The decision of the Lok Sabha to send the National Medical Commission Bill to a standing committee for a relook is the right one. First proposed in 2016 , the Bill aims to overhaul the corrupt and inefficient Medical Council of India, which regulates medical education and practice. But despite its plus points, the NMC isn’t the game-changing legislation it could have been. One of its goals is to rein in corruption in the MCI through greater distribution of powers. This is sought to be accomplished through an independent Medical Advisory Council to oversee the National Medical Commission, the proposed successor of the MCI. But all members of the NMC are members of the Council, undermining the latter’s independence. This, and other concerns, must be addressed. Perhaps the most controversial provision of all is for a bridge course allowing alternative-medicine practitioners to prescribe modern drugs. One motivation could be to plug the shortfall of rural doctors by creating a new cadre of practitioners. But if this was the rationale, better solutions exist.
The shortfall of MBBS doctors is partly due to the fact that many of them seek a post-graduate degree to improve career prospects. MCI regulations prevent even experienced MBBS doctors from carrying out procedures like caesarians and ultrasound tests, while nurses are barred from administering anaesthesia. Empowering doctors and nurses to do more is a reform many have called for, and that would have been easier to implement than a bridge course for AYUSH practitioners. Yet, the NMC Bill hasn’t taken it up. Another way to bolster healthcare delivery is a three-year diploma for rural medical-care providers, along the lines of the Licentiate Medical Practitioners who practised in India before 1946. Chhattisgarh tried this experiment in 2001 to tackle the paucity of doctors it faced as it was formed. Graduates from such a three-year programme would only be allowed to provide basic care in under-served pockets. Massive protests by the Indian Medical Association and poor execution derailed the Chhattisgarh experiment, but the idea wasn’t without merit. India has no choice but to innovate with health-care delivery models to tackle the challenges it faces. The trick is to base these innovations on evidence. There is plenty of evidence that MBBS doctors and nurses can do more than they are legally allowed to do. But integrating alternative-medicine practitioners into modern medicine requires a lot more thought. The government will do well to empower existing doctors before attempting more ambitious, and questionable, experiments.
