By Rattan Chand
Under the Ayushman Bharat scheme, the government has fixed the target to establish 1,50,000 health and wellness centres (HWCs) by 2022. These centres would be established by transforming the existing health sub-centres and primary health centres (PHCs) into HWCs. The HWCs will provide preventive, promotive, rehabilitative and curative care for an expanded range of services encompassing mother and child health services, communicable diseases, non-communicable diseases, elderly care, oral health, ENT care, and basic emergency care. The services in HWCs will be provided through a mid-level healthcare provider / community health officer (CHO) at sub-centre HWCs and a medical officer at PHC-HWC, supported by other staff.
As on March 31, 2018, 1.58 lakh sub-centres and 0.26 lakh primary health centres were functioning in the country. There are around 9000 vacancies of PHC medical officers in the country. Even if all the PHCs are transformed in to HWCs, the government is still required to transform 1.24 lakh rural sub centres in to HWCs. This would mean that 1.24 lakh community health officers (CHO) need to be positioned at HWCs to be established in the rural areas throughout the country.
One of the chronicle challenges faced by the government is to post medical officers at the health facilities in rural/semi-urban areas and ensure that they stay in these areas. As on March 31, 2018, 25 per cent positions of medical officers and 74 per cent of positions of specialists were vacant at primary health centres and community health centres.
The erstwhile Medical Council of India has failed in its responsibility to train adequate number of medical professionals to provide health services in the rural/ semi-urban areas. According to the Indian Medical Association, about 10 lakh quacks practice allopathic medicine in India, though some put this number at 25 lakh. According to IMA, there are three categories of quacks: those who have no qualification at all, those practise modern medicine with degrees in alternative systems like ayurveda or unani and the third practise systems such as electro-homeopathy and Indo-allopathy which have no validity in India. In the absence of healthcare providers, the rural people have no choice but to avail the services of these quacks. People look satisfied with the services provided by the quacks as they are near to their homes, accessible round the clock and their services are affordable. The IMA has to recognize that the untrained professionals have been practising in India since decades and the situation needs to be remedied without losing any time.
The National Medical Commission (NMC) Bill, 2019 passed by Parliament on August 1, 2019 seeks to repeal the Indian Medical Council Act, 1956 and provide for a medical education system which ensures: (I) availability of adequate and high-quality medical professionals, (ii) adoption of the latest medical research by medical professionals, (iii) periodic assessment of medical institutions, and (iv) an effective grievance-redressal mechanism.
One of the provisions in the NMC Bill passed by Parliament is that the NMC may grant a limited medicine practice licence to certain mid-level practitioners connected with the modern medical profession. These mid-level practitioners may prescribe specified modern medicines in primary and preventive healthcare. In any other cases, these practitioners may only prescribe medicines under the supervision of a registered medical practitioner. The government plans to position these practitioners at about 1.25 lakh new HWCs to be established by 2022.
It is this provision of granting limited practice licence to certain mid-level practitioners that the Indian Medical Association is mainly protesting and asking the doctors to go on a strike. The IMA in the past has also resisted various efforts by the government to remedy the situation and place medical personnel in rural areas. The IMA, being a powerful lobby, had thwarted various initiatives in the past, be it compulsory posting of new medical graduates in rural areas or bridge course to AYUSH doctors to provide primary healthcare services in rural areas. The time has come that the situation be suitably tackled so that rural people also get quality healthcare services. The passing of the National Medical Commission Bill is a welcome step which is likely to bring quality health services close to rural communities and will also bring many reforms in the healthcare system in the country.
The author is Director, EGROW Foundation