• NMC bill proposed for a bridge course to enable AYUSH doctors to practice allopathic medicine in a limited capacity.
• While this was a move to bridge the shortage in our health system, opposition to the proposal led the centre to delegate the idea to states for consideration. 

What is the controversy regarding AYUSH practitioners?

• Our traditional medicine constitutes five major streams namely AYUSH (Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy).
• Practitioners of these streams of traditional medicine have thus far been legally sanctioned to operate within their respective domains only.   
• “National Medical Commission Bill”, has proposed permitting AYUSH doctors to prescribe limited allopathic on completion of a bridge course.
• This has triggered a controversy as a mere bridge course to enable allopathic practice is seen by some as akin to legitimising quackery.
• Union government has withdrawn the proposal due to opposition, but it has nonetheless passed the buck to the state governments to consider the same.
• As the government seeks to overcome manpower shortage through such quick fixes, protestors argue that the risk involved shouldn’t be overlooked. 

What is the state of our health infrastructure?

• The last mile of healthcare delivery in India occurs through sub-centres and primary health centres (PHCs).
• 61% PHCs have just one doctor, while nearly 7% are functioning without any
• 33% of PHCs do not have a lab technician, and 20% don’t have a pharmacist. 
• In states like Odisha, more than 3,000 government posts for doctors or about 50% of all government medical doctor posts are lying vacant.
• India faces an acute shortage of allopathic doctors (about 5 lakh doctors are needed) and the present doctor-patient ratio stands a poor 1:1700. 
• In this context, unqualified medical practitioners have sprouted up in large numbers particularly in states such as UP, Jharkhand and Bihar.
• While increasing the number of seats in medical colleges is a viable long term strategy, the immediate needs of our population are also too massive.

Is it logical to see AYUSH practitioners as fillers to address the problem? 

• “Ayushman Bharat Scheme” envisions upgraded sub-centres and PHCs as the fulcrum for delivering primary healthcare.
• It is but unclear on how the staffing needs of these centres would be met in a uniform manner nationally.
• Given the paucity of MBBS doctors, it makes sense to leverage the ready availability of large AYUSH practitioners for limited allopathic practice.
• Appropriate bridge courses for AYUSH doctors, accompanied by sound regulatory mechanisms, will indeed help in them dole out allopathic medicine.
• The current outrage could’ve been primarily based on the measly 6 month duration for the bridge course, an aspect that could be addressed. 
• Notably, in courses like Ayurveda, nursing, physiotherapy or pharmacy, the curriculum has several strands similar to that of a MBBS course.
• Hence, better course integration through additional training in pharmacology and medicine with clinical clerkships, could sufficiently equip AYUSH docs.

How has such programs fared worldwide?

• In the U.S., a 2 year bridge program for “paramedics and nurses” designates them as “Physician Assistant” (PA) once they clear the certification exam. 
• Over the years, the program has grown in scale to address the shortfall in the U.S. health system and more than 8 million patients saw PAs in 2017.  
• Similar programs also exist in U.K. and New Zealand and have made significant contributions to the overall health metrics of those countries.
• As of 2013 in Bangladesh, three-year training qualifies a sub-assistant community medical officer (SACMO) to practice.
• Incidentally, 89% of healthcare delivery in rural Bangladesh is being taken care primarily by SACMOs.
• Assistant doctors in China, clinical associates in South Africa, and assistant medical officers in Malaysia are all based on similar models.

What is the way ahead?

• The Idea - Considering the enormity of the situation and the worldwide precedents, calling AYUSH bridge course “legal quackery” is a stretch.
• A properly designed and imparted bridge course for limited allopathic practice and subsequent monitoring could indeed help in improving the health metrics.  
• Such providers can help in disease prevention, a dire need considering India’s continuing burden of both communicable and non-communicable diseases.
• Significantly, a strong AYUSH cadre could also help in curtailing irrational medical practice, and existing rampant abuse of drugs such as antibiotics.
• Implementation - As a lot of technicalities are involved in designing the course and regulating it, the centre needs to take primacy in the process.
• While implementing could be delegated to the states, it is not a prudent approach for the centre to have ceded the entire idea to states due to protests.