Background Note on National Nursing and Midwifery Commission Bill, 2023

Background

  The National Nursing and Midwifery Commission (NNMC) Bill, 2023 was first proposed by the Government of India in November 2020 and is getting introduced by the Ministry of Health and Family Welfare (MoHFW) in the Parliament during this Monsoon Session. The Bill proposes to remove the currently governing Indian Nursing Council (INC) Act, 1947, and replace it with a National Nursing and Midwifery Commission. The INC Act currently is responsible for ensuring the educational standards, minimum entrance requirements, and prescribing curriculum for nursing courses. ^[1]   However, nursing and midwifery professionals in the country are facing several challenges due to a lack of educational qualifications. Furthermore, the uneven distribution of nursing institutes and the gap in the quality of teachers and nursing curriculum subjects these professionals to a lack of opportunities and forces them to out-migrate to different fields or to the private sector. This has resulted in an acute shortage of nursing staff i.e., 17 nurses per 10,000 population in the country.^[2] In order to address these issues NNMC Bill 2023 aims to propose regulation and maintenance of standards and quality of education and services provided by midwives and nurses. Along with the regulation of standards and quality of nursing services, the envisaged Commission would also assure pre-registration of education, maintain Central Registers and State Registers, assess institutions, prescribe entrance requirements for nursing curriculum, and would also standardize the nomenclature to the International Standard Classification of Occupations.^[3]        

Constitution and Functions of Proposed National Nursing Midwifery Commission (NNMC)^[4]

 

• The Chairperson of the NNMC would be appointed by the Union Government based on the ranks of eminent nursing and midwifery professionals.

 

• Further, the Commission would consist of members who have been the nursing advisor to the union government and military nursing professionals with the rank of additional director or above along with the three representatives from the Directorate General of Health Services, Indian Council of Medical Research and the National Medical Commission selected by the Union Government.

 

• On a biennial basis, the Ministry of Health of Family Welfare would also rotate ten nursing leaders, five each from nursing and midwifery service and educational institutes of excellence. A total of 26 eminent nursing experts would be nominated by the state or central governments. There would be a mandatory member from a charitable institution and an eminent personality from the relevant fields of health research or law and ethics who would be nominated by the Union Government.^[5]

 

• The Bill proposes the formulation of a Nursing and Midwifery Advisory Council that would be chaired by the NNMC chairperson. The overall function of this Council would be to advise the Commission on all functions. This council would also have members representing states and UTs from across the country and include the Chairman of the University Grant Commission and the Director of the National Assessment and Accreditation Council. The aim of this council is envisaged to provide a platform for all states and UTs to voice their concerns and opinions to advise the Commission and assist in the implementation of the common agenda, policies, and actions related to nursing services and training, and research.

 

• The Union Government would also establish four autonomous boards that would work under the NNMC’s administration. State Nursing and Midwifery Commissions would also be established in each state and these state commissions along with autonomous boards would work with the national commission to carry out all of its functions.

Major Functions of the Proposed Commission^[6]

  Some of the essential functions of the NNMC Bill will potentially be coordinated through four boards and state commissions which are:  

• The Commission would coordinate the common entrance exams for the undergraduate, postgraduate, and diploma courses for nursing and midwifery services.

 

• It would also regulate and maintain the standards for nursing and midwifery education along with prescribing the curriculum, assessment, faculty quality, and institutions. Along with prescribing and regulating the professional code of conduct of the concerned professionals.

 

• It would also ensure the rights and responsibilities of registered professionals and associates and provide mechanisms for receiving their complaints and grievance redressal.

 

• The Commission would also assess the requirements of nurses and midwives in the healthcare system and advise the government on the same.

 

• Regulating professional code of conduct and encouraging nursing and midwifery ethics.

 

• Regulate the limited prescribing authority for nurse practitioners (NPs) who have been granted requisite nursing and midwifery qualification criteria prescribed by the Post Graduate Education Board.

 

Concerns and Recommendations^[7]

 

• The proposed commission would not adequately represent the professionals of the relevant field and private sector. This underrepresentation of professionals from the field might impact the development and implementation of best practices of nursing and midwifery on the ground. Thus, the Bill needs to ensure that equal representation of nurses and midwifery professionals takes place.
• As per the proposed Bill, there could be a single standard for professional practice, as well as a common curriculum for all the national exit examinations and educational programs, which would establish a single national registration system. Therefore, the Bill needs to specify that even if the registration process is done at the state level, the license should be applicable throughout the country.

 

• The available text of the bill has no provision to regulate the nursing service conditions such as nurse-patient ratio, working hours of the concerned professionals, leaves and other benefits to them, their minimum compensation, etc. The Bill can potentially work to include the provisions of the International Labour Organization’s Nursing Professional Convention and add adequate provisions for regulating nursing service conditions.^[8]

 

• The available version of the Bill also misses out on the provisions to ensure the sustaining competency of nurses for the long term, like provisions of relicensing, continuation of education, minimum practice standards, competence review, etc. The requirement for relicensing of health professionals has become very crucial around the world, ensuring the upgradation of knowledge accompanied by practicing certificates. It would be beneficial if national standards for the competency of the nurses are well-established.

 

Conclusion

  The Bill addresses the long pending concerns of poor educational standards, the regional disparity in educational institutions for nursing services, the poor scope of practice, and gender-based discrimination in the concerned profession and brings hope for more than 33 lakh nurses and midwives in the country. The provisions of the Bill might also encourage the growth and autonomy of these professionals and would also ensure a dignified and sustainable workspace for them.         DISCLAIMER: The opinions expressed herein are entirely those of the author(s). Swaniti makes every effort to use reliable and comprehensive information, but Swaniti does not represent that the contents of the report are accurate or complete. Swaniti is a nonprofit, non-partisan group. This document has been prepared without regard to the objectives or opinions of those who may receive it.[NOTE: This bill analysis is prepared on the basis of information and materials available in media sources or the public domain only. The Bill is yet to be introduced in the Parliament, hence, the note will be updated as and when a text of the Bill is available]     [1] Ministry of Health and Family Welfare (2020), ‘Draft the National Nursing and Midwifery Commission Bill 2020’, accessed at: https://main.mohfw.gov.in/newshighlights-21 [2] Statista (2023), Density of healthcare professionals per 10,000 inhabitants in India in financial year 2021, accessed at: https://www.statista.com/statistics/1252937/india-healthcare-professional-density [3] Supra Note 1 [4] Ibid [5] Peter R., Sharma S. (2022), ‘National Nursing and Midwifery Commission Bill: Hopes and Challenges’, accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8121323/   [6] Peter R., Sharma S. (2022), ‘National Nursing and Midwifery Commission Bill: Hopes and Challenges’, accessed at:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8121323/ [7] Health Systems Transformation Platform (2020), ‘Feedback on the Draft National Nursing and Midwifery Commission (NNMC), Bill, 2020’, accessed at: https://www.hstp.org.in/wp-content/uploads/2020/12/midwifery-commission-bill-2020.pdf [8]                  International            Labour     Organization            (2005),     ILO          Nursing    Personnel                Convention             No.          149,         accessed                at: https://www.ilo.org/wcmsp5/groups/public/---ed_dialogue/---sector/documents/publication/wcms_508335.pdf