India’s healthcare system in crisis

Context:

• The National Medical Commission Bill seeks to make structural changes in an exploitative health-care system.

Introduction:

• However, Indian Medical Association (IMA) has strongly opposed the bill.
• The NMC bill seeks to replace the apex medical education regulator, the Medical Council of India (MCI), with a new body National Medical Commission (NMC). It is against this bill that doctors have decided to go on strike, leaving the fate of patients requiring urgent treatment hanging in the balance.

Bill’s highlights:

• The Bill seeks to repeal the Indian Medical Council Act, 1956 and provide for a medical education system which ensures availability of medical professionals.
• The Bill puts in place a mechanism to assess and rate medical colleges regularly, with a high monetary penalty for failure to comply with standards.
• Three such failures will result in the de-recognition of a college.
• There is also an enabling provision for the government to regulate the fees of up to 40% seats in private medical colleges.
• NITI Aayog data show that this amount falls in a Goldilocks zone, wherein the regulation can be made revenue neutral for the college by nominally raising fees for non-regulated students.
• The Bill provides relaxation of the criteria for approving a college in specific cases.
• Presently, there is a blanket standard for establishing a medical college in India, which disregards the contextual realities in some areas such as difficult terrain or a low population density.
• The Bill has provided for a bridge course for AYUSH/non-allopathic doctors.
• Thirteen States now permit AYUSH doctors to prescribe varying levels of allopathic care. The NMC Bill will bring in a homogenisation of such rules without diluting the varied systems of medicines.
• The Bill provides for two separate national registers – allopathic doctors, and AYUSH doctors who complete the bridge course, respectively.

Major flaws in the Bill:

• The fundamental flaw in the proposed Medical Commission is the lack of clarity on its function.
• The Commission should only be expected to monitor and regulate the training of health-care personnel and maintain professional standards.
• Having an almost entirely nominated commission, as the present Bill provides, is unhealthy.

Factors responsible for health crisis in India:

Article 47 of the Constitution makes it clear that the state is duty-bound to improve public health, but India continues to face a health crisis. The factors responsible for health crisis in India are given below:

• An Absolute shortage and an inequitable presence of doctors and over-burdened hospitals.
• Although India has 10 lakh medical doctors, it needs 3, 00,000 more in order to meet the World Health Organisation standard of the ideal doctor-population ratio.
• There is an 81% shortage of specialists in community health centres (CHC), the first point of contact for a patient with a specialist doctor.
• Another fact is that 2% of providers of “modern medicine” in rural areas do not have a medical qualification.
• Shortfall in the number of medical practitioners.
• High capitation fees charged by private colleges can have a negative effect in terms of affordability of medical services.
• The regulatory authority has been unable to act despite the fact that over half the 60,000 medical students graduating every year are from private medical colleges.
• Corruption in the issuing of licences and regulatory requirements, many such academic institutions have a faculty of questionable standards, with obvious repercussions on the quality of education imparted.
• Low funding for health sector in the budget.
• Health-services inequality between urban and rural India.
• Disconnect between the public-health and medical-education systems
• Low level of public investments in preventive health facilities.
• India spends very low percentage of its GDP on health sector.

Important schemes and Initiative in Health Sector:

Schemes:

• Mission Indradhanush:The Ministry of Health & Family Welfare has launched “Mission Indradhanush “ to fully immunise more than 89 lakh children who are either unvaccinated or partially vaccinated.
• The National Health Mission (NHM): The National Health Mission (NHM) encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include Health System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases.
• Ayushman Bharat: This was aimed at making path breaking interventions to address health holistically, in primary, secondary and tertiary care systems, covering both prevention and health promotion.  NHPS to provide health insurance of Rs 5 Lakh to 10 crore poor and vulnerable households.

Initiatives:

• National Health Policy 2017(NHP):
• Recently the government launched new National Health Policy 2017(NHP).
• The plan aims to strengthen India’s healthcare system.
• The policy proposes to increase the public health expenditure by 2.5 percent of the GDP from the current 2 percent GDP spending on healthcare.
• The policy aims to reduce the maternal mortality rate, infant and child death rate due to many noncommunicable and infectious diseases.
• Door to door screening of early detention treatment of cancer, and heart disease and diabetes.

Way ahead:

• Strengthening primary centres.
• To address the urgent need for better access to medicines India should embark on the necessary regulatory and other mechanisms for pharmacy reform that will ensure the procurement prescribing and dispensing of low cost generics and eliminate the abuses of prescriber mark-ups.
• India needs to make the commitment to provide the level of public funding for medicines that is expected of a country that is becoming a growing economic power.
• Increase health system capacity through adequate funding.
• Training informal healthcare workers

Conclusion:

The quality of the health-care system needs attention. It is ironic that, while India is a hub for medical tourism (in 2016, India issued 1.78 lakh medical visas), it is a common sight in government hospitals to have patients sleep in corridors waiting for their outpatient department appointments. The Bill seeks to make structural changes in a stagnant and increasingly exploitative health-care system. This is a step in right direction.