The Ministry of Health and Family Welfare has released FAQs on the National Medical Commission (NMC) Bill 2019, perhaps in a bid to allay the prevailing apprehensions regarding certain aspects of the Bill such as Clause 32, NEXT.

“Clause 32: Limited License to practice at Mid-level as Community Health Provider:

India has a doctor-population ratio of 1:1456 as compared with the WHO standards of 1:1000. In addition, there is a huge skew in the distribution of doctors working in the Urban and Rural areas with the urban to rural doctor density ratio being 3.8:1. Consequently, most of our rural and poor population is denied good quality care leaving them in the clutches of quacks. It is worth noting that at present 57.3% of personnel currently practicing allopathic medicine does not have a medical qualification.       

The ambitious Ayushman Bharat initiative announced by GoI in this year’s Budget Speech needs 1,50,000 mid-level providers within the next 3-5 years to provide comprehensive primary and preventive care. It will take 7-8 years to ramp up the supply of doctors, therefore, in the interim we have no option but to rely upon a cadre of specially trained mid-level providers who can lead the Health and Wellness Centres.

There are international examples of Health Systems permitting such Community Health workers. Countries such as Thailand, United Kingdom, China, and even New York have permitted Community Health Workers/Nurse Practitioners into mainstream health services, with improved health outcomes.

Since we have shortage of doctors and specialists, the task shifting to Mid- level Provider will relieve the overburdened specialists. This is merely an enabling provision to grant limited licence only in primary and preventive healthcare to practice medicine at mid-level to such persons, who qualify such criteria as may be specified by regulations which will have an overwhelming representation of Doctors. Chhattisgarh and Assam have experimented with the Community Health Workers. As per independent evaluations (carried out by Harvard School of Public Health), they have performed very well and there is no ground of concern if the quality of personnel is regulated tightly.”

(Source: PIB, Ministry of Health & Family Welfare, Aug. 6, 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA