The much-awaited Kerala Public Health Bill 2023 is just one step away from becoming law. Billed as a game-changer, it will consolidate and unify the existing laws relating to public health in the state.
The Bill that envisions “proactive and reactive” measures in matters that affect public health, also gives priority in preventing and controlling emerging diseases, and existing communicable and non-communicable diseases.
But on the flip side, the Bill has resulted in the state’s public health sector becoming a divided house as it opened a new front between modern medicine and the AYUSH sector. All thanks to certain provisions, as also vaguely worded sections of the Bill.
Modern medicine vs AYUSH
On one side of the conflict is the state chapter of the Indian Medical Association (IMA), representing modern medicine. Standing opposed to it is the AYUSH Aikyavedi, a platform that brings together Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy.
As IMA sees red because 0f the government’s “last-minute changes” in the Bill to include the AYUSH sector, the latter says that their demands have not been fully met.
With AYUSH Aikyavedi planning to take up the matter with the state government, sparks could fly between them and the IMA.
Awaiting the Governor’s assent
It was on last Tuesday, 21 March, that the Kerala Public Health Bill 2023 was passed in the eighth session of the 15th Kerala Legislative Assembly.
However, the Bill was passed without any discussion as the CPI(M)-led government decided to cut short the legislative business and adjourn the House indefinitely, following protests by the Opposition.
The Bill, which now awaits the Governor’s assent to become an Act, will supersede the two acts — Madras Public Health Act, 1939 and the Travancore-Cochin Public Health Act, 1955 — which currently govern the public health sector of the state.
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First draft dominated by modern medicine
What irked the AYUSH sector most was a provision that mandated only a “registered medical practitioner of modern medicine” could certify a person as free from communicable disease or notifiable communicable disease.
Another one was the constitution of the State Public Health Authority (SPHA), the District Public Health Authorities (DPHA), and Local Public Health Authorities (LPHA). These were included in the first draft of the Bill.
As per the first draft, the SPHA, DPHA, and LPHA will be headed by officials representing modern medicine and it would have the power to issue directions on public health matters, to any department of the government.
While the AYUSH sector questioned the legal validity of the issuance of a certificate only by a registered medical practitioner of modern medicine, it also objected to the name “Authority” as it sounds “authoritative” — contrasting with AYUSH practitioners, who would be deemed as not being authoritative enough.
They instead suggested a “Committee” comprising representatives of AYUSH, other departments, and people’s representatives.
The changes to the first draft
Eventually, these two provisions were changed in the final draft after the matter was taken up with the government.
Regarding the issuance of the certificate, it was amended to state that “a registered medical practitioner” — irrespective of which medical system one represents — could certify a person as free from communicable disease or notifiable communicable disease.
In the case of the formation of the SPHA, DPHA, and LPHA, it was amended make them State Public Health Committee (SPHC), District Public Health Committees (DPHC), and Local Public Health Committees (LPHC).
“Suspense was there regarding the very inclusion of AYUSH in these committees and giving the right to issue the certificate. It was a meeting attended by Chief Minister Pinarayi Vijayan, Assembly secretary MM Basheer, Parliamentary Affairs Minister K Radhakrishnan, MLA Mathew T Thomas, and others, which finally decided to include AYUSH,” a source told South First.
It is learned that the meeting considered the opinion that the Bill, without AYUSH representation, might become ultra vires as it will come into conflict with a Centre legislation — the National Commission for Indian System of Medicine (NCISM) Act, 2020.
Section 34 (c) of this Act, which mentions the rights of persons to practice, guarantees the right to a duly qualified medical practitioner to sign or authenticate a medical or fitness certificate or any other certificate required by any law.
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‘A result of constant intervention’
As the AYUSH sector celebrates the recognition it has been accorded in the Bill, Dr Sadath Dinakar, chairman, legal committee, of the Ayurveda Medical Association of India (AMAI), told South First that they had to earn it.
“It is an irony that even though the AYUSH is a recognised system, we had to knock at the door of the government to include us also in the Public Health Bill. We earned that recognition. But we are not at all satisfied,” said Dr Dinakar.
According to him, the AMAI had sent representations to all concerned reminding them that overlooking AYUSH might have repercussions.
“The first draft of the Bill was nothing but a blatant violation of the existing Union laws. It violated the provisions of the NCISM Act and the Indian Medicine Central Council Act of 1970. If the government had not considered the AYUSH system, it would have resulted in a legal battle,” said Dr Dinakar.
‘The fight is not over yet’
According to Dr Abhil Mohan, treasurer of AYUSH Aikyavedi, public health is not the prerogative of modern medicine and it is disheartening that the AYUSH sector had to fight for even consideration.
“To discriminate between practitioners of modern medicine and AYUSH is unjust,” he contended.
“Ours is also a recognised system of medicine. But unfortunately, when the first draft of this Bill came out, the AYUSH sector was given the cold shoulders,” Dr Mohan, who is also the general secretary of the Siddha Medical Association of India, told South First.
He added that it was at this juncture that a decision was made to form AYUSH Aikyavedi to bring the sector’s concerns and suggestions to the government’s notice and to coordinate the fight for “acceptance”.
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Some of the concerns that still exist with the Bill, as pointed out by the AYUSH sector, include making the Director of Health Services the State Public Health Officer and vesting them with a lot of powers; absence of the role, duties, and power of the SPHC, DPHC, and LPHC; not appointing a protocol committee for framing the guidelines for treating various ailments by including representatives from the AYUSH sector and others.
Earlier, five of the 15-member Assembly Select Committee, which examined the Bill in detail and held discussions with experts, stakeholders, and citizens before finalising it, had undersigned a dissenting note. In it, the members expressed concern over giving excessive powers to the LPH Officer and overlooking other systems of medicine in the preparation of treatment protocols.
The Aikyavedi is now in the process of drafting representations to the chief minister and health minister to bring clarity to these aspects and define the role of the AYUSH sector.
‘No lab tests in AYUSH; no treatment for communicable diseases’
At the same time, the IMA has vehemently stated that AYUSH cannot be considered part of the public health system.
Dr Sulphi N, state president of IMA, told South First, “There is a campaign by AYUSH practitioners that they have the right to certify a person as free from communicable disease or notifiable communicable disease. But that is not possible. They were intelligently excluded.”
He further added, “It has clearly been stated that a registered medical practitioner who treats a person for communicable or notifiable communicable diseases could certify him/her as free from the same after considering examinations, including lab tests.
“There are no tests in Ayurveda or Homoeopathy. Also, these parallel systems of medicine lack treatment for communicable diseases, like the plague and rabies, and notifiable diseases like Japanese encephalitis.”
He also alleged that the state government had to yield to a certain extent due to the bullying by AYUSH practitioners at various platforms, including at the meetings convened by the Assembly Select Committee.
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Journey of the Bill
The demand for a unified Public Health Bill has been there for some time now. The first step towards making this demand a reality was taken on 4 October, 2021, as the first draft of the Bill was published in the gazette. Then, on 27 October, 2021, the Bill was presented in the Assembly.
On the same day, it was sent for the consideration of the Select Committee. The committee then held six meetings in Thiruvananthapuram, Ernakulam, Kozhikode, and Kottayam districts to elicit suggestions and opinions. It was on 13 March, 2023, that the final draft was approved.
The Bill touches upon various aspects, including emerging diseases related to climate change, zoonoses, lifestyle diseases, antimicrobial resistance, safe food, water and sanitation, and others.
Ensuring the one-health approach in all aspects, it also gives priority to senior citizens, women, children, and migrant laborers.