As of April 30, Telangana has 1,012 confirmed cases of COVID-19 (9th highest in the country). Of these, 367 have been cured, and 26 have died. In this blog, we summarise some of the key decisions taken by the Government of Telangana for containing the spread of COVID-19 in the state and relief measures taken during the lockdown.
Movement Restrictions
For mitigating the spread of COVID-19 in the state, the Government of Telangana took the following measures for restricting the movement of people in the state.
Closure of commercial establishments: On March 14, the government ordered for the closure of cinema halls, amusement parks, swimming pools, gyms and museums until March 21 which was later extended to March 31.
Lockdown: To further restrict the movement of people, the state and central governments announced lockdown in the state and country. The lockdown included: (i) closing down state borders, (ii) suspension of public transport services, (iii) prohibiting congregation of more than five people. The entities providing essential commodities and services were exempted from these restrictions.
Starting from April 20, the central government allowed certain activities in less-affected districts of the country. However, on April 19, the state government decided not to allow any relaxation in Telangana until May 7.
Health Measures
Telangana Epidemic Diseases (COVID-19) Regulations, 2020: On March 21, the government issued the Telangana Epidemic Diseases (COVID-19) Regulations, 2020. The regulations are valid for one year. Key features of the regulations include:
(i) All government and private hospitals should have dedicated COVID-19 corners,
(ii) People who had travelled through the affected areas should be home quarantined for 14 days,
(iii) Procedures to be followed in the containment zones among others.
Private Hospitals: On March 22, for increasing the availability of healthcare facilities in the state, the government issued an order prohibiting private hospitals from performing any elective surgeries. The hospitals were also instructed to have separate counters for respiratory infections.
Increasing the health workforce in the state: On March 30, the government issued notification for the recruitment of medical professionals on a short term basis.
Prohibition on spitting in public places: On April 6, the Department of Health, Medical and Family Welfare department banned spitting of paan, any chewable tobacco or non-tobacco product, and sputum in public places.
Welfare measures
To mitigate the hardships faced by the people, the government took various welfare measures. Some of them are summarized below:
Relief assistance: On March 23, the government announced the following measures:
Factories: On March 24, the government directed the management of factories to pay the wages to all workers during the lockdown period.
Migrant Workers: On March 30, the government decided to provide 12 kg of rice or atta and one time of support of Rs 500 to all migrant workers residing in the state.
Regulation of school fees: On April 21, the government ordered all private schools not to increase any fees during the academic year of 2020-21. The schools will charge only tuition fees on a monthly basis.
Deferment of collection of rent: On April 23, the government notified that house owners should defer the rent collection for three months. Further, the owners should collect the deferred amount in instalments after three months.
Administrative Measures
Deferment of salaries: The government announced 75% deferment of salaries of all the state legislators, chairperson of all corporations and elected representatives of all local bodies. The government employees will have salary deferment from 10% to 60%. Employees of the Police Department, Medical and Health Department, and sanitation workers employed in all Municipal Corporations and Municipalities are exempted from deferment of salary.
Chief Minister's Special Incentives: The government granted special incentives to certain categories of employees as follows:
For more information on the spread of COVID-19 and the central and state government response to the pandemic, please see here.
Today, the National Medical Commission Bill, 2019 was passed by Lok Sabha. It seeks to regulate medical education and practice in India. In 2017, a similar Bill had been introduced in Lok Sabha. It was examined by the Standing Committee on Health and Family Welfare, which recommended several changes to the Bill. However, the 2017 Bill lapsed with the dissolution of the 16th Lok Sabha. In this post, we analyse the 2019 Bill.
How is medical education and practice regulated currently?
The Medical Council of India (MCI) is responsible for regulating medical education and practice. Over the years, there have been several issues with the functioning of the MCI with respect to its regulatory role, composition, allegations of corruption, and lack of accountability. For example, MCI is an elected body where its members are elected by medical practitioners themselves, i.e., the regulator is elected by the regulated. Experts have recommended nomination based constitution of the MCI instead of election, and separating the regulation of medical education and medical practice. They suggested that legislative changes should be brought in to overhaul the functioning of the MCI.
To meet this objective, the Bill repeals the Indian Medical Council Act, 1956 and dissolves the current MCI.
The 2019 Bill sets up the National Medical Commission (NMC) as an umbrella regulatory body with certain other bodies under it. The NMC will subsume the MCI and will regulate medical education and practice in India. Under the Bill, states will establish their respective State Medical Councils within three years. These Councils will have a role similar to the NMC, at the state level.
Functions of the NMC include: (i) laying down policies for regulating medical institutions and medical professionals, (ii) assessing the requirements of human resources and infrastructure in healthcare, (iii) ensuring compliance by the State Medical Councils with the regulations made under the Bill, and (iv) framing guidelines for determination of fee for up to 50% of the seats in the private medical institutions.
Who will be a part of the NMC?
The Bill replaces the MCI with the NMC, whose members will be nominated. The NMC will consist of 25 members, including: (i) Director Generals of the Directorate General of Health Services and the Indian Council of Medical Research, (ii) Director of any of the AIIMS, (iii) five members (part-time) to be elected by the registered medical practitioners, and (iv) six members appointed on rotational basis from amongst the nominees of the states in the Medical Advisory Council.
Of these 25 members, at least 15 (60%) are medical practitioners. The MCI has been noted to be non-diverse and consists mostly of doctors who look out for their own self-interest over public interest. In order to reduce the monopoly of doctors, it has been recommended by experts that the MCI should include diverse stakeholders such as public health experts, social scientists, and health economists. For example, in the United Kingdom, the General Medical Council which is responsible for regulating medical education and practice consists of 12 medical practitioners and 12 lay members (such as community health members, administrators from local government).
What are the regulatory bodies being set up under the NMC?
The Bill sets up four autonomous boards under the supervision of the NMC. Each board will consist of a President and four members (of which two members will be part-time), appointed by the central government (on the recommendation of a search committee). These bodies are:
How is the Bill changing the eligibility guidelines for doctors to practice medicine?
There will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-speciality medical education in all medical institutions regulated under the Bill. Further, the Bill introduces a common final year undergraduate examination called the National Exit Test for students graduating from medical institutions to obtain the license for practice. This test will also serve as the basis for admission into post-graduate courses at medical institutions under this Bill. Foreign medical practitioners may be permitted temporary registration to practice in India.
However, the Bill does not specify the validity period of this license to practice. In other countries such as the United Kingdom and Australia, a license to practice needs to be periodically renewed. For example, in the UK the license has to be renewed every five years, and in Australia it has to renewed annually.
How will the issues of medical misconduct be addressed?
The State Medical Council will receive complaints relating to professional or ethical misconduct against a registered medical practitioner. If the medical practitioner is aggrieved of a decision of the State Medical Council, he may appeal to the Ethics and Medical Registration Board. If the medical practitioner is aggrieved of the decision of the Board, he can approach the NMC to appeal against the decision. It is unclear why the NMC is an appellate authority with regard to matters related to professional or ethical misconduct of medical practitioners.
It may be argued that disputes related to ethics and misconduct in medical practice may require judicial expertise. For example, in the UK, the regulator for medical education and practice – the General Medical Council (GMC) receives complaints with regard to ethical misconduct and is required to do an initial documentary investigation in the matter and then forwards the complaint to a Tribunal. This Tribunal is a judicial body independent of the GMC. The adjudication decision and final disciplinary action is decided by the Tribunal.
How does the Bill regulate community health providers?
As of January 2018, the doctor to population ratio in India was 1:1655 compared to the World Health Organisation standard of 1:1000. To fill in the gaps of availability of medical professionals, the Bill provides for the NMC to grant limited license to certain mid-level practitioners called community health providers, connected with the modern medical profession to practice medicine. These mid-level medical practitioners may prescribe specified medicines in primary and preventive healthcare. However, in any other cases, these practitioners may only prescribe medicine under the supervision of a registered medical practitioner.
This is similar to other countries where medical professionals other than doctors are allowed to prescribe allopathic medicine. For example, Nurse Practitioners in the USA provide a full range of primary, acute, and specialty health care services, including ordering and performing diagnostic tests, and prescribing medications. For this purpose, Nurse Practitioners must complete a master's or doctoral degree program, advanced clinical training, and obtain a national certification.
