NCAH Act: A welcome move for allied & healthcare professionals

The National Commission for Allied and Healthcare Professions Bill, 2020 (NCAH Act) has been passed by Parliament after a long wait. The Act provides for the regulation and maintenance of standards of education and services by allied and healthcare professionals, assessment of institutions, maintenance of a Central Register and State Register, and creation of a […]

The National Commission for Allied and Healthcare Professions Bill, 2020 (NCAH Act) has been passed by Parliament after a long wait. The Act provides for the regulation and maintenance of standards of education and services by allied and healthcare professionals, assessment of institutions, maintenance of a Central Register and State Register, and creation of a system to improve access, research and development and the adoption of latest scientific advancements and for matters connected. 

The Act defines an ‘allied health professional’ as an associate, technician or technologist trained to support the diagnosis and treatment of any illness, disease, injury or impairment. Dr Harsh Vardhan, the Union Minister for Health and Family Welfare, explained the reasons and objectives of the Bill as, “Honourable Members, I would say that most of you must have had paid a visit to a hospital at some point in your life, and I wish not, but you might have had to … Please recall those days and remember the people who took care of you and who brought you out of your illness. You may remember the name of the doctor. You may remember the name of the hospital. But do you also remember the name of the persons who took your blood samples, gave you physiotherapy, took your X-ray, advised you on what you should eat, checked your eyesight, assisted your doctor or surgeon, looked into microscopes and bid you farewell with a smile? Who are these people?” They are varied health professionals: lab technicians, physiotherapists, radiographers, dieticians, record keepers, optometrists, X-ray technicians and many more, who are a critical part of the healthcare system and the foundation of the pyramid.

According to studies, the role of doctors, undoubtedly critical, varies between 25 to 50 percent in the entire healthcare chain. A saying goes, “The doctor is next to God, the nurse is next to the doctor, and the pharmacist is closest to the patient’. But there are others who are as vital and integral to the healthcare chain. In fact, these healthcare professionals are the bedrock of an increasingly complex healthcare system. After enacting the National Medical Commission Bill, 2019, which was fiercely contested by a large body of medical practitioners, another transformative piece of legislation, the NCAHP Act, has been enacted. It covers a wide range of healthcare professions which were unrecognised or unregulated till date. The Act is a paradigm shift in healthcare delivery as it recognises the specialised skills and contributions of more than 56 types of allied and healthcare professionals.

The nation, nay, the world, has witnessed the invaluable contribution of these professionals during the Covid-19 pandemic as frontline health workers risked their lives every day fighting the virus. The need for the development and maintenance of standards of services and education of these professionals through a national regulatory body has been long overdue. As early as 1948, the Bhore Committee had stressed the importance of ‘human resources for health with right skills and training’, followed by a host of committees over the years.   The first attempt at such a legislation was made in 1953 but the proposal never received the priority that it deserved, perhaps for a lack of unanimity and the dominance of a doctor-centric healthcare system. 

The Minister told the Rajya Sabha on 16 March, while responding to the debate on the NCAHP Bill, that bills were introduced on this behalf under different names in 2007 and 2011 which lapsed, and between 2015 and 2021, the legislative proposal was redrafted as many as 75 times. The NCAHP Bill, 2011 was introduced in the Rajya Sabha in December 2011. However, the bill faced opposition from the existing regulatory bodies. The Standing Committee on Health made wholesale recommendations on the bill. A new bill was introduced in the Rajya Sabha on 31 December 2018. It was referred to the Standing Committee on Health and Family Welfare on 4 January 2019. Based on the recommendations made by the Committee in its 117th Report in January 2020, a fresh bill, titled the NCAHP Bill, 2020, was introduced in the Rajya Sabha on 15 September 2020 by withdrawing the pending bill of 2018. The Committee made 110 recommendations and the Government accepted 102.

The Minister assured Parliament that some recommendations and the observations of many of the members who participated in the debate would be suitably incorporated in the rules to be framed under the Act. The Act would regulate and leverage the qualified allied and healthcare workforce and ensure high quality multidisciplinary care ‘in line with the vision of universal health coverage moving towards a more care-accessible and team-based model’. The Act would reform and regulate this entire sector in order to give these professionals their due, increase their employment opportunities, and, more importantly, enhance their dignity by recognising their true worth within the country and globally.  

According to a WHO report, there would be a demand of 1.80 crore such professionals by 2030 and qualified Indian professionals would cater to the global shortage. Further, their potential can be utilised to reduce the cost of care and to make quality healthcare services accessible to all. The Act envisages the establishment of a Central Statutory Body as the National Commission for Allied and Healthcare Professions. The Commission will frame policies and standards, regulate professional conduct and prescribe qualifications for all these professions. It will be supported by ten broad Professional Councils, each comprising one or more professions. The institutional structure would enable the assessment and rating of all the allied and healthcare institutions to ensure uniform standards and quality assurance. The Act provides for the registration of all the allied and healthcare professionals. All the professions have been coded as per the International Labour Organisation’s international standards for the classification of occupations which also allows them global recognition and mobility.

A National Allied and Healthcare Advisory Council to advise the National Commission with representation from all the states is provided under the Act to enable adequate representation from all states and Union Territories. Further, each state will have a separate State Council with four autonomous Boards pertaining to undergraduate education, postgraduate education, assessment and rating, and ethics and registration. At a time when there is an acute need for critical reforms in public health, the Act will provide a robust institutional mechanism to improve access to health by focusing on the preventive, promotive, curative and rehabilitative needs of the population. While doctors, nurses, dentists and pharmacists in India are regulated through their respective regulatory bodies, the allied and healthcare professions are still unstructured and unregulated. The potential of these professionals can be harnessed to reduce the cost of care and make quality healthcare services accessible to all. A healthcare professional includes a scientist, therapist, or any other professional who studies, advises, researches, supervises, or provides preventive, curative, rehabilitative, therapeutic, or promotional health services. Such a professional should have obtained a degree under this Act. These are mentioned in the Schedule to the Act and they include life science professionals, trauma and burn care professionals, surgical and anaesthesia related technology professionals, physiotherapists, and nutrition science professionals, etc. Anyone who contravenes the provisions of the Act shall be punished. 

Globally, most countries have a regulatory framework for standardised education and training. But in India, there was an absence of a regulatory framework and lack of a standardised education curriculum as well as training for these allied and healthcare professionals – a void now removed. The NCAHP Act, 2020 is a landmark legislation which will go down in the history of healthcare revolution in India. It will go a long way in transforming the healthcare scenario as it makes a paradigm shift in the administration of the entire healthcare system.  

India is on course for wholesale health sector reforms. Apart from the two transformative laws enacted, and referred to above, the Medical Termination of Pregnancy (Amendment) Act, 2021 has been passed during this Budget session. But the arch of reform would be completed with the enactment of the National Nursing and Midwifery Commission Bill, the National Dental Commission Bill, the Surrogacy Bill, and the Assisted Reproductive Technology (Regulation) Bill. Hopefully, the government will complete the remainder of the health sector reforms, mindful of the fact that healthcare costs hit voters hard and, if ignored, will hit back at politicians harder. Healthcare is no more a thing of benevolence but an integral part of the right to life, and a game changer for electoral politics.

The author is former Additional Secretary, Lok Sabha, and a public policy expert. The views expressed are personal.