What is the issue?
- A contentious element of the National Medical Commission (NMC) Bill 2017 is the contemplated bridging of multiple streams of medicine.
- While there are sticky issues, a pluralistic and integrated medical system involving “AYUSH and Allopathy” remains a solution worth exploring.
What is the proposal?
- NMC bill is an attempt to revamp the medical education system in India to ensure an adequate supply of quality medical professionals.
- A clasue in the bill proposes a joint sitting of the NMC, the Central Council of Homoeopathy and the Central Council of Indian Medicine.
- This sitting is for deciding on the approving for specific bridge course to enable practicioners to prescribe basic medicines across domains.
- The debates surrounds the ability of Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy (AYUSH) practitioners to cross-practise.
- It also highlights the current restrictions on allopathic practitioners from practising higher levels of caregiving by co-opting other domains.
Why is the situation demanding?
- Signficantly, the pressure in the primary health system is huge, which is struggling with a dismal physician-population ration of 0.76/1000.
- This is amongst the lowest in the world and is due to a paucity of MBBS-trained primary care physicians which is particularly severe in rural areas.
- Notably, the Urban-rural disparities in the face of an increasing burden of chronic diseases make health care in India both inequitable and expensive.
- There is hence an urgent need for a trained cadre to provide accessible primary-care that covers minor ailments, and health promotion services.
- Additionally, risk screening for early disease detection and appropriate referral linkages, are essential to ensure that people receive timely care.
What is the current level of integration?
- AYUSH cross-prescription has been a part of public health and policy discourse for over a decade and NMC 2017 merely calls for its mainstreaming.
- There are more than 7.7 lakh registered AYUSH practitioners currently and their current academic training is pretty intergrationist.
- Notably, it includes conventional biomedical syllabus, that covers anatomy, physiology, pathology and biochemistry.
- Also, efforts to gather evidence on the capacity of bridge-trained AYUSH physicians to function as primary-care physicians is already underway.
- Hence, the call for a structured, capacity-building mechanism is only logical.
What do various studies say?
- A report of the National Health Mission in 2010, noted high utilisation of AYUSH physicians in primary health centres (PHCs) across many states.
- While their deployment at PHCs was to rationalise resource allocation, a lack of appropriate training in allopathic drug dispensation was a major deterrent.
- Also, the 2013 Shailaja Chandra report on the status of Indian medicine, noted several areas where AYUSH physicians were the sole care providers in PHCs.
- The report also made a call for the appropriate skilling of this cadre to meet the demand for acute and emergency care at the primary level.
- Hence, a capacity-building strategy using AYUSH physicians through a bridge-training programme is needed to meet the demand for primary care.
- Along with the use of evidence-based protocols, the delivery of quality and standardised primary health care can prove a game changer in the sector.
What is the way ahead?
- Capacity-building of AYUSH practitioners is only one of the multi-pronged efforts required to meet the objective of achieving universal health coverage.
- Other efforts include training personnels such as nurses, Auxiliary Nurse Midwives (ANM) and rural medical assistants, and ASHA activists.
- All these will create a cadre of mid-level service providers as anchors for the provision of comprehensive primary-care services.
- Hence, further discussions should focus on substantive aspects of this solution rather than bringing its logic into question.
- Aspects of “program design, implementation, monitoring, audit, technical support and legal framework” need to be debated to streamline things.
Source: The Hindu
