The National Commission for Indian System of Medicine Bill, 2019 was formulated to integrate the medical and research institutions dealing with the Indian System of Medicine (ISM), under a national commission.The necessity of this Bill was in question because of the existence of the Central Council of Indian Medicine under the Indian Medicine Central Council (IMCC) Act, 1970, both of which the Bill seeks to replace.
The current Council aimed at improving standards of ISM (consisting of AYUSH) and ensuring better healthcare, however, the Act of 1970 failed to keep up with time. Hence, lack of regulatory measures, absence of ethics and failure to provide transparent measures resulted in degradation of medical education which in turn affected the quality of healthcare services. In 2016, the Central Government constituted a Committee chaired by Vice-Chairman, NITI Aayog to review the Indian Medicine Central Council Act and the said Committee recommended for enactment of the National Commission for Indian System of Medicine Bill, 2018 on the same lines as that of the National Medical Commission Bill, 2018. The motive of the NCISM Bill, 2019 thus is to overcome the faults of the IMCC Act, 1970.
To increase integrity and accountability, the members of the National Commission will be ineligible for a second term, will not be allowed to accept a position at any institution of the ISM for 2 years from their retirement or removal from the Commission – provisions that were absent in the Act of 1970 which allowed for bribery and corruption, ineffective role of the Executive Committee and lack of fair inspections and recommendations by the Council. Until now, there was no separate eligibility criteria for teaching in institutions of ISM. Professionals who held the required medical qualification from their respective alma mater were eligible to teach and practice. The NCISM Bill, 2019 proposes to conduct national level eligibility tests for teachers of the ISM, examinations for entrance at undergraduate and postgraduate level, and exit tests for granting licences. The nature of the examination has not been specified in the Bill itself. A centralised examination system will ensure competency and quality and the subjectivity that arises from institutional qualification shall be negated.
Quality in Medical Education
The four autonomous boards will provide for a greater scope for focus which was lacking in the structure of the Central Council of Indian Medicine (CCIM). Earlier, the executive body of the CCIM was alone responsible for evaluation of institutions, supervising examinations and granting permissions for colleges/increasing admission capacity. According to the new system, the Board of Ethics and Registration for ISM will be responsible for maintaining the proposed national register and ensure compliance to the ethics of the ISM while the Medical Assessment and Rating Board for ISM will be in charge of administering permissions for new institutions, setting minimum standards of quality of education and assessing institutions accordingly. The Bill introduced provisions for imposition of monetary penalty, reducing intake or stoppage of admissions and recommending to the Commission for withdrawal of recognition in case of non-compliance to standards enforced by the Boards by institutions of ISM. This provision will greatly contribute to improving the quality of services provided that it is implemented with integrity on the lines of the NAAC Accreditation System.
Delivery of Health Care Services
One of the objectives of the NCISM Bill, 2019 is to provide for universal healthcare and promote national health goals viz., reducing malnourishment, equity in facilities, affordability and plurality in available choices. In order to do so, the glaring urban bias has to reduce and the focus must be on improving medical facilities in rural areas. Even today, the rural population continues to resort to unlicensed, unregulated medicinal practices in absence of better alternatives. Research displaying the spatial mapping of health centres shows how the majority of villages are located several kilometers away from a Public Health Centre. Government data show that country-wide there are over 20% vacancies of doctors in the PHCs which do not take into account high levels of absenteeism among doctors and support staff. As of today, corruption, lack of will and complacency of authorities have prevented the revamping of the system to suit the rapidly changing times. The Ministry of AYUSH expects that once the NCISM is established, it will evaluate the requirement of human and material resources for adequate healthcare and frame policies to achieve the goals. Moreover, in order to ensure the quality of services, only practitioners licensed and registered in the national register of ISM will be allowed to deliver their services. It also expects involvement of State governments through PPPs for making medical education more affordable.
Potential for Change
Currently, several ISM practitioners are licensed to practice allopathy through various statutory rights at the State level. As pointed out by National Integrated Medical Association (NIMA, there is no provision regarding the practice of the modern system of medicine by ISM. This ambiguity may result in chaos and weaken the structure of medical facilities currently in place on a wide scale as several subscribers of ISM serve as family physicians, emergency paramedics etc., and help in making medicinal services available locally, especially in rural areas. The ambiguity is critical when viewed in light of ISM doctors legally administering life-saving drugs, assisting in childbirth and providing their services in the ‘golden hour’ in case of emergency where allopathy doctors and surgeons are seldom readily available. It is essential that the National Commission forms subsequent policies after taking cognizance of the role of the existing network of ISM practitioners in the modern medical industry. Adding a clause in the Bill that retains the license of doctors of ISM to practice allopathy after appropriate training will clear the ambiguity and will allow for a smoother transition to the new system.
The provisions of the NCISM Bill, 2019 have an excessive central bias, in contrast to the democratic structure of the current CCIM. Health is a subject of the State list and yet, the constitution of the proposed NCISM hugely underrated the role and representation of the States and Union Territories. Powers granted to the Central Government under the Bill are susceptible to misuse and may compromise the independence of the Commission and the Autonomous Boards, reducing their function to a mere advisory role. The Bill doesn’t provide for the representation of any existing research faculties of ISM although encouraging research is one of its fundamental goals.
- State health ministries, councils, universities should have a greater representation in the National Commission. The current structure of the Centre Council of Indian Medicine can be taken as an example for the same.
- Care must be taken that medical education doesn’t become exam-centred after the commencement of national level tests. For this, the Boards of Ethics and Registration for ISM and the Medical Assessment and Rating Board can consider both continuous evaluation and the final nation-wide qualifying tests for granting teaching/practising licences.
- Instead of seeing the Indian System of Medicine and Allopathy as mutually exclusive, subsequent policies must try to actively integrate the two. District health programmes can promote holistic wellness by popularising preventive and curative measures of the ISM. Allopathic drugs and surgeries already follow a diagnostic structure and can be continued alongside the ISM.
Numerous studies have already pointed out the lack of infrastructure, absenteeism of doctors and the impact of the mismanagement on the public health sector. Simply stating the need is of no consequence. Although a Bill is not meant to ensure executive success, policies enforced by the National Commission should mandatorily maintain an up to date citizens’ charter that will contain a concrete plan of action, clear attainable objectives and short term, measurable goals that make up the larger national health goals. Enforcing a performance-based salary evaluated by bio-metric attendance and transparent records, actively cracking down on the prevalent corruption and slacking, providing good infrastructure and enough incentives might ensure that services are readily accessed by the people and delivered dutifully by the medics.
By Vineha Tatkar, Research Associate, Policy