The government plans to let medical practitioners without MBBS degrees offer basic healthcare services. We need more doctors, but quality standards should not be diluted
The National Medical Commission (NMC) Bill, 2019, which was passed by the Rajya Sabha last week with some modifications and sent to the Lok Sabha for approval, has evoked widespread protests from doctors. The Indian Medical Association (IMA), a representative body of doctors, has called an all-India strike tomorrow against a few contentious aspects of the bill. This follows a four-day strike by resident doctors of Delhi’s All India Institute of Medical Sciences and Safdarjung Hospital, which ended on Sunday. Of particular concern, say the protestors, is Section 32 of the NMC Bill that would grant “limited" licences to an estimated 350,000 “community health providers" to practise allopathic medicine, provided they meet a set of qualifying criteria. What this suggests is that practitioners of ayurveda, yoga and naturopathy, unani, siddha and homoeopathy could undertake a “bridge course" and legally start offering primary healthcare. According to the IMA, letting patients be treated by people without MBBS degrees would amount to quackery gaining legitimacy in a country full of fraudulent cures and dodgy practices.
It is true that India is woefully short of trained doctors, especially in the countryside. The shortage has slowed the state’s programme to scale up healthcare facilities and medical education infrastructure. There just aren’t enough qualified professionals to treat the country’s 1.3 billion people and formally train others to do so. Despite decades of effort, India still has less than one doctor for every 1,000 people, the World Health Organization’s minimum ratio for a country’s healthcare adequacy. Moreover, for the efficacy of big-ticket welfare schemes such as Ayushman Bharat—which covers 500 million citizens with health insurance—a vast leap needs to be taken on that count. All these factors argue in favour of a pragmatic approach, a licensing system by which paramedics and others with an elementary grounding in healthcare could make up a part of the shortfall. In any case, chemists in this country are known to hand out pills to sundry customers who cite minor ailments. This is because public services are unreliable and many find themselves priced out of the private market, which makes medical consultancy unaffordable.
However, in its rush to raise the doctor-population ratio and enhance service capacity, the government does risk sending the profession down a slippery slope that could eventually turn the classic Hippocratic Oath, “First, do no harm", on its head if left unchecked. Usually, it is professional peers who raise alarms on service quality. And when they do, they deserve a hearing. While it is nobody’s case that MBBS holders are all paragons of perfection and virtue—they do have an interest in keeping the supply of qualified physicians low—the potential damage that could be done to the reputation of Indian doctors should make us pause for thought and review the objections to the proposal. One way to prevent dilution of standards is for an independent panel of well-regarded doctors to keep a close watch on the eligibility process for licences. It involves a common test on the assumption that practical training has already been imparted; if the test is found to be letting dubious practitioners acquire allopathic credentials, then the newly set up NMC would have to either drop or revise the idea. Patients who are not insistent on consulting allopaths need not despair, for they have plenty of options anyway. Increase supply by all means, but not if the risks outweigh the benefits.
