Physician, heal thyself. This ancient Greek idiom, fits India of the 21st century like a pair of gloves. More than and above everything else, this country, an economic powerhouse, needs reasonably good medical care.
The introduction of the national medical commission bill 2017 has stirred a hornet’s nest, bringing out to the fore several controversies, none more jarring than the role of powerful lobbies in India’s medical ecosystem. With a vast impoverished population, any solution is easier offered than executed.
First consider some gory statistics, which shows us where we stand.
A 2016 World Health Organisation (WHO) study throws good light on the dire situation of India’s health super structure. There are some 10.4 lakh private medical establishments in India, of which hospitals account for a mere 8 per cent. Most of such doctors are lone practitioners running small nursing homes and clinics.
Critically, most do not possess a medical qualification. In urban areas, while 58 per cent of doctors have a medical degree, in rural areas, where health services are most needed, only 19 per cent are qualified to be medical practitioners.
Of the allopathic doctors – which constitute the main medical stream in India apart from ayurveda, unani and homoeopathy that is the alternative stream – only 31.4 per cent are educated till the secondary school level and 57.3 per cent lack any formal medical qualification.
The government’s own comprehensive National Sample Survey Office (NSSO) report brought out telling details. According to it, barring the metros and large cities, there are more unqualified practitioners rather than regular doctors.
Like most professions in India, heavy unionisation rides rough shed over any notion of quality control. The interest of all allopathic doctors are represented by the Indian Medical Association (IMA), whose all India membership of 2 lakh gives them clout enough to keep the forces of law and order at bay.
Many IMA members are single practitioners, running their little sweatshops called clinics with the help of young school dropouts engaged as helpers. These helpers are ‘trained’ to handle acute illnesses, treating serious medical conditions with the help of antibiotics, IV fluids, and even steroid injections. Once ‘sufficiently’ skilled, they set up their own little clinics, attaching to themselves the prefix of ‘Dr’ – a prefix that the world knows them by in the most respectful terms possible.
In other words and to put it bluntly, quacks outnumber qualified medical doctors in India by a long shot. Both the government and the IMA are well aware of the malaise. Publicly, they may rant against quackery, but in private they look the other way. In fact the IMA’s overall grouse is aimed at practitioners of the alternative medicine stream, the ayurveds, unanis and homoeopaths, for taking away their ‘customers’.
The new bill and for that matter the National Health Policy of 2016 overlook this countrywide phenomenon altogether. Under strict interpretation of law, the Medical Council of India and state medical councils are enjoined to take action against those who practice allopathic medicines without being enrolled on the medical register. Keeping customer safety in view, this should be considered a serious omission in the bill.
In addition to these two lobbies, there is a third influential grouping, the National Integrated Medical Association (NIMA), which forcefully advocates ‘integrated medicine’.
In other words, this lobby backs ayurveda practitioners to practice modern medicine and even allopathy. Interestingly, no less than prime minister Narendra Modi made this point at two important meetings recently, saying that ayurveda practitioners are turning to modern medicine instead of traditional medicine, which defeats the very purpose of his government’s upgradation of the department of Ayush to ministry of Ayush in 2014.
That the importance of traditional medicines was felt by the government is evident when the department of Ayush (abbreviated for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopath) was set up in 2013 and continued by the Congress-led UPA government. The point is this: in modern advanced countries of the world, where medicine itself is so niche and highly specialised (not to mention exceedingly expensive as well), where is the scope for such a casual inter-disciplinary approach? Strangely – but not surprisingly – the national medical commission bill has completely overlooked these seedy aspects of the health scenario.
The new bill must take stock of the ground realities. India needs, on a large scale, thousands of community-level accredited practitioners, not full-fledged doctors. Such volunteers need to be trained to provide the first line of care to acute illnesses and be in a position to refer them to a regular doctor. Obviously, such a system can only become possible if the medical education law allows for it. The long suffering public is naturally agitated about the state of public and private medical educational institutions, admissions to many of which are conducted through donations and chandas.
The government has done well to bring forward new legislation to replace the old medical council. But unless the new bill confronts some old realities, it is going to make little difference to the common patients, for whose aid, presumably the new bill has been introduced.