Standards set for paramedics

People aspiring to be paramedics will now need to have hands on training for better job prospects. Union health minister Ghulam Nabi Azad on Wednesday released the National Occupational Standards for Allied Health and Paramedics which makes such training a must in the course module for healthcare skills sector.

The standards, ready for 15 out of 27 identified services, have been prepared by the Healthcare Sector Skill Council (HSSC) after a market survey and negotiations with various stakeholders, including government and private hospitals, small nursing homes and laboratories. The standards are not mandatory, but set the benchmark for good practices. This means that for the job of ward boy, technician or laboratory assistant, it will not be enough to have theoretical knowledge, but also practical training to provide better service to patients. 

"The standards are benchmark for best practices in the sector. So far we have had educational qualification as criteria for recruitment in skills sector. Now the criteria will be a performance-based," said Sanjay Chhabra, director of HSSC.

The health minister, while lauding the effort, said, that the government attaches high priority to skill development, aimed at creating productive employment. 

The standards are likely to gain more importance once the National Skills Development Corporation (NSDC) includes it as mandatory criteria while giving grants to training institutes. NSDC is a public-private partnership working as the nodal funding agency for skills sector in India.

Jobs for which standards have been set   Occupational standards have been released for the following jobs: general duty assistant, emergency medical technician-basic, emergency medical technician-advanced, vision technician, refractionist, cardiac care technician, radiology technician, medical laboratory technician, histotechnician, phlebotomytechnician, blood bank technician, dialysis technician, anaesthesia technician, operating theatre technician and diabetes educator. Jobs for which occupational standards are yet to be released: dental laboratory technician, dental hygienist, dental assistant, dietician assistant, basic/frontline health workers, home health aide, medical records and health information technician, pharmacy assistant and physiotherapy assistant.

"We have partnered with 12 institutions in healthcare sector. In near future, their funding will depend on meeting these standards," said S Ramadorai, chairperson, NSDC. NSDC will launch a pilot project next week for one month with two institutes which will look at implementation of the new standards.

HSSC plans to release standards for 24 services.

"There are many more services. But we decided to prepare occupational standards for 24, based on a market survey by Accenture Ltd. Out of these, standards for 15 have been finalised and released. Rest will also be released soon after comments from the stakeholders," said Chhabra.

Allied health professionals (AHPs),  however, do not welcome the move and believe this as a major dilution of their demand of proper regulation with greater involvement of the government.

"Without a legal mechanism the standards do not hold ground. Why would a training institute follow the standards if there is no regulation and fear of legal repercussions?” said Kaptan Singh Sehrawat, general secretary of Joint Forum of Medical Technologists of India, an umbrella organisation of AHPs in India.  “A report of the Public Health Foundation of India (PHFI), an advocacy group, in December 2012, had recommended establishing a regulatory mechanism by an Act of Parliament for uniform standards across the country, that would have to be mandatorily followed. Other recommendations of PHFI report have also not been considered while preparing the standards," said Sehrawat. 

AHPs are demanding a government body to look into setting up of standards rather than agencies with corporate backing. Many of the services of which standards have been released, do not find mention in government jobs—emergency medical technician, for example. It seems that the standards have been lifted from those of other countries, instead of tailoring them to the healthcare needs in India, they say.

Huge shortfall of professionals

The demand to regulate allied health sector has been growing in India. A Bill to this effect was initiated in 2007. But before it could be passed general elections took place and the Bill got dropped. A new Bill, the National Commission for Human Resources for Health Bill was tabled in the Parliament in August, 2010. But in November 2012, the Bill was rejected by the Parliamentary Standing Committee on Health and Family Welfare.   

The gap in need and availability of such professionals is glaring in India. The PHFI report had estimated that the country needs more than 6.5 million allied health professionals (AHPs) against the available 300,000. This data is disputed as these professionals are not registered with any agency. But no one denies that there is huge gap in demand and supply.
 

Demand-supply gap
Discipline	Demand	Supply	Gap
Opthalmology	145,236	17,678	127,558
Rehabilitation	1,862,584	40,265	1,822,319
Surgical & intervention	205,088	7,215	197,873
Medical laboratory	76,884	15,214	61,670
Radiography & imaging	23,649	4,352	19,297
Audiography & speech	10,599	3,263	7,336
Medical technology	239,657	3,587	236,070
Dental Assistance technology	2,048,391	6,243	2,042,148
Surgery, anaesthesia	862,193	4,050	858,143
Miscellaneous	1,074,473	181,511	892,962
Total	6,548,754	283,378	6,265,376
Source: Public Health Foundation of India, 2012

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