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.
