest when the Bill was first passed in the Lok Sabha. Many doctors have termed the aforementioned practice as draconian and undemocratic. But keeping their requests at abeyance, the Rajya Sabha passed the said Bill on 31st July, 2019 completely ignoring the voices of the fraternity for a Bill that was intended to be passed for their protection. 

These mass protests and continuing dissent points out to the various questions that blot the very existence of the Bill. Whether a mid- level practitioner merely connected to the field of medical science fulfil the standards of healthcare and way of life as enumerated under Article 21 of the Indian Constitution? Does the standard of healthcare for the rural population differ from that of the urban population? And whether the facility of a bridge course actually fills in for the lack of medical professionals or will it only act as a roadway for glory for these practitioners? The aforesaid questions themselves indicate the need for a landmark change in order to protect the sanctity of the field of medicine as a noble profession, which cannot be ensured with a mere addition of certification and license.

In light of the aforesaid, it is therefore crucial to understand that the consequences of this arbitrary legislation can cause a grave impact to the Indian Healthcare System. The central theme of the Bill was to prescribe rules for examinations and expand the ambit of medical practice. But what the Bill fails to establish is the ambit of the reach of proper healthcare facilities to the poorest sections of the society. The Bill does not comment on the lack of basic facilities and amenities for doctors and patients in Government Hospitals and the question of why qualified medical professionals do not extend their services to rural areas still remains unacknowledged. 

It is the view of WHO that once mid-level practitioners are adequately trained, supported and supervised, they can deliver essential health services and can contribute greatly to Public Health. Though the Government tried to make this view the basis of its legislation, but failed to understand its essence. The aforesaid view of the International organization is in the nature of additional services and not mere substitution. An increase in the quantity of more unqualified personnel with a license to practice allopathy cannot override the wisdom of a single trained medical professional. It is the actual harmony of community health providers with practitioners of formal medicine that will initiate the transformation of the Indian Healthcare System. Therefore it is pertinent to reconsider the Bill as it loses sight of the more fundamental question of advancement of quality healthcare services in India, as focusing only on increasing the number of professionals will not lead to genuine progress.