Mid level providers will be trained to augment primary care: Dr Vinod K Paul, Member, NITI Aayog

Dr Vinod K Paul

National Medical Bill will reform medical education. There is misconception about mid level providers among a section of medical fraternity that it will encourage quacks, but I assure everyone that it won’t do so, said Dr Vinod K Paul, Member, NITI Aayog, Government of India while delivering speech at Healthcare Summit Jharkhand recently held in Ranchi.


He further said there is no bridge course for Ayush in the Bill. “Mid level providers by definition is above the nurses and below the doctors and specialists. ANM, nurses would get extra trainings. We will be empowering those who are above nurses,” Paul said.

‘Mid level providers augment doctor led team’

It is proven facts across globe that mid level providers augment doctor led team to boost care delivery system. In several European countries, mid level providers are a norm. We don’t have such mechanism in place because our rule doesn’t allow so. We are not creating barefoot doctors. We are not certifying quacks. We will be providing extra trainings to mid level providers thereby equipped her to provide first line of treatment for diabetes and other diseases. It is needed to fill human resource gap in the wake of shortage of doctors across country.


‘Jharkhand witnessing progress in healthcare’

Though Jharkhand is a new State, it has lots of potential. The State is making big strides in the leadership of Chief Minister Raghubar Das. We are also trying to contribute to the Jharkhand’s healthcare delivery bandwagon, which is evolving in unprecedented manner.

One of the biggest healthcare protection scheme Ayushman Bharat was launched from this State last year.  Jharkhand has witnessed tremendous progress on this front, leveraging the scheme to create affordable model of healthcare.

We are working to further accelerate the programme and trying to resolve issues like harmonisation of packages and its rates. Our objective is to reach last-mile through the programme.

Jharkhand along with Andhra Pradesh and Haryana witnessed incremental progress on different healthcare indicators in Niti Aayog’s health index. It proves that one can accomplish things with his grit and determination.

‘Resource should be optimally used’

We need to ensure that available resource should be optimally used to improve deliverables in healthcare.

I agree that more money is needed to resuscitate healthcare sector. Healthcare sector should get eight percent allocation of total GDP in every state, as per our national health policy. There should be 2.5 percent GDP allocation on health. But the Centre is responsible for only one third of the total 2.5 percent. States should contribute to rest of the two third portions. We should aim to reach this target by 2025 and for that States need to increase budget by eight percent.

‘More health for money is equally important’

It means that we should ensure that available resources should be used in prudent manner. Our government gives us the opportunity to translate resources into achievements. Jharkhand has outperformed in terms of resources as well.

Challenges of healthcare sector

Human resource is a major challenge in healthcare. Infrastructure like bed ratio is another constrain.  One bed is available per 3,000 people in our country. It should be improved to 1 per 1,000. As per National Health policy there should be two bed per 2,000 people.

We together need to deliberate on how to improve healthcare infrastructure both in public and private sector in the State. Private investment is needed in both secondary and tertiary care if we want to improve our record on infrastructure front. Ayushman Bharat has emphasized on one India and one model of healthcare including public and private–primary, secondary and tertiary care. Pro people approach drives both public and private sector. Jharkhand needs support of private sector to boost healthcare delivery mechanism.

‘Single window opportunity is needed to give clearance’

Investors want no hassle on front of clearance and if they find lesser number of windows in other States then they opt for that.

Healthcare is important sector as it opens avenue of jobs, increases survival of our children, and serves country in creating a healthy society. One bed paves path for four jobs.

Primary Care

Primary care is another important area which needs to be focus upon. It is primarily the responsibility of a State. Human resource is available in primary care, based on nurses.

We have announced that all sub centres would be developed as wellness centres. Nurses would get bit more extra trainings. Mid level providers are part of the team who contribute to bolster primary care. Sub centres are not deficient of HR. Primary care should be unleashed.

Primary care doesn’t put extra load on exchequer and considered cheap comparatively. We already have nurses, technology, and plenty supply of medicines. We need to ponder on ‘plan of action’ to accelerate primary care.


Being cost effective, telehealth has huge scope today. Jharkhand can study Andhra model for the same. If the State Government feels that satellite communication could be helpful apart from broadband services, we can work on it through ISRO.

Poshan Abhiyan

Poshan Abhiyan is equally important which aims to end malnutrition, stunted growth, and anemia. The State should also prioritise this.  Asha workers should spread awareness on how to feed small children.




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