Health policy in India has never quite looked at our healthcare personnel as a complete unit which includes various groups, such as allopathic doctors, doctors of Indian systems of medicine, dentists, nurses, physiotherapists, etc. Management of these personnel has been largely left to individual councils (medical council, nursing council, dental council) etc. In fact, for some categories of healthcare personnel like physiotherapists there isn’t even a recognised council, although they have been demanding one.
The Indian Medical Council (now abolished), the Indian Dental Council, the Central Council of Indian Medicine, the Indian Nursing Council and the Pharmacy Council of India are statutory bodies, constituted under specific Acts of Parliament. There are no such statutory bodies for paramedical personnel, physiotherapists, medical social workers, physician assistants and nutritionists, though there are some registered organisations trying to do the work of such councils.
Even where the statutory councils are concerned, they are largely focussed on the number of colleges and the number of seats, the curriculum of the respective courses and the elections to these councils. Though all the statutory councils maintain a database of personnel, it is neither a live register nor an updated one, barring perhaps the nursing council, which has initiated the creation of a National Unique Identity Number (NUID) for Indian nurses and the creation of a live register.
Do our policymakers know how many practising allopathic doctors are there in the country? Well, they would say, 9.22 lakh as per the Indian Medical Register. However, how many of those listed in that register are actually alive today, how many have retired from active practice, how many have gone abroad, and how many are qualified to practise but do not find their names in the register simply because the state medical councils have not yet forwarded their names to be included in it? These are questions to which no answers are forthcoming.
There is also no uniform system of re-registration of the healthcare workforce, which is a sad reality given the dynamic and ever evolving nature of the medical field. Further, any patient would like to know the credentials of the healthcare worker that he or she trusts his or her life with. Medicine, by definition, has the problem of asymmetry of information between patient and doctor. Worse, quacks abound, but patients do not often know enough to distinguish between a genuine doctor and a quack.
As a medical administrator in the private sector, I deal with the problem of registration of doctors when they move from one state to another. They have to register themselves every time they move to a new state to practise. For this, they have to take a no objection certificate from the medical council of the state they are moving out of and register themselves in the medical council of the state they are moving into. Instead of this bureaucratic jamboree, a single national registration number will go a long way in avoiding duplication and confusion. It is, after all, one country, and we have a uniform curriculum across.
A centralised live database will help address the multitude of problems listed above. This database can be made online and have a section open to general public where they can see the registration details and qualifications of their healthcare workers. A live updated database will also help provide accurate, real-time data of the number, geographical distribution and specialisation of our healthcare personnel to help with prudent policy planning.
This live database may be created and maintained by a single body, the activities of which may be coordinated and supervised by an overarching medical body since it has to work with the various councils in various states, health being a state subject. The centralised body for registration would bring in a single registration number and when the states register the healthcare personnel, it will automatically be uploaded onto this national database. Since the curricula of all the medical courses are centrally decided, the states should not have much concern in agreeing to this.
This databank is proposed to be one single national database of all healthcare workers of all systems of medicine. These would include allopathic doctors, doctors practising Indian medicine, dentists, nurses, pharmacists, technicians, physician assistants, physiotherapists, dieticians, etc. A mechanism for deleting names from the centralised database (for instance, in case of death of the healthcare worker) needs to be worked out as no uniform mechanism currently exists.
This proposed body is by no means intended to encroach into the autonomy of individual councils or for that matter over the autonomy of states in the subject of health. On the contrary, it is designed to support various councils and work in partnership with them. The recent example of streamlining indirect taxation by introducing GST goes to prove that such a collective exercise with the states is possible and prudent.
(The writer is Group Medical Head, Parkway Pantai India Operations)