T’puram: The Centre’s deregulation cell under the cabinet secretariat has placed two health-sector reform proposals before the state govt as part of phase II of the ‘Compliance Reduction and Deregulation’ initiative, part of ease of doing business. The two proposals (accessed by TOI) relate to simplifying interstate practice for medical professionals and streamlining the licensing framework for healthcare establishments. At present, medical practitioners registered in one state are required to obtain separate registration and, in most cases, a no objection certificate (NOC) to practice in another state. In Kerala, the regulatory framework is governed by the Kerala State Medical Practitioners Act, 2021, which empowers the state medical councils for modern medicine, Indian Systems of Medicine (ISM) and homeopathy to grant registration. Nurses must obtain registration under the Kerala Nurses and Midwives Act, 1953, through the Kerala Nursing Council, while paramedical technicians require registration from the Kerala Paramedical Council. A doctor registered in another state must therefore secure registration and/or an NOC before being permitted to legally practice in Kerala. The Centre has recommended that the state should consider allowing medical practitioners doctors, nurses and technicians who are registered in any state medical council or listed in the National Medical Register (NMR) to practice without requiring fresh registration or prior approval here. The arrangement may be based on self-certification, and the state need not seek an NOC from the practitioner’s previous state. The reform seeks to leverage the National Medical Register framework under the National Medical Commission (NMC) to enable seamless interstate mobility of healthcare professionals. “The proposal to make registration in one state valid in another can help address the shortage of doctors, particularly in rural and border districts. In areas such as Idukki, Palakkad and Wayanad, it could attract more doctors who are registered in neighbouring states. Registrations elsewhere are also granted after due diligence, so there is no reason to doubt their credibility,” said Kerala Govt Medical Officers’ Association (KGMOA) general secretary Jobin Joseph. Implementing this proposal would require a policy decision by the state govt and possible amendments to the relevant Acts and Rules governing registration and licensing. Any move to dispense with the existing dual-registration requirement would involve legislative changes and procedural adjustments by the respective councils. The second proposal addresses the multiplicity of licences required to establish and operate a healthcare facility in Kerala. At present, healthcare establishments must obtain approvals under multiple laws and regulatory regimes, including the Kerala Clinical Establishments Act, the Drugs and Cosmetics Act, the Biomedical Waste Management Rules, the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, the Surrogacy (Regulation) Act, 2021 and Rules, 2022, the Assisted Reproductive Technology (ART) (Regulation) Act, 2021 and Rules, 2022, the Food Safety and Standards Act for hospital kitchens, fire and safety NOCs, pollution control board consent and local self government trade licences. Even a standalone radiology centre may have to secure numerous clearances from different wings within and outside the health department.Under this reform, the Centre has proposed creation of a single nodal agency within the health and family welfare department to function as the exclusive point of contact for healthcare-specific approvals. This nodal body would coordinate with all relevant departments to secure licences, registrations and NOCs on behalf of investors. The proposal also allows for onboarding a third-party private entity to manage coordination functions against a fee paid by the healthcare establishment.“As for creating a single nodal agency for establishing hospitals or clinics, it can certainly ease procedures and encourage the setting up of new clinics and smaller hospitals, especially at a time when the healthcare sector is witnessing a significant influx of corporate players,” he added.
