Friday, January 27, 2023

A Healthcare Revolution

The landmark law will recognise the skills of over 56 types of frontline health workers, increase their employment opportunities and enhance their true worth within India and globally.

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By Devender Singh Aswal

The National Commission for Allied and Healthcare Professions Bill, 2020 (NCAH Act) was passed by Parliament recently after a long and anxious wait, particularly by health professionals. The Act provides for regulation and maintenance of standards of education and services by allied and healthcare professionals, assessment of institutions, maintenance of a central and state register and creation of a system to improve access, R&D and adoption of latest scientific advancements.

The Act defines an allied health professional as an associate, technician, or technologist trained to support the diagnosis and treatment of any illness, disease, injury or impairment. Dr Harsh Vardhan, minister for health and family welfare, explained the reasons and objects of the Bill: “I would say that most of you must have paid a visit to a hospital at some point of time in your life…. Please recall those days and remember the people who took care of you and brought you out of your illness. You may remember the name of the doctor. You may remember the name of the hospital. But do you also remember the name of the persons who took your blood samples, gave you physiotherapy, took your X-ray, advised you on what you should eat, checked your eyesight, assisted your doctor or surgeon, looked into microscopes and bid you a farewell with a smile. Who are these people?”  They are varied health professionals–lab technicians, physiotherapists, radiographers, dieticians, record keepers, optometrists, X-ray technicians and many more–who are a critical part of the healthcare system and the foundation of its entire pyramid.

According to studies, the role of doctors, undoubtedly critical, varies between 25-50% in the entire health care chain. A wag said: “A doctor is next to God, the nurse is next to the doctor and the pharmacist is closest to the patient.” But there are others who are also an integral part of the healthcare chain.

In fact, healthcare professionals are the bedrock of this growing complex system.  After enacting the National Medical Commission Bill, 2019, which was fiercely contested by a large body of medical practitioners, another transformative piece of legislation, NCAHP Act, has been enacted. It covers a wide range of healthcare professions which were unrecognised or unregulated. The Act is a paradigm shift in healthcare delivery as it recognises the specialised skills and contributions of more than 56 types of allied and healthcare professionals.

The nation, nay the world, has witnessed the invaluable contribution of these professionals during Covid-19. These frontline health workers risked their lives every day fighting the pandemic. The need for development and maintenance of standards of services and education of these professionals through a national regulatory body has been long overdue. As early as 1948, the Bhore Committee had stressed the importance of “human resources for health with right skills and training”, followed by a host of committees over the years.

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The first attempt at such a legislation was made as early as 1953, but the proposal never received the priority it deserved, perhaps for lack of unanimity and the dominance of the doctor-centric healthcare system.  Vardhan told the Rajya Sabha that Bills were introduced in this regard under different names in 2007 and 2011. But these lapsed, and between 2015 and 2021, the legislative proposal was redrafted as many as 75 times.

The NCAHP Bill, 2011, was introduced in the Rajya Sabha in December 2011. However, there was opposition to it from existing regulatory bodies. The Standing Committee on Health made wholesale recommendations to the Bill. A new Bill was introduced in the Rajya Sabha on December 31, 2018. It was referred to the Standing Committee on Health and Family Welfare on January 4, 2019.

Based on the recommendations made by the Committee in its 117th Report in January 2020, a fresh Bill titled the NCAHP Bill, 2020, was introduced in the Rajya Sabha on September 15, 2020, by withdrawing the pending Bill of 2018. The Committee made 110 recommendations and the government accepted 102. Vardhan assured Parliament that some recommendations and observations by members who participated in the debate would be suitably incorporated in the rules to be framed under the Act.

The Act would regulate and leverage qualified allied and healthcare workforce and ensure high quality multidisciplinary care “in line with the vision of Universal Health coverage moving towards a more care accessible and team based model”. The Act would reform and regulate this entire sector in order to give these professionals their due, increase their employment opportunities, and more importantly, enhance their dignity by recognising their true worth within the country and globally.

According to a WHO report, there would be a demand of 1.80 crore such professionals by 2030 and qualified Indian professionals would cater to the global shortage. Further, their potential can be utilised to reduce the cost of care and to make quality healthcare services accessible to all.

The Act envisages establishment of a central statutory body such as the National Commission for Allied and Healthcare Professions. The Commission will frame policies and standards, regulate professional conduct and prescribe qualifications for all these professions. It will be supported by ten broad professional councils, each comprising one or more professions. The institutional structure would enable assessment and rating of all the allied and healthcare institutions to ensure uniform standards and quality assurance.

The Act provides for registration of all the allied and healthcare professionals. All the professions have been coded as per the International Labour Organisation’s standards for classification of occupations. This allows them global recognition and mobility.

A National Allied and Healthcare Advisory Council to advise the National Commission with representation from all states is provided under the Act. Further, each state will have a separate state council with four autonomous Boards pertaining to undergraduate and post-graduation education, assessment, rating, ethics and registration. At a time when there is an acute need for critical reforms in public health, the Act will provide a robust institutional mechanism  to improve access to health by focusing on preventive, promotive, curative and rehabilitative needs of the population.

While doctors, nurses dentists and pharmacists in India are regulated through their respective regulatory bodies, allied and healthcare professions are still unstructured and unregulated. The potential of these professionals can be harnessed to reduce the cost of care and to make quality healthcare services accessible to all. A healthcare professional includes a scientist, therapist or any other professional who studies, advises, researches, supervises, or provides preventive, curative, rehabilitative, therapeutic, or promotional health services. Such a professional should have obtained a degree under this Act. These are mentioned in the Schedule to the Act and they include life science professionals, trauma and burn care professionals, surgical and anaesthesia-related technology professionals, physiotherapists, nutrition science professionals, etc. Anyone who contravenes the provisions of the Act shall be punished.

Globally, most countries have a regulatory framework for standardised education and  training. But in India, there was an absence of a regulatory framework and lack of standardised education curriculum as well as training for these allied and healthcare professionals, a void that has now been removed. Also, the Act makes a significant shift from the doctor-led model to a more care-accessible and team-based model. This is very much in line with the vision of Universal Health Coverage as laid down by the National Health Policy rolled out in 2017 and also by the Ayushman Bharat.

The NCAHP Act, 2020 is a landmark legislation which will go down in the history of healthcare revolution in India. It will transform the healthcare scenario and make a paradigm shift in the ministration of the entire healthcare system and make it efficacious. Apparently, India is on the course of wholesale health sector reforms. Apart from the two transformative laws enacted, and referred to above, the Medical Termination of Pregnancy (Amendment) Act, 2021 has been passed during this budget session.  But the arch of reform would come to a full circle with the enactment of the National Nursing and Midwifery Commission Bill, the National Dental Commission Bill, the Surrogacy Bill, and the Assisted Reproductive Technology (Regulation) Bill.

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Hopefully, the government would complete these reforms, mindful of the fact that healthcare costs hit the voters hard and, if ignored, will hit them harder. Healthcare is no more a benevolence, but an integral part of the right to life.

The writer is ex-Additional Secretary, Lok Sabha and a public policy expert. Views expressed are personal.

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