Thursday, November 24, 2016

A life of dignity: New mental health care law is imminent and it will help fill a yawning treatment gap

The National Mental Health Survey 2016 published by NIMHANS recently showed that 13.7% of Indians are likely to have a mental illness during their lifetime. The survey also highlighted the huge treatment gap for mental illness ranging from 28-83%. Treatment gap refers to the proportion of people who need treatment for a mental illness but do not get it. Stigma, discrimination and violation of rights are everyday occurrences for persons with mental illness and their families.Research has shown that mental illness is associated with poverty and we will not meet the sustainable development goals on good health and well-being (SDG 3) and ending poverty (SDG 1) unless we address the health and social needs of persons with mental illness and their families and ensure their inclusion in all development activities.
The Mental Health Care Bill 2013, which was passed by the Rajya Sabha in August 2016, addresses some of these important issues. The Bill, which now awaits the approval of the Lok Sabha before it becomes law, aims to ensure that persons with mental illness receive the treatment they need in their own communities and are enabled to live a life of dignity .
It makes provision for a range of effective mental health services to be provided at public health facilities in each district. It also provides for free treatment of homeless persons with mental illness and those living below the poverty line. All medicines for treatment of mental illness on the essential drugs list will be made available free of charge at government health facilities.
Recognising the importance of Ayurveda and other Indian systems, the Bill provides for free AYUSH treatment for mental illness in government facilities.The Bill also makes it mandatory for insurance companies to provide medical insurance for mental illness treatment on an equal basis with insurance for physical illness.
Government also recognises that an adequate number of trained mental health professionals are required to reduce the treatment gap. India needs more psychiatrists, clinical psychologists, psychiatric nurses, psychiatric social workers, professional caregivers and counsellors. To begin with, government is committed to training all medical officers in public health facilities to provide emergency mental health services. The Bill also commits the government to make all necessary efforts to increase the number of mental health professionals to international levels in the next ten years. All these measures will usher a new era in the treatment of mental illness in our country , reduce the financial burden on patients and their families and reduce the treatment gap for mental illness in our country .
Government has delivered on its promise of decriminalising suicide in the new Bill, a longstanding demand of professionals, patients, families and recommended by the Law Commission of India. Government is acutely aware that suicide is an emerging health priority in India and the Mental Health Care Bill requires central and state governments to launch suicide prevention programmes and broad public health measures to reduce suicides. The health and family welfare ministry is committed to do all it takes to stop the suicide epidemic especially amongst young people in this country .
Advance Directive is one of the most innovative provisions of the Bill. For the first time in India, persons with mental illness will have the right to specify in advance their choice of treatment and name their own representative to ensure their treatment wishes are carried out when they are acutely ill and not able to decide themselves. This provision is in line with government's belief that people should have more control over their own treatment and doctors should implement people's treatment wishes.
I have no doubt that when the Mental Health Care Bill is passed by the Lok Sabha and becomes law, it will be implemented by government in letter and spirit. This will change the face of mental health care in India and help us meet our commitments under the WHO Action Plan 2013-2020. I call upon everyone, including mental health professionals, patients and caregiver organisations and individuals to join hands with the government in implementing the Mental Health Care Act, 2016 and enable persons with mental illness to live a life of dignity and hope.
The writer is Union health minister

Wednesday, November 23, 2016

Bill to replace MCI likely in ongoing Parliament session

The government is likely to place the bill that seeks to replace the Medical Council of India (MCI) with National Medical Commission (NMC) before Parliament in the ongoing Winter Session.
"The proposed National Medical Commission Bill, 2016 has been finalised by the Aayog and it is likely to be placed before Parliament for passage in the current session," a source said.
The bill has to be approved by the Cabinet after which it will be placed before Parliament, the source added.
Earlier this year, a high-level committee headed by Niti Aayog Vice-Chairman Arvind Panagariya looked into the issue of poor regulation of medical education by MCI and proposed replacing MCI with NMC.
Besides Panagariya, the panel included Prime Minister's Additional Principal Secretary P K Mishra, Niti Aayog CEO Amitabh Kant and the Union Health Secretary.
The committee was formed to suggest reforms in the Indian Medical Councils (IMC) Act, 1957.
After approval, NMC will become the main regulatory body and will take over all roles and responsibilities of MCI.
The new body will have eminent doctors and experts from related fields to steer medical education in the country so as to ensure quality of education is at par with global standards.
NMC will have around 19-20 members, including the chairman, and their tenure will be about five years. It will also have members from other fields such as economics and law.
It will have four boards Under Graduate Medical Board, Post Graduate Medical Board, Accreditation and Assessment Board and a board for registration of medical colleges as well as monitoring of ethics in the profession.
There will also be a Medical Advisory Council (MAC), with members from states who can be an eminent professional such as a professor from a medical college and the like. There will be two members from Union Territories. NMC members will also be its members and its role will be advisory.
Earlier this year, a parliamentary committee had called for revamping the MCI, saying it has failed in its role as a regulator which has led to a downfall in India s medical education system.

Niti panel snubs critics, pushes plan to replace MCI

Image result for niti aayog

Despite opposition from certain quarters, including Indian Medical Association (IMA), the high-powered committee headed by Niti Aayog vice-chairman Arvind Panagariya has moved forward with the plan to replace the Medical Council of India (MCI) with National Medical Commission.

A bill to replace MCI is likely to be introduced in the current session of Parliament.

The final draft of the NMC, finalised by the Panagariya panel last week, retained the provision that a government appointed broad-based searchcum-selection committee will select medical education regulators, instead of them being nominated and elected as used to happen in MCI.

The IMA has objected to the move, saying that in its eagerness to restructure the MCI to overhaul medical education, the panel is taking away its autonomy and democratic structure.

The Alliance of Doctors for Ethical Healthcare had termed the draft NMC Bill a "huge disappointment", saying the policy directions given shows that it seeks to further accelerate privatisation and commercialisation of medical education in the country .

However, an official said that the Panagariya panel tried to balance the concerns about high cost of medical education for meritorious but poor and disadvantaged students, with the worry that a fee cap might be a deterrent for the entry of private players in a sector where capacity expansion can brook no delay .

Will dissolving the Medical Council of India help medical education?

Hundreds of doctors across the country are protesting against the proposed National Medical Commission Bill (NMC Bill), which seeks to dissolve the Medical Council of India (MCI), calling it “an undemocratic move.”
One of the primary responsibilities of the MCI is to regulate medical education in the country. The NITI Aayog suggested the creation of NMC in August 2016. The proposed bill has suggested forming an NMC, which will be a policy-making body for medical education. Scrapping MCI might not be the right move in the long term, experts have said.
The proposed NMC Bill 2016 suggests that the Central government will establish autonomous Boards for conducting undergraduate and postgraduate education, assessment and rating of medical institutions and registration of medical practitioners, among other things.
According to Dr KK Aggarwal, national president elect, Indian Medical Association, “Scrapping MCI will cripple the functioning of the medical profession by making it completely answerable to the bureaucracy and non-medical administrators. Instead, the government must consider introducing amendments to the existing MCI Act to make it transparent, accountable, robust and self-sufficient.”
Dr Aggarwal says the autonomy of the regulatory body has to be upheld. Experts also suggest that providing for an accreditation authority for medical education on the lines of the authority vested with the All-India Council for Technical Education in respect of technological institutions through National Accreditation Board can be a solution.
Vesting MCI with the authority to prescribe service conditions and payable scales for full-time teaching faculties in medical colleges on par with the UGC can be another solution.
The government had invited suggestions from stakeholders and public on the proposed NMC Bill. Dr Manish Prabhakar, president, Indian Medical Students’ Association, says an NMC, if formed, will be “undemocratic and highly detrimental to budding doctors, community and medical associations.”
The NMC also aims to prescribe norms for determination of fees for a proportion of seats, not exceeding 40%, in private medical educational institutions. The Commission will also be responsible for conducting the National Eligibility-cum Entrance Test and a National Licentiate Examination for admission into post-graduate courses in medical colleges.
The bill also seeks to establish Undergraduate and Postgraduate Medical Education Boards that will be responsible for determining and prescribing standards and overseeing all aspects of medical education at undergraduate and postgraduate levels, respectively. They will also be given the task to develop a competency-based dynamic curriculum (including assessment) at the two levels and prescribing guidelines for setting up medical institutions, besides developing curricula and conducting examinations.

But will dissolving MCI help achieve these goals? Dr Arun Aggarwal, former president Delhi Medical Council and professor of excellence, Maulana Azad Medical College, Delhi, says, “Replacing MCI with another regulatory body does not guarantee that the current issues in medical education will be resolved. How can we be sure that the new commission will function without any glitches and be corruption-free?”
The new commission also seeks to merge the existing National Board of Examination (NBE), which is responsible for regulating post-graduate medical education in the country, with the Postgraduate Medical Education Board.
“The Supreme Court in its judgment dated April 3, 2016, while placing an oversight committee for MCI, had mandated a period of one year for the government to undertake reforms in regulation of medical education and set up appropriate systems in place. The apex court will review the position in April 2017. The tenure of MCI will also be completed in a year’s time. Thus, achieving high growth in healthcare to meet the growing needs is an area of high priority. Reforms in medical education are necessitated and will have to be undertaken sooner than later. However, the needs of medical profession namely professional autonomy and identity have to be appropriately addressed while holding the professionals accountable,” says Dr Bipin Batra, executive director, NBE.

Sunday, November 13, 2016

PG NEXT Question of the Day 13-11-2016

Identify the organism on the basis of the morphology of egg shown below

a. Ascaris
b. Enterobius
c. Echinococcus
d. Trichuris 

Ans: B. Enterobius

(Ref: K.D Chatterjee 13th edition, p227)

Egg of Enterobius vermicularis:
Colourless- non bile stained
Asymmetrical shaped- flattened on one side and convex on the other side: Plano-convex/ D-shaped
Surrounded by a transparent shell
Contains a coiled tadpole like larva
Floats in saturated solution of common salt

Saturday, November 12, 2016

PG NEXT Question of the Day 12-11-2016

The bacterial growth medium shown below belongs to 

a. Enriched medium
b. Enrichment medium
c. Selective medium
d. Indicator medium

Ans: B. Enrichment medium

(Ref: Ananthanarayan 9th edition, p28-33)

Simple medium: nutrient agar and Mueller-Hinton agar
Enriched medium: Blood agar, chocolate agar, egg and serum based medium 
Enrichment medium: Selenite F and alkaline peptone water
Differential medium: MacConkey agar and blood agar
Selective medium: Lowenstein-Jensen medium, Thayer-Martin medium, Wilson and Blair medium

Friday, November 11, 2016

PG NEXT Question of the Day 11-11-2016

Identify the test depicted in the picture below

a. Sodium fluoride test
b. Teichmann test
c. Diatoms test
d. None of the above

Ans: C. Diatoms test.

Circular, triangular, oval, rectangular, linear, crescentic or boat shaped with silica wall, chlorophyll and brown pigment Diatomin.

Ref: KSN Reddy, Essentials of Forensic Medicine & Toxicology, 33rd ed, p 371.