Health reforms continue unabated
By Devender Singh Aswal
The National Commission for Allied and Healthcare Professions Bill, 2020 (NCAH Act) has been passed by Parliament during the just concluded budget session after a long and anxious wait, particularly by the 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 Register and State Register and creation of a system to improve access, research and development and adoption of latest scientific advancement and for matters connected. The Act defines ‘allied health professional’ as an associate, technician, or technologist trained to support the diagnosis and treatment of any illness, disease, injury, or impairment. Dr Harshvardhan, Minister for Health & Family Welfare, explained the reasons and objects of the Bill, thus – ‘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 who 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 eye sight, assisted your doctor or surgeon, looked into microscopes, and bid you farewell with a smile. Who are these people?’ They are varied health professionals – the 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 the pyramid of the entire healthcare system.”
According to studies, the role of doctors, undoubtedly critical, varies between 25 to 50 percent in the entire health care chain. A wag said, ‘Doctor is next to God, Nurse is next to the doctor and pharmacist is closest to the patient’, but there are others who are as vital and an integral part of the health care chain. In fact, health care professionals are the bedrock of the growingly complex health care 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 which covers a wide range of healthcare professions which were unrecognised or unregulated till date. The Act is a paradigm shift in healthcare delivery as it recognises the specialised skills and contributions of more than 56 types of the allied and healthcare professionals.
The nation, nay the world, has witnessed the invaluable contribution of these professionals during COVID-19 as the frontline health workers who 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. The first attempt at such a legislation was made as early as 1953 but the proposal never received the priority that it deserved, perhaps for lack of unanimity and the dominance of a doctor centric healthcare system. The Minister told the Rajya Sabha on 16 March, while responding to the debate on the NCAHP Bill, that Bills were introduced in this behalf under different names in 2007 and 2011 which lapsed, and between 2015 and 2021, and as many as 75 times the legislative proposal was redrafted. The NCAHP Bill, 2011, was introduced in the Rajya Sabha in December, 2011. However, there was opposition to this Bill from the existing regulatory bodies. The Standing Committee on Health made wholesale recommendations on the Bill. A new Bill was introduced in the Rajya Sabha on 31 December, 2018. It was referred to the Standing Committee on Health and Family Welfare on 4 January, 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 15 September, 2020 by withdrawing the pending Bill of 2018. The Committee made 110 recommendations and the Government accepted 102. The Minister assured Parliament that some recommendations and the observations of many of the 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 the 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, 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 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 as 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 international standards for classification of occupations which also allows them global recognition and mobility.
A National Allied and Healthcare Advisory Council to advise the National Commission with representation from all the States is provided under the Act to enable adequate representation from all States and Union Territories. Further, each State will have a separate State Council with four autonomous Boards pertaining to under-graduate education, post-graduation education, assessment and rating and 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 need of the population. While doctors, nurses dentists and pharmacists in India are regulated through their respective regulatory bodies, the allied and healthcare professions are still unstructured, unregulated. The potential of these professionals can be harnessed to reduce the cost of care and to make quality of 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, and nutrition science professionals, etc. Anyone who contravenes the provisions of the Act shall be punished.
Globally, most of the 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 now removed. Also, the Act makes a significant shift from the doctor-led model to a more care-accessible and team-based model which is very much in line with the vision of the Universal Health Coverage as laid down by the National Health Policy rolled out in 2017 and also by Ayushman Bharat.
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 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. Hopefully, the Government would complete the remaining health sector reforms, mindful of the fact that health care costs hit the voters hard and, if ignored, it will hit the vote seekers harder. Health care is no more a benevolence but an integral part of the right to life, and for electoral politics a game changer.
(The Author is ex-Additional Secretary, Lok Sabha, and a public policy expert. Views expressed are personal.)