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EDITORIAL
Year : 2019  |  Volume : 13  |  Issue : 1  |  Page : 1-4

The allied and health-care professions bill 2018: Implications for physiotherapists


Professor, Physiotherapy, Punjabi University, Patiala, Punjab, India

Date of Web Publication29-Jun-2019

Correspondence Address:
Prof. Akhoury Gourang Kumar Sinha
Professor, Physiotherapy, Punjabi University, Patiala, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/PJIAP.PJIAP_17_19

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How to cite this article:
Sinha AG. The allied and health-care professions bill 2018: Implications for physiotherapists. Physiother - J Indian Assoc Physiother 2019;13:1-4

How to cite this URL:
Sinha AG. The allied and health-care professions bill 2018: Implications for physiotherapists. Physiother - J Indian Assoc Physiother [serial online] 2019 [cited 2019 Sep 17];13:1-4. Available from: http://www.pjiap.org/text.asp?2019/13/1/1/261815

The WHO defines human resources for health (HRH) as the stock of all individuals engaged in the promotion, protection, or improvement of population health.[1] HRH encompasses all of the men and women who work in the health field not only physicians and nurses but also public health workers, policymakers, educators, clerical staff, scientists and pharmacists,[1] and many others.

The modern health-care delivery systems throughout the world establish regulatory mechanisms to acknowledge, regulate, and upgrade the qualifications of all kind of health-care professionals. However, Indian efforts with regards to the regulation of human resources in health present quite a gloomy picture. Even after 70 years of independence, India has not created a coherent human resource policy for health.[2] Health workforce in Indian health-care system has been defined with focus limited to few cadres such as doctors, nurses, and pharmacists. Several other health-care professionals – the part and parcel of modern medical establishment whose quality and competency of often play a major role in making the system sensitive and efficient – have remained unidentified, unregulated, and underutilized.

The need of a statutory mechanism for enumeration, standardization, and regulation of these professions has been expressed by a number of experts.[2] With the changing socioeconomic milieu and epidemiological shift in disease pattern, the model of health care is worldwide is moving toward patient-centric multidisciplinary care from the doctor-centric health system – for which it is absolutely necessary that everybody who deals with patients has some recognition and set standard of education and competencies. There is a broad consensus among policymakers that that without ensuring the standards of education and certification of all the HRH the task of achieving millennium goal of health for equitable health across the country cannot be fulfilled.

On December 31, 2018, Government of India (GOI) has introduced the Allied and Healthcare Professions (AHP) Bill 2018[3] in Rajya Sabha. The bill has been referred to standing committee for further examinations and recommendations.

This bill seeks to establish an umbrella council for the regulation of all the health-care professionals for which so far there exists no statutory regulatory body. The main aim of this bill is to provide a mechanism for regulation and maintenance of standards of education and services by allied and health-care professionals. Bill specifies some 15 categories of AHP in the schedule which include life science professionals, surgical, and anesthesia-related technology professionals; trauma and burn care professionals; physiotherapists, occupational therapists, nutrition science professionals; surgical and anesthesia-related technology professional; renal technology professional; cardiovascular, neuroscience, and pulmonary technology professional; physician associate or physician assistant, health and information management professionals; medical laboratory sciences professional; medical radiology, imaging, and therapeutic technology professional; primary, community, and other miscellaneous care professional; behavioral health sciences professional; ophthalmic sciences professional; and nutrition science professional. The central government may amend this schedule after consultation with the Allied and Healthcare Council which keeps the door open for inclusion of new professions as they emerge in the course of time.

This bill classified the 53 professions; it seeks to regulate in two broad categories, namely allied health professional and health-care professional. Those professionals who studies, advises, researches, supervises or provides preventive, curative, rehabilitative, and therapeutic or promotional health services are referred as health-care professional whereas those who perform any technical and practical task to support diagnosis and treatment and to support implementation of any health-care treatment and referral plan, recommended by a medical, nursing, or any other health-care professionals are described as the AHP. It is clear from these definitions that allied health-care professionals would carry out the technical and practical tasks recommended by health-care professionals to support the implementation of health-care treatment or referral plan. Another distinguishing feature between these categories is the duration of education. For health-care professionals, the duration of the education program shall be equal to or more than 3600 hours whereas the duration of the education program for diploma or degree allied health-care profession shall not be less then 2000 hours. Hence, the education program of health-care professionals would be 1600 hours more than that of allied health-care professionals.

AHP bill 2018 proposes to constitute a central council and state councils in every state of India. The central council would frame policies and standards related to education and professional services; whereas the state councils would enforce and implement these policies and standards. The central council would consist of 48 members, and state councils would have 29 members. The composition is council is kept as such that besides the ex officio representatives of different departments and ministries of GOI and some selected institution of national importance, almost each of the 15 categories of professions – that this council seeks to regulate – would get one representative and the chairman of the councils shall be elected from these professional representatives. Like UGC, AICTE, and RCI, in this bill also, there is no provision of the election of council members and all the members would be nominated by GOI (central council) or state government (for state council). Each member's term shall be of 2 years, and they can be renominated for maximum three terms giving a person maximum of 6 years and minimum of 2 years to serve in the council. Considering the huge task ahead, the tenure of council seems little short. It would be better, if the tenure of council is extended by 1 or 2 years. Three to five years' time would be adequate to develop a long-term policy and monitor its effects.

Constitution of professional advisory bodies in both central and state councils is another feature of this council. These advisory councils would examine the specific issues relating a given category and give specific recommendation or advise to the council. In general, the advisory councils shall be headed by the members of the category for which the advisory council would be created. There is no bar on the numbers of advisory council that central or a state council may have as the bill provides for constitution of as many professional advisory bodies as may be necessary. However, the bill is silent on the size of advisory council. If seems these advisory councils would be constituted on need-based manner. It would have been better if in addition to these advisory councils; there should have been a provision of permanent board for each professional categories. Such boards exist in some countries and perform the day-to-day task related to individual professions. Constitution of permanent board has the potential to take away all the resistance that is currently being buildup by different categories of the professionals.

Functions of the central council shall include framing policies and standards related to education and professional services. For regulating professional conduct, it seeks to frame a code of ethics and etiquette and maintain Central Register of the professionals in separate parts in each of the recognized categories. Inclusion in the register would be essential to provide the professional services and after the enactment of this bill no person, other than a registered allied and health-care professional, hold office as an allied and health-care professional, in any institution and provide service in any of the recognized categories in any state. There is a provision of penalty for misuse of titles and misrepresentation. A person not registered with council if takes or uses the description of an allied and health-care professional, shall be punished with fine up to Rs 2 lakh or imprisonment up to 1 year or both. Further, whoever contravenes any of the provisions of this act or any rules or regulations made under this act shall be punished with imprisonment of 1 year extendable to 3 years or with fine of Rs l lakh - 5 lakh or with both.

Person who offers his/her services in any of the recognized categories on or before the commencement of this act shall be allowed to register under the provisions of this act within 2 years from such commencement in the manner. No allied and health-care professional shall discharge any duty or perform any function not authorized by this act or any treatment not authorized by the field of his/her profession. These provisions would help curb the rampant quackery and malpractices.

For regulating the standard of education – the council would prescribe the qualifications for each profession – including name of the course, entry criteria, duration and would frame minimum standards of education, courses, curricula, physical and instructional facilities, staff pattern, staff qualifications, quality instructions, assessment, examination, training, research, and continuing professional education. It shall also decide the maximum tuition fee payable in respect of courses of these courses and proportionate distribution of seats as per the requirements of the country.

Providing uniform examinations for entry with common counseling for admissions and uniform exit or licensing examination are the other features worth mentioning. As of now, for admission to a given course, a student has to apply for different colleges and universities and face inconvenience besides spending good amount of money. A common entrance examination in line of the National Eligibility Entrance Test of medical education would comfort the students. Variation in syllabi, training infrastructure, and quality of teachers often leads to the different competency level of the two persons holding the same degree from two institutions. A common licensure examination would ensure a minimal essential competency that a professional must possess. This step would provide assurance to the consumers about the quality of service.

The task of implementation of these educational guidelines is left with state councils. Under constitution of India, health is state subject, and this mode of functioning shall ensure a national uniformity while respecting constitutional rights of the state. The bill intends to create a fresh vision of health-care delivery with a patient-centric approach and focus on moving to a multidisciplinary team-based care with strengthening the workforce by testing task shifting models.


  Implications for Physiotherapists Top


In spite of having wider presence in the health-care sector (both government and private) across the country, the profession of physiotherapy is an unregulated health profession in India while in several developed and developing countries it is regulated by the state. The term physiotherapist is a legally protected title in several countries. Physiotherapists have been demanding an independent regulatory body for their professions since a long time and GOI at least on two instances had come up with bills, though due to various reasons these were not enacted. AHP bill 2018 provides another opportunity to get the statutory regulatory body for the profession of physiotherapy.

Unlike many professions included in the bill physiotherapy profession has elaborate educational standards and distinct qualifications. However, these have not received statutory protection in India. The absence of statutory protection of the physiotherapy title has permitted a large number of unqualified and semi-qualified people to pose and practice as physiotherapists. Taking advantage of nonexistent statutory prescription of entry-level qualification several institutions (many of them are government institutions) are running obsolete diploma and certificate programs in physiotherapy often without any infrastructure and teaching faculty with the sole purpose of tilting the scale against the qualified workforce in the market-driven economy.[4] Enactment of this bill would hopefully curb this situation and as such the profession of physiotherapy stands to benefit the most from the enactment of this bill.

Physiotherapists have been demanding independent physiotherapy council. In one or two states of India, there are independent physiotherapy councils, and there is an apprehension among some section of the community that without independent regulatory body the standards of physiotherapy education and the status of practicing professionals would get diluted. However, it needs to be understood that the task of a regulatory body is to set forth uniform educational and qualification standards and establish a central registry for certified individuals and prescribe standards of professional conduct and determine which actions amount to professional misconduct. All the exiting councils work in this framework only. Regulatory councils do not work for hierarchy, status, or pay scale of a profession.

It is true that this bill does not provide for independent physiotherapy central council. However, it has all the provisions that are required for regulation and independent practice of physiotherapy professionals. Some of these important provisions that seem to benefit the physiotherapy profession include establishment of central and state register, regulation of education, provision of ethical guideline, and punishment for unauthorized use of professional titles. Further the term “paramedical” – considered by many as derogatory – does not find any mention in the bill due to which all previous bills were fiercely opposed. Rather physiotherapy in this bill is included under the category of healthcare professionals. The AHP bill 2018 defines physiotherapy professional as a person who practices physiotherapy by undertaking comprehensive examination and appropriate investigation, provides treatment and advice to any persons preparatory to or for the purpose of or in connection with movement or functional dysfunction, malfunction, disorder, disability, healing and pain from trauma and disease, using physical modalities including exercise, mobilization, manipulations, electrical and thermal agents, and other electro therapeutics for prevention, screening, diagnosis, treatment, health promotion, and fitness. Further, it states that the physiotherapist can practice independently or as a part of a multidisciplinary team and has a minimum qualification of a baccalaureate degree. This definition is a most comprehensive one that besides describing the duties and responsibility also sets the scope of practice as per the international standards and practices.

The demand of separate council for a single profession emerges from the desire of professional self-regulation that is perceived as a measure of recognition, legitimization, and political power to a profession. In the all the exiting councils of health-care professionals, the majority of members come from the same profession, and it is natural for physiotherapist to expect the formation of council on the similar line.

However of late many of these self-regulatory councils are found engaged in protecting not the broader national needs but the interests of an exclusive membership. These bodies have been seen engaging in serious conflict of interests and failing to take action against erring members.[2] Further existence of several autonomous players – each responsible for the regulation of only one part of health service delivery – has complicated the comprehensive planning of health sector and often acts as an obstacle in finding out a synergistic approach to address the human resource requirement of the country.[5]

Further, if the existing model of establishing one regulatory council for one profession is followed then fulfillment of the task of regulating all the health-care professionals would require establishment of as many as 53 councils (identified during drafting of this bill) in addition to existing 7 councils. What hassles such situation – in terms of the logistics, financial, and coordination – would create can only be imagined. Sometimes back, the National Commission for HRH bill, 2011,[6] was mooted to establish an overarching body for providing an overall frame work for the regulation of human resources of all the disciplines of health according to the actual health need of the country. Due to various reasons, this bill could not sail through. In the larger interest of health need of this country, such efforts are still needed. AHP may service as a reference point for coordinate planning of health human resources.

The idea of self-regulation of professionals seems to have outlived its utility and the need of multidisciplinary bodies having representations from all sections of the society to undertake the regulation of human resource not only for health but also for judiciary, and other fields are increasingly being recognized. The regulatory bodies for health should work keeping patient care and the health need of the country as priority not the benefit of any specific professional category. This thinking is reflected in other bills related to the regulation of homeopathy, ayush and medical profession tabled by the government in the same session of parliaments. The National Council for Indian System of Medicine would consist of 29 members out of which only 6 members would be elected [7] whereas the national council for homeopathy would consist of 20 members out of which four members would be elected by the registered homoeopathic medical practitioners.[8]

The first idea of regulatory body for allied and health-care professionals was originated some 53 years ago. However, the stiff opposition from a variety of organized and powerful professional groups has not let it acquire a material shape. A strong political will is needed this time too to counter the forces that always put obstacles in the implementation of such legislation. With the return of the same majority government that had tabled this bill in the last session of the parliament one would hope that AHP Council is constituted at the earliest and pave the way for much-needed reform in the health sector.

 
  References Top

1.
World Health Organization. Country Office for India, Not Enough Here Too Many There, Health Workforce in India. 2007.  Back to cited text no. 1
    
2.
Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human resources for health in India. Lancet 2011;377:587-98.  Back to cited text no. 2
    
3.
The Allied and Healthcare Professions (AHP) Bill 2018 available at https://www.prsindia.org/sites/default/files/bill_files/Allied%20Health-RS%20Intro-E-311218%20Bill%20Text.pdf. [Last accessed on 2019 Jun 17].  Back to cited text no. 3
    
4.
Sinha AG. Physiotherapy needs protection under law. In Physiotherapy in Health Care: Need and The Reality (Ed) Sinha AGK, Kumar M, Singh S, publication bureau Punjabi university Patiala; 2012. p. 55-64. ISBN: 9788130201337.  Back to cited text no. 4
    
5.
Sinha AG. Implications of NCHRH bill 2011 on physiotherapy profession. Physiotimes 2012;4:54-7.  Back to cited text no. 5
    
6.
The national commission for human resources for health bill 2011 Available at https://www.prsindia.org/sites/default/files/bill_files/Bill%20Text_17.pdf. [Last accessed on 2019 Jun 17].  Back to cited text no. 6
    
7.
The National Commission for Indian System of Medicine Bill; 2019 available at https://www.prsindia.org/sites/default/files/bill_files/Nationl%20commission%20for%20Indian%20system%20of%20medicine%20bill%2C%202019.pdf. [Last accessed on 2019 Jun 17].  Back to cited text no. 7
    
8.
The National Commission for Homoeopathy Bill; 2019. Available at https://www.prsindia.org/sites/default/files/bill_files/Nationl%20commission%20for%20Homoeopathy%20bill%2C%202019.pdf. [Last accessed on 2019 Jun 17].  Back to cited text no. 8
    




 

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