Healthcare needs better collaboration
Allied health professionals can play a critical role in ensuring better quality healthcare services to the people, especially in far-flung areas
In a developing country like India, where poor people, particularly those in the rural and remote areas, are still left unattended in terms of quality healthcare, allied health professionals (AHPs) can play an important role in bridging the gap in healthcare delivery value chain.
The AHPs are concerned with the identification, diagnostic evaluation, and treatment of acute and chronic diseases and disorders; provision of dietary and nutrition services; rehabilitation services; and management and operation of health systems. Additionally, the AHPs often work in a multidisciplinary team with other healthcare professionals, such as doctors and nurses to ensure best quality care for patients. While the much-awaited regulator to ensure standard is yet to see the light of the day, the need of AHPs, like medical lab technicians, optometrists and radiologists, has resulted in the mushrooming of institutes/colleges without affiliation or recognition across the country at the cost of educational standards as well as public health.
A report by the Public Health Foundation of India (PHFI) in 2012, raised the alarm bells. The lack of planned courses and institutions, non-uniform nomenclature for the existing courses, diverse standards of practice and qualified faculty pose a threat to the quality of skills of the AHPs. Due to lack of central regulatory authority in this sector, there is no structured/standard allowance system being followed throughout the country, said the report prepared by Kavita Narayan from PHFI, which has put the shortage of AHPs to be around 64 lakh.
GS Grewal, a Ludhiyana-based gastroenterologist and former president of the Punjab Medical Council, rued that allied health services are the most neglected part of health services in the country as far as standards of healthcare and regulations are concerned. Also, as on date, nursing standards are not in any way comparable to any developed country. So are the standards of X-ray, OT, lab technicians etc. Rather, they are breeding place of quacks, he added.
Now, all hopes are pinned on the proposed Allied and Healthcare Professional's Central Council Bill, 2015, to bring professions under the legal ambit. Inter-ministerial consultations are currently going on to regulate the AHPs to potentially create an institutional structure that can meet the ever growing demand. The draft Bill proposes to regulate over 50 types of allied and healthcare professionals, separate State councils to implement the standards, curricula of such courses as well as imposing penalties for non-compliance of statutory provisions.
The proposed draft Bill is likely to be placed before the Committee on Establishment Expenditure (CCE) of the Finance Ministry within the fortnight and will be tabled in Parliament thereafter. Once it clears all legal hurdles, all AHPs will come under the umbrella of a council, as is in the case of medical professionals, dental and nursing stream. This would not only make such professionals accountable to their professions, but will also protect their rights and ensure their professional development, said Arun Singhal, Joint Secretary (medical education), Health Ministry.
The National Health Policy (NHP) 2017 too emphasises on improving paramedical skills by developing training courses and curriculum for super specialty paramedical care (perfusionists, physiotherapists, occupational therapists, radiological technicians, audiologists, MRI technicians, etc).
The policy recognises their role — keeping in view the demographic, maternal and child mortality and the rise in lifestyle diseases that the country is facing. It also recognises the need to address their shortfall. Planned expansion of allied 18 technical skills is a key policy direction. The policy will allow for multi-skilling with different skill sets so that when posted in more peripheral hospitals there is more efficient use of human resources, as per the NHP.
The PHFI, painted a grim picture. In its report, it highlighted that India is short by 8.5 lakh anaesthetists and technicians trained to run an operation theatre, 20.4 lakh dental staff (dental technicians and hygienists), 1.27 lakh ophthalmologists and optometrists, 18 lakh rehabilitation specialists (clinical psychologists), 61,000 medical laboratory technicians, 19,000 radiographers, 7,500 audiology and speech language specialists and 2.3 lakh medical staff-like dieticians. This gap does not augur well for India if it wants to achieve Universal Healthcare to all.
Calling them as an untapped treasure, critical to fixing the gaping holes in India's health workforce, particularly the severe shortage of physicians and specialists, the report notes that it would be a grave mistake to not utilise the capacities of this resource. As the Government envisaged providing universal access to healthcare during the 12th five-year plan (2012-2017), the availability of skilled AHPs will emerge as the cornerstone to the success of India's public sector health reforms, it said.
More so, the Government has an ambitious plan to transform 150,000 health subcentres into health and wellness centres to strengthen primary healthcare. With those holding MBBS degrees refusing to come forward to serve the rural sector, skilled community health workers and allied health professionals are the ray of hope for the Government and society in longer term.
(The writer is Special Correspondent, The Pioneer)
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