Draft Nursing Bill: ‘Not Focused on Healthcare Workers, Seeks to Centralise Control’

In a bid to overhaul a crumbling healthcare system amid the COVID-19 pandemic, the Ministry of Health and Family Welfare has finalised the National Nursing and Midwifery Commission Bill, 2020.

The Ministry of Health and Family Welfare has decided to repeal the existing Indian Nursing Council Act and replace it with the National Nursing and Midwifery Commission BiIl, 2020. The draft of the Bill, which has been circulated, aims to replace the largely autonomous Indian Nursing Council with a government-appointed body. Comments and recommendations for the Bill must reach the ministry before December 6.

The Bill is set to replace the Indian Nursing Council Act, 1947. However, activists and healthcare workers say that the Bill does little to help front line workers and is instead diluting the provisions of the previous law to give the Centre more control.

The Bill primarily concerns itself with nursing colleges and teaching institutes. The government is said to be planning a national entry and exit step different undergraduate nursing examinations conducted by different medical institutes.

The proposed legislation comes at a crucial time as India faces the pandemic with a crumbling healthcare system and is witnessing an acute shortage of nurses. India is one of the countries with the biggest shortage of nurses and is also short on healthcare workers.

There are just 1.7 nurses per 1,000 people in India, according to the Union Health Ministry’s data. The number is far lesser than the WHO’s prescribed minimum of three. Livemint reported that in March, the government told the Rajya Sabha that India has 3.07 million registered nursing personnel, including nurses, midwives and nursing assistants.

However, nurses unions across India say that the numbers are not accurate as they fail to represent many who remain unregistered. Out of these conservative figures – in spite of the government being the dominant provider of preventive care services – it is important

to note that NSSO data and that compiled by various nurses associations shows that up to 70% of all health workers in India are employed by the private sector. The gap is also evident in the urban versus rural distribution.

The government claims that the draft bill has tried to be more inclusive, (it has even mentioned the term midwifery for the first time) enabling it to include many others in the profession. However, the most alarming concern is the abolition of the nursing council and its replacement with a centralised body.

Less Representation, Demands of Healthcare Workers not Highlighted

The draft Bill replaces the Indian Nursing Council with a new representative body called National Nursing and Midwifery Commission. This body will have representatives from the Centre and the states.

Speaking to NewsClick, A.R. Sindhu of the Centre of Indian Trade Unions said that the government wants to project as if it is “revamping our healthcare and its education system. However, the proposed Act is a bid to stifle the democratic and representative way in which our nursing council had been functioning; it had its flaws but it was representative at least.”

“The government wants to centralise control in education and now in this sector. The proposed draft gives enormous powers to the center. There is no mention of the ASHA workers or of the characteristic contribution of other front line workers. All of their thinking has gone into centralising control and power,” she added.

The COVID-19 pandemic has placed a significant burden of the care work on the shoulders of nurses and other front line healthcare workers. They have been been protesting for regulated norms of service and patient care, fixed details of nurse to patient ratio and a focus on working conditions. They now feel let down by the proposal.

Joldin Francis, general secretary of the United Nurses Association said: “While the proposed changes in education are welcome, we are alarmed about the way in which the character of the nursing council is being altered. It was fairly democratic and now we do not have the option of that representation. More importantly, the concerns of the nurses, like working conditions and the number of hours of work among other key concerns, do not find any mention.”

The draft of the Bill has been made available to the public for comments until December 6. Associations across the country have stated that they will follow up with the recommendations to ensure that the democractic character of the institutions is maintained.

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