Context

• The Union Cabinet has approved the Allied and Healthcare Professions Bill, 2018 that aims to regulate and standardize the education and services by allied and healthcare professionals.
• The Bill provides for setting up of an Allied and Healthcare Council of India and corresponding State Allied and Healthcare Councils which will play the role of a standard-setter and facilitator for professions of Allied and Healthcare such as physiotherapists, nutritionists and workers in laboratories etc.

Background

• In the current state of healthcare system, many allied and healthcare professionals remain unidentified, unregulated and under-utilised.
• India’s health system is highly focused on efforts towards strengthening limited categories of professionals such as doctors, nurses and frontline workers (like Accredited Social Health Activist or ASHAs, Auxiliary Nurse Midwife or ANMs).
• However, numerous others have been identified over the years, whose potential can be utilised to improve and increase the access to quality driven services in the rural and hard to reach areas.

About

• The Bill provides for structure, constitution, composition and functions of the Central Council and State Councils, e.g. framing policies and standards, regulation of professional conduct, creation and maintenance of live registers, provisions for common entry and exit examinations, etc.
• The Central Council will comprise 47 members, of which 14 members shall be ex-officio representing diverse and related roles and functions and remaining 33 shall be non-ex-officio members who mainly represent the 15 professional categories.
• The State Councils are also envisioned to mirror the Central Council, comprising 7 ex-officio and 21 non-ex officio members and Chairperson to be elected from amongst the non-ex officio members.
• Professional Advisory Bodies under Central and State Councils will examine issues independently and provide recommendations relating to specific recognised categories.
• The Bill will also have an overriding effect on any other existing law for any of the covered professions.
• The State Council will undertake recognition of allied and healthcare institutions.
• Offences and Penalties clause have been included in the Bill to check mal­practices.
• The Bill also empowers the Central and State Governments to make rules.
• Central Govt. also has the power to issue directions to the Council, to make regulations and to add or amend the schedule.
• An Interim Council will be constituted within six months of passing of the Act, holding charge for a period of two years until the establishment of the Central Council.
• The Council at the Centre and the States are to be established as body corporate with a provision to receive funds from various sources.
• Councils will also be supported by Central and State Governments respectively through Grant-in-aid as needed. However, if the State Government expresses inability, the Central Government may release some grant for initial years to the State Council.
  
  

  Allied and Healthcare Professionals According to the World Health Organization (WHO), Allied health personnel are personnel who have specific connections with the art and science of health care and are recognised as members of the health team in the national health system. They are educated with different levels of professional qualifications, in a recognised or accredited health or health-related or academic Institution. The allied and healthcare professionals include individuals involved with the delivery of health or related services, with expertise in therapeutic, diagnostic, curative, preventive and rehabilitative interventions. They work in interdisciplinary health teams including physicians, nurses and public health officials to promote, protect, treat or manage a person’s physical, mental, social, emotional and environmental health and holistic well-being.

Analysis

Need for such legislation

• Allied and Healthcare Professionals (A&HPs) constitute an important element of the health human resource network, and the skilled and efficient Allied and Healthcare Professionals (A&HPs) can reduce the cost of care and dramatically improve the accessibility to quality driven healthcare services.
• Globally, Allied and Healthcare Professionals typically attend undergraduate degree programme of a minimum of three to four years to begin with and may attain up to PhD level qualification in their respective streams. However, most of Indian institutions offering such courses lack standardisation.
• Majority of the countries worldwide, have a statutory licensing or regulatory body that is authorised to license and certify the qualifications and competence of such professionals, particularly those involved in direct patient care (such as physiotherapist, nutritionist etc.) or those whose occupation impact patient care directly (such as lab technologists, dosimetrists etc.).
• Though such professionals have existed in the Indian healthcare system for many decades, a considerable gap in the allied and healthcare space is because of a lack of a comprehensive regulatory framework and absence of standards for education and training of A&HPs.
• The Bill thus seeks to establish a robust regulatory framework which will play the role of a standard-setter and regulator for Allied and Healthcare professions.

Significance

• The allied health professionals in India are not covered by medical or nursing councils. Lab technicians, X-ray technicians, ICU technicians or people who are not covered by any other council and are currently unregulated, the bill aims to bring all the existing allied and healthcare professionals on board during the first few of years from the date of establishment of the Council.
• The Allied and Healthcare Professions Bill will provide an opportunity to create qualified, highly skilled and competent jobs in healthcare by enabling professionalism of the allied and healthcare workforce.
• High quality, multi-disciplinary care in line with the vision of Ayushman Bharat, moving away from a 'doctor led' model to a 'care accessible and team based’ model.
• There’s an opportunity to cater to the global demand (shortage) of healthcare workforce which is projected to be about 15 million by the year 2030, as per the WHO Global Workforce, 2030 report.
• It is estimated that the Allied and Healthcare Professions Bill, 2018 will directly benefit around 8-9 Lakh existing Allied and Healthcare related professionals in the country and several other graduating professionals joining workforce annually and contributing to the health system.
• However, since this Bill is directed to strengthen the healthcare delivery system at large, it may be said that the entire population of the country and the health sector as a whole will be benefited by this Bill.

Challenges

• The biggest challenge lies in effective implementation of the bill. The act should not be good only on paper and well drafted piece of regulation but be one that is effectively implemented.
• Institution teaching the allied healthcare professionals will need to be accredited. However, given the history of healthcare regulation in India, there could be scope for manipulation. Also, what if the training provided to the allied professionals does not match the standards.
• While the act lay down strict regulations, what happens when the supply of professionals is less than the demand? How will stipulation on higher qualifications help if supply of talent is not matched? These questions need to be addressed.
• Many hospitals today do not publicly declare their rates and are not transparent about their pricing.
• The reason some experts are sceptical is because there is so much money involved that there is always the danger of abuse. That also needs to be minimised.
• The healthcare regulation in India certainly has room for improvement and therefore what is being done to ensure that the new councils will not go down the same path? Also, what will be done to ensure that this will not be used by the big and powerful healthcare providers for eliminating smaller players under the garb of enforcing quality?
• High quality delivery in tier II and tier III cities and towns needs to be ensure, where even doctors are in short supply, let alone high quality allied healthcare professionals. How all these questions will get addressed is yet to be seen.

Way Forward

• State government and medical community must all be on board and young people joining training courses to be such professionals must see the need for standards - laying down the curriculum, syllabus and laying down the period of training.
• Regulation works best when the regulators as well as those to be regulated understand the need to be disciplined.

Learning Aid

Practice Question:

“In the current state of healthcare system, there exist many allied and healthcare professionals, who remain unidentified, unregulated and under-utilised.” In the light of the given statement, critically analyse the Allied and Healthcare Professions Bill, 2018.