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A “bridge course” provision in the National Medical Commission Bill 2017, which was introduced recently in the Lok Sabha, has invited widespread debate. According to the provision, doctors of Indian systems of medicine and homoeopathy (AYUSH) will be allowed to prescribe limited allopathic medicines upon passing the course.
The president of the Indian Medical Association (IMA) has gone to the extent of saying that introducing the course will be equivalent to sanctioning quackery as it will create “an army of half-baked doctors”. Objections like these have previously derailed innovative yet pragmatic measures like the three-year diploma for rural healthcare providers introduced by Chhattisgarh in response to the shortage of doctors in the state.
Complete consensus
Before examining the validity of the IMA’s concern, it is important to appreciate that the bridge course will only be introduced if all the members present at a joint sitting of the NMC, the Central Council of Homoeopathy (CCH), and the Central Council of Indian Medicine (CCIM) vote in its favour.
In this scenario, if even one of the voting members expresses a reservation, the course will never be approved. Additionally, the Bill specifies that the members present in the joint sitting can spell out the health conditions for which AYUSH practitioners will be allowed to prescribe certain allopathic medicines.
Assuming that the course is introduced, equating AYUSH practitioners with ‘quacks’ reeks of an intellectual arrogance that is completely unfounded. Students of homoeopathy, for instance, are trained in almost every subject that an MBBS student is taught during their five-and-a-half-year undergraduate course. It is often the case that textbooks, faculty and even the lecture halls where students of MBBS and Bachelor of Homoeopathic Medicine and Surgery (BHMS) are taught, are the same. Like their MBBS counterparts, BHMS students also undertake an internship, including a six-month stint at a hospital.
Forget AYUSH doctors who go through several years of formal training, a rigorous study conducted by Jishnu Das of the World Bank showed that when patients were trained to present a standardised set of symptoms to providers from the public and informal sectors, those in the latter category performed better in terms of time spent with patients, as well as adherence to medical history checklists. They were also just as likely as public sector doctors to manage a case correctly. In fact, these informal providers with little or no training whatsoever are the first point of contact for people with health problems in many parts of the country. In this context, slamming the bridge course on the pretext that it will deteriorate the “quality” of healthcare delivery does not seem to be grounded in today’s reality.
We face a severe shortage of skilled healthcare professionals. We currently have 1 allopathy doctor for approximately 1,613 people as against the World Health Organization norm of 1 doctor per 1,000 population. This assumes that 80 per cent of the 10.23 lakh doctors registered with the Medical Council of India or State medical councils as of March 31, 2017, are in active service. It is worth pointing out that the Indian Medical Register does not reflect doctors who have retired, left the country or passed away; therefore, the total universe of doctors in the country might actually be smaller than the official figures.
The shortage is compounded by the concentration of medical colleges in States like Andhra Pradesh, Karnataka, Tamil Nadu, Kerala, Gujarat and Maharashtra, as well as the reluctance of doctors to serve in rural areas despite measures such as compulsory rural internships. In fact, it is estimated that urban areas have four times as many doctors as rural India.
Stepping up
In this scenario, the nearly 8 lakh AYUSH practitioners in the country have been providing primary healthcare in several areas. In accordance with sub-clause (iii) of Rule 2 (ee) of the Drugs and Cosmetics Act Rules, some State governments have issued orders allowing AYUSH doctors to prescribe allopathic medication. The validity of such orders has been upheld by the Supreme Court. While enhancing the supply of allopathic doctors is undoubtedly the main goal, achieving the ideal doctor-population ratio could take decades. Till such time we simply cannot deny large parts of our population access to even the most basic and potentially lifesaving healthcare.
The NMC Bill, 2017 attempts to facilitate integration of the different systems of medicine in a much broader sense. Clause 49 of the Bill calls for a joint sitting of the NMC, CCH and CCIM, at least once a year and proposes “specific educational modules or programmes to develop bridges across the various systems of medicine”.
Integrative medicine
Medical pluralism is a reality in several countries. In China, there is a traditional medicine department in every college teaching allopathic medicine and vice versa. In India, there are well documented examples of doctors of one system of medicine prescribing medication from other systems. For example, a study conducted in KEM Hospital in Mumbai highlighted that while 99 per cent of resident doctors were not even aware of the fundamentals of ayurveda, they were prescribing medicines like Liv 52 for liver ailments. It is high time then that mechanisms are put in place for enabling this integration in medical institutions across the country.
The bridge course is not a silver bullet for India’s primary health woes or allopathic doctor shortages. However, it is an important part of a broader effort to empower and better utilise the capabilities of AYUSH practitioners for healthcare delivery. While it will be up to the collective wisdom of professionals to decide whether or not to introduce the course as well as to determine its syllabus and testing mechanism, we should not dismiss the underlying philosophy of ending the siloed approach to medical education on the basis of false propaganda.
The writer is with the office of the vice-chairman, NITI Aayog. The views are personal
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