National Medical Commission Bill may institutionalize quackery in India
Recently in August 2019, the Government of India (GOI) has approved the controversial Bill of National Medical Commission (NMC), through a majority vote in both the houses of the Parliament. This bill was aimed at bringing about one of the most significant reforms in medical education in India and proposed to replace the Medical Council of India (MCI), the overarching central authority regulating medical education, with an NMC. The NMC Bill repealed the Indian Medical Council Act, 1956  and has replaced the MCI, which was dissolved in 2010 following corruption charges against its President. As per the Bill, the NMC will have diverse responsibilities such as approving and assessing medical colleges, conducting common MBBS entrance and exit examinations, and regulating medical course fees.
While the Bill has been mostly well-received, three clauses, in particular, have drawn considerable criticism from some sections of the medical fraternity. The largest representing the national body of the doctors, the Indian Medical Association (IMA), has been calling this Bill 'anti-poor', 'anti-student' and 'undemocratic' and promotes quackery. Perhaps the most debated provision in the NMC Bill is Clause 32, which, according to critics, amounts to institutionalizing quackery. It would help to provide a license to 3,50,000 non-medical persons or Community Health Providers (CHP) to practice modern medicine. According to the Bill, the NMC may grant limited license to practice medicine at mid-level as CHP to such person connected with the modern scientific medical profession who qualifies such criteria as may be specified by the regulations. We wondered how the closed monitoring of these CHPs would be possible by the GOI, and many of these ‘licensed individuals’ could practice all types of modern medicine on their patients, who would be at their mercy and a significant risk.
IMA, however, insisted that it can never accept Section 32 of the Act providing for unqualified non-medical persons being registered and allowed to practice. Their ability and capability will always be doubtful and not to talk about irreparable damage to healthcare management. This Bill proposes a bridge course of six months duration, for practitioners of AYUSH to enable them to prescribe modern medicines. It is unimaginable how a six-month capsule course can be equated with 5 to 15 years of education, training, and clinical experience of qualified medical doctors. Although the NMC bill states that ‘no person is allowed to practice medicine as a qualified medical practitioner other than those enrolled in a State Register or the National Register, any person who contravenes this provision will be punished with a fine between Rs. 1,00,000 and 5,00,000’, still this Bill allows AYUSH practitioners to prescribe modern medicines at such level as notified by the GOI. There are differing views on whether AYUSH practitioners should prescribe modern medicines. The GOI claims that the bridge course may promote the positioning of AYUSH practitioners as stand-ins for allopathic doctors owing to the shortage of doctors across the country. This may affect the development of AYUSH systems of medicine as independent systems of medicine. Further, they note that under the Bill, AYUSH doctors do not have to go through any licentiate examination to be registered by the NMC, unlike other doctors.
It is undeniable that the doctor population ratio in India is suboptimal (1:1655 compared to the World Health Organization (WHO) standard of 1:1000).  Additionally, there is a severe scarcity of doctors in many areas, as reflected in the urban to rural doctor density ratio of 3.8:1. An introduction of the bridge course for AYUSH practitioners, under this Bill, may help fill in the gaps of availability of medical professionals.  But, if the purpose of the bridge course is to address shortage of medical professionals, it is unclear why the option to take the bridge course does not apply to other cadres of allopathic medical professionals such as Nurses, and Dentists. Moreover, a big question is: Will a six-month course be enough? If they are to be deployed as middle-level care providers or community health officers, do they have adequate skills at the end of six months? Moreover, on what empirical evidence is those six months being decided?
We also believe it has been the failure of GOI, in the past, to produce enough qualified and competent basic doctors and to provide adequate healthcare facilities in rural and remote areas for patients and due incentives for healthcare professionals to provide their services there. GOI should focus on quality, not only on quantity. Our bureaucrats are continually looking for numbers. So they come with all the non-serious ideas of three- and six-month training/courses and force the system to churn out substandard training, and we end up with people giving poor treatment.
The provision of providing some healthcare facilities in these areas through CHP and AYUSH workers may only be a temporary salvage for the GOI, but does not seems to be a long term solution and would jeopardize the safety and wellbeing of the patients and public.
Competing interests: No competing interests