2018 has been an eventful year for
the country, especially in the medical arena. A lot has happened and it
has left all of us in anticipation of the coming year 2019.
MBBS curriculum revised after more
than two decades … an ambitious target for complete elimination of TB from the
country by 2025… legislations have been passed …. some only by the Lower
House….some have been tabled in the Parliament and are yet to be discussed
before they can be enacted … outbreaks….natural calamities….These were but few
of the stories that made headlines this year.
India took a step closer to universal
health coverage with the launch of Ayushman Bharat.
But, perhaps the most momentous of
all events this year was the dissolution of autonomy of medical profession and
replacement of the Medical Council of India (MCI) with a Board of Governors.
Let’s take a look at some
of the top health stories in India in 2018. These have been listed in no
specific order.
Medical Council of India dissolved and
so was the autonomy of the medical profession
The Medical Council of India (MCI)
was dissolved with immediate effect on Sept. 26, 2018 and superseded by a Board
of Governors after the Govt. brought an Ordinance called the Indian Medical
Council (Amendment) Ordinance, 2018 to set up a committee to run the MCI until
Parliament passes the National Medical Commission (NMC). A 7-member Board
of Governors was announced with Dr. VK Paul as
its chairman.
New MBBS curriculum
The MBBS curriculum was revised. In
November, the new undergraduate curriculum was finalized by the MCI BoG. It
will be implemented in the 2019-20 academic session. The “Competency-based UG
Curriculum for the Indian Medical Graduate” focuses on medical ethics, better
doctor-patient relationship and outcome-based learning. Another new feature is
the introduction of elective subjects. Now students can pick up subjects of
choice and dedicated time has been allotted for self-directed learning and
co-curricular activities. The new MBBS curriculum has a course called
Attitude, Ethics and Communication (AETCOM) which will run across years.
Students will be assessed for how they communicate with patients; how they
counsel people for organ donations or other challenging procedures; how
sensitively do they offer care and obtain consent. All these things will count
along with competencies and skills.
National Medical Commission Bill 2017
The government is hoping to pass the
National Medical Commission (NMC) Bill. The bill is currently pending in
Parliament and will be first taken up in the Lok Sabha. The Bill seeks to
replace the MCI with a National Medical Commission as a regulatory body for
medical education and practice in the country. Among other provisions, the Bill
establishes four autonomous Boards under the supervision of the NMC:
Under-Graduate Medical Education Board, Post-Graduate Medical Education Board,
Medical Assessment and Rating Board and Ethics and Medical Registration Board.
The Bill was introduced in the Lok
Sabha on Dec. 29, 2017; it was referred to a Standing Committee on January
4, 2018 on account of opposition from the Indian Medical
Association (IMA) to certain provisions of the Bill. The Standing
Committee submitted its report on March 20, 2018 following which the Union
Cabinet approved certain official amendments to the NMC Bill. It
is unlikely to get passed seeing the tough stand taken by the
IMA.
Ayushman Bharat - Pradhan Mantri Jan
Arogya Yojana launched
Ayushman Bharat - Pradhan Mantri Jan
Arogya Yojana, the world’s largest government funded healthcare
program was launched by the Prime Minister Shri Narendra Modi at Ranchi,
Jharkhand on Sept. 23, 2018. It provides a cover of up to Rs. 5 lakhs per
family per year, at any government or empanelled private hospital, for
secondary and tertiary care hospitalization. More than 10 crore vulnerable
entitled families - approximately 50 crore beneficiaries - will benefit
from the scheme. The amount of 5 lakh would cover all investigations, medicine,
pre-hospitalization expenses etc. All pre-existing conditions are covered.
There is no restriction on family size, age or gender.
India sets a target
for complete elimination of TB by 2025 at the Delhi End TB Summit
“India is determined to address the
challenge of TB in mission mode. I am confident that India can be free of TB by
2025. The global target for eliminating TB is 2030, but today I announce that
the target for India to eliminate TB is 2025, five years before the global
target,” said the Prime Minister Narendra Modi as he inaugurated the Delhi
End TB Summit and launched the TB Free India Campaign on March 13, 2018.
The Delhi End TB Summit
was jointly organized by the Government of India, Stop TB Partnership and
WHO South East Asia Regional Office (SEARO).
Supreme Court’s allowed “Living Will” in
a landmark decision
In a landmark judgement, the Supreme
Court of India allowed an individual to draft a living will specifying that
they not be put on life support if they slip into an incurable coma.
The order was passed by a five judge
Constitutional bench comprising Chief Justice of India, which said “Human
beings have the right to die with dignity.” Though the judges gave four
separate opinions, all of them were unanimous that a Living Will should be
allowed, because an individual should not be allowed to continue suffering in a
vegetative state when they don’t wish to continue living, and know full well
that they will not revive. However, the Apex Court has set forth strict
guidelines on how to execute the mandate of the living will.
Surrogacy (Regulation) Bill 2018 passed
by the Lok Sabha
The Surrogacy (Regulation) Bill 2018,
which had been introduced in the Lok Sabha in 2016, was passed by the Lower
House on Dec. 19, 2018. The Bill is to be debated in the Rajya Sabha and passed
by the Upper House before it can be enacted.
The Bill prohibits
commercial surrogacy, and allows altruistic surrogacy. Altruistic
surrogacy does not involve any monetary compensation to the surrogate mother
other than the medical expenses and insurance coverage during the pregnancy.
The intending couple must be Indian citizens and married for at least five
years with at least one of them being infertile. The surrogate mother has
to be a close relative who has been married and has had a child of her own.
Only Indian citizens can avail surrogacy.
Undertaking or advertising commercial
surrogacy, exploiting the surrogate mother and selling or importing human
embryo or gametes for surrogacy have been considered offences under the Bill
with a penalty of 10 years and a fine of up to 10 lakh rupees.
Consumer Protection Bill 2018 passed by
the Lok Sabha
The
Consumer Protection Bill 2018 was passed by the Lok Sabha on
Dec. 20, 2018. The bill, among other things, proposes setting up of
the Consumer Disputes Redressal Commission and forums at the
District, State and National levels to examine and decide
on consumer complaints. Appeals from the District Commissions
will be heard by the State Commission and from the State Commission by the
National Commission. Appeals from the National Commission will be heard by the
Supreme Court.
The Bill has also defined the
pecuniary jurisdiction of the three disputes redressal agencies, which have
been substantially increased from those provided in the present
Consumer Protection Act 1986.
· For District Forum,
the jurisdiction has been increased to Rs one crore (from up to Rs 20 lakh
at present).
· For State
commission, the jurisdiction has been increased to between Rs one crore
and up to Rs 10 crore (from more than 20 lakh but not exceeding Rs one crore at
present).
· For National
commission, the jurisdiction has been increased to above Rs 10 crore (from
more than one crore at present).
Other amendments proposed are as
follows:
· District, state and
national fora do not require judicial members.
· Not only persons
but associations and other bodies can complain to consumer fora
· Consumer Mediation
cells at district, state and national level.
· District, state and
national councils, which are advisory in nature
· A
Central consumer authority which has judicial powers, can
conduct investigations, search and make judgements
Cabinet approves Allied and Healthcare
Professions Bill, 2018
In November, the Union Cabinet
chaired by Prime Minister Shri Narendra Modi approved the Allied and Healthcare
Professions Bill, 2018 for regulation and standardization of education and
services by allied and healthcare professionals. The Bill provides for setting
up of an Allied and Healthcare Council of India and corresponding State Allied
and Healthcare Councils which will play the role of a standard-setter and
facilitator for professions of Allied and Healthcare.
The Bill will also have an overriding
effect on any other existing law for any of the covered professions.
Nipah virus outbreak in Kerala
In May, an outbreak of the Nipah
virus was reported from Kerala. It was localized in Kozhikode and Malappuram
districts of Kerala and claimed 17 lives. The outbreak was officially declared
over on June 10, 2018. This was the third outbreak reported in India.
An advisory released by the Health
Ministry said that “the Nipah virus disease is not a major outbreak and
is only a local occurrence”. The outbreak was traced to fruit bats. In
July, the Indian Council of Medical Research (ICMR) confirmed fruit bats were
the primary source of the virus.
Zika virus outbreak in Rajasthan
The third outbreak of Zika virus in
less than two years was reported in India from Jaipur in Rajasthan. The first
case was reported in the end of September. More than 130 cases were
detected. For the first time, during this epidemic, scientists found mosquitoes
that were infected with the virus, indicating that it was being transmitted
locally. Sequencing of five Zika virus strains collected during the
Jaipur outbreak suggest that the known mutations linked to fetal
microcephaly are not present in the current strain.
In January-February 2017, the first
three cases of laboratory-confirmed Zika virus infection in India were detected
in Ahmedabad, Gujarat. In the same year in July, transmission of Zika virus was
also confirmed from Krishnagiri District in Tamil Nadu. The World Health
Organization (WHO) puts India in category 2 in the classification of
Zika’s prevalence, which indicates an ongoing transmission of the virus.
HIV and AIDS (Prevention and Control)
Act, 2017
The HIV and AIDS (Prevention and
Control) Act, 2017 was notified by the Government and came into force from
Sept. 10, 2018. The Act aims to end the epidemic by 2030 and safeguard the
rights of people living with or affected by HIV by addressing HIV-related
discrimination through legal accountability and establishing mechanisms for
complaint enquiry and grievance redressal.
The Act lists various grounds on
which discrimination against HIV positive persons and those living with them is
prohibited. These include the denial, termination, discontinuation or unfair
treatment with regard to: (i) employment (ii) educational establishments (iii)
health care services (iv) residing or renting property (v) standing for public
or private office and (vi) provision of insurance (unless based on actuarial
studies). The Act also prohibits the requirement for HIV testing as a
pre-requisite for obtaining employment or accessing health care or
education.
ICMR has a new Director General
Professor Balram Bhargava, Professor
of Cardiology at All India Institute of Medical Sciences (AIIMS), New Delhi
took charge as the new Director General of Indian Council of Medical Research
(ICMR) and Secretary of the Department of Health Research, Ministry of Health
& Family Welfare.
A new Director General of Health
Services appointed
Dr S Venkatesh is the new Director
General of Health Services (DGHS).
A new Drugs Controller General of India
Joint Drugs Controller Dr S Eswara
Reddy was appointed as the new Drugs Controller General of India (DCGI).
New IMA National President
Dr Santanu Sen, also a Member of
Parliament, took over as the National President; Dr RV Asokan was elected
as the Secretary General.
India assumes office of CMAAO
President-Elect
Dr KK Aggarwal took over as the
President-elect of Confederation of Medical Associations in Asia and Oceania
(CMAAO).
Supreme Court bans sale of
Bharat Stage IV vehicles from April 1, 2020
A three judge bench of the
Supreme Court headed by Justice Madan B Lokur has said that no Bharat Stage IV
vehicle shall be sold across the country with effect from April 1, 2020. The
Bharat Stage VI (or BS-VI) emission norm would come into force from April
1, 2020 across the country.
The BS IV norms have been enforced
across the country since April 2017. In 2016, the Centre had announced that the
country would skip the BS-V norms altogether and adopt BS-VI norms by
2020.The apex court was deciding whether grace period should be given to
automobile manufacturers for the sale of BS-VI non-compliant vehicles after
April 1, 2020.
MTNL Perfect Health Mela celebrated its
silver jubilee
The MTNL Perfect Health Mela, the
annual flagship event of the Heart Care Foundation of India, celebrated its
silver jubilee with the theme “Affordable Healthcare”. A National Campaign on
Hands-only CPR 10 in collaboration with Ministry of Youth Affairs, Govt. of
India was launched on the inaugural day. “Evening Conclaves” thematic
panel discussions with celebrity guests were the highlight of the Mela this
year. Topics discussed at these Conclaves included antimicrobial resistance,
indoor pollution, harm reduction, safe water and air, CSR, infertility and
non-communicable diseases.
A one-of-its-kind Spiritual
Inter-Faith Conference on air, sanitation and antimicrobial resistance was also
organized by HCFI along with the World Fellowship of Religions, in which
eminent dharma Gurus of all religions participated as speakers.
Kerala Floods
In August, Kerala suffered its worst
flood in 100 years. All 14 districts of the state were placed on red alert.
According to the Kerala government, one-sixth of the total population of Kerala
had been directly affected by the floods and related incidents. The Government
of India declared it a Level 3 Calamity, or “calamity of a severe nature”.
Viral load test for people living with
HIV/AIDS
The Viral Load testing for all People
Living with HIV/AIDS (PLHIV) was launched by the Health Minister in February as
“a big step forward in treating and monitoring people living with HIV”. The
initiative will provide free of cost viral load testing for 12 lakh PLHIV on treatment
in the country at least once a year. It will optimize the utilization of
1st line regimens, thus preventing drug resistance. It will also help in
strengthening ‘Mission Sampark’ in tracking LFU (Loss to Follow Up) PLHIV.
Govt. ban on manufacture of
oxytocin formulations set aside by Delhi High Court
In May, the Ministry of Health and
Family Welfare restricted the manufacture of Oxytocin formulations for domestic
use to public sector only. It also banned the import of Oxytocin and
its formulations. This order was to come into effect from July 1, 2018.
As per the order, no private
manufacturer would be allowed to manufacture the drug for domestic use. Only
Karnataka Antibiotics & Pharmaceuticals Ltd (KAPL), a public sector
company, would be manufacturing this drug for domestic use and will supply the
drug to registered hospitals and clinics in public and private sector directly.
Oxytocin in any form or name would not be allowed to be sold through retail
Chemist.
But, on Dec. 14, the Hon’ble Delhi High
Court set aside the Govt.’s decision to ban private firms from producing and
selling oxytocin. The bench of Hon’ble Justice S Ravindra Bhat and Hon’ble
Justice AK Chawla said that the government’s decision was arbitrary and
unreasonable and that there was no scientific basis behind the Center’s
decision restricting private companies from making or supplying the drug to
prevent its alleged misuse in the dairy sector for increasing milk production.
Cabinet approves the Protection of Human
Rights (Amendments) Bill, 2018
The Union Cabinet chaired by Prime
Minister Shri Narendra Modi approved the Protection of Human Rights
(Amendments) Bill, 2018 for better protection and promotion of human rights in
the country.
National Viral Hepatitis Control Program launched
The National Viral Hepatitis Control
Program was launched by the Health Minister on World Hepatitis Day (July 28)
with the goal of ending viral hepatitis as a public health threat by 2030 in
the country.
India retains the WHO South-East Asia Regional Director
position
India retained the top WHO position
in South-East Asia Region Office (SEARO) with Dr Poonam Khetrapal Singh
unanimously re-elected as Regional Director WHO South-East Asia for another
five-year term beginning February 2019. She is the first woman to have been
elected to the position of Regional Director for WHO South-East Asia Region
after an illustrious career in the Indian civil service, World Bank and WHO.
Last year Soumya Swaminathan an
Indian Paediatrician and Clinical Scientist known for her work in
Tuberculosis on 3 October 2017 was appointed as the Deputy
Director General of Programmes at the World Health Organization.
ENDS Controversy
In August, the Ministry of
Health released an advisory on Electronic Nicotine Delivery Systems (ENDS)
including e-cigarettes, Heat-Not-Burn devices, Vape, e-Sheesha, e-Nicotine
Flavored Hookah, and the like products asking states not to allow its sale or
distribution.
But on 28th December Public
Health England (PHE) released a new film showing the devastating harms that
come from smoking, and how this can be avoided by switching to an e-cigarette
or using another type of quit aid.
The film has been released as part
of PHE’s Health Harms campaign, which encourages smokers to attempt
to quit this January, by demonstrating the personal harm to health from every
single cigarette. The film features smoking expert Dr Lion Shahab and Dr
Rosemary Leonard, visually demonstrating the high levels of cancer-causing
chemicals and tar inhaled by an average smoker over a month, compared to not
smoking or using an e-cigarette.Research estimates that while not risk-free,
vaping is at least 95% less harmful than smoking.
Dr Lion Shahab, leading smoking
cessation academic from University College London, said: “The false
belief that vaping is as harmful as smoking could be preventing thousands of
smokers from switching to e-cigarettes to help them quit. Research we and
others have conducted shows that vaping is much less harmful than smoking and
that using e-cigarettes on a long-term basis is relatively safe, similar to
using licensed nicotine products, like nicotine patches or gum. Using
e-cigarettes or nicotine replacement such as patches or gum will boost your
chances of quitting successfully.”
Govt. bans use of antibody test kits to
diagnose malaria
The Health Ministry prohibited the
manufacture for sale, sale and distribution of the test kits used in Antibody
Detecting Rapid Diagnostic Tests for routine diagnosis of malaria after it was
found that the test was triggering false alarms. As per the notification,
although the test is economical, the false positive rates in endemic areas were
high. People with fever who tested positive in the rapid antibody test, were
later tested negative in antigen test.
Plastic Waste Management (amendment)
rules notified
The Ministry of Environment, Forest
and Climate Change has notified the Plastic Waste Management (Amendment) Rules
2018. The amended Rules lay down that the phasing out of Multilayered Plastic (MLP)
is now applicable to MLP, which are “non-recyclable, or non-energy recoverable,
or with no alternate use.”
Dr KK Aggarwal
Padma
Shri Awardee
President Elect Confederation of Medical Associations in Asia and
Oceania (CMAAO)
Group
Editor-in-Chief IJCP Publications
President
Heart Care Foundation of India
Past National President IMA
