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Not the bill we need

The health sector in India is at a crossroads. In the recent past, there have been

  • Over the years, in spite of repeated amendments, the functioning of the MCI never reached a satisfactory stage.

24-arun-bal-week Dr Arun Bal

The health sector in India is at a crossroads. In the recent past, there have been numerous incidents of regulatory failures and controversies, leading to an environment of distrust between society and doctors. The bill approved by the cabinet to replace the Medical Council of India (MCI) with the National Medical Commission (NMC) is likely to complicate matters further.

Indian health sector is unique. It has many indigenous disciplines of medicine, each with a separate regulatory system. Therefore, trying to correct one of them while tinkering with others is not likely to work. Regulation of the medical profession in India started with the establishment of the MCI as a statutory body in February 1934, under the Indian Medical Act, 1933. This act was repealed in 1956 and replaced with the Indian Medical Council Act, 1956.

Over the years, in spite of repeated amendments, the functioning of the MCI never reached a satisfactory stage. There have been numerous complaints of corruption, and of recognition and revalidation of medical colleges with poor infrastructure. In 2015, the NITI Aayog was entrusted with finding a solution and it proposed the formation of the NMC.

The NMC bill envisages a multi-tier structure with an advisory council consisting of 64 members selected or nominated by the government. Selected members of the NMC include “experts” from administration, law, science, research and consumer organisations. The commission, which will be selected by a search committee headed by the cabinet secretary, will have four autonomous boards for fulfilling the current functions of the MCI.

The bill proposes to make the recognition of medical colleges easier and to remove revalidation. It also allows recognised medical colleges to start new courses without prior permission of the regulator. This is a major shift which is likely to create a plethora of courses by private medical colleges without proper supervision and infrastructure. For the first time, the regulator will have powers to decide the fee structure. However, the bill allows the NMC to regulate the fees of only 40 per cent of the seats in private medical colleges.

The bill proposes an exit exam for all graduates, supposedly, to create medical graduates with the same level of competence. This will make the MBBS exams almost redundant. Another feature of the bill, which is likely to have detrimental consequences in the long term, is the deletion of section 15 of the medical council act, which allows only modern medicine graduates to practise modern medicine. This change will allow AYUSH and homeopathy graduates, whose practice is governed by separate acts, to practise modern medicine without adequate training. The bill is silent on the role of state medical councils and hints at allowing more private entities (read corporates) to start medical colleges.

It is true that the manpower situation in the Indian health sector is dismal—20 per cent of the requirement. Statistically, 14 to 15 per cent of pregnant women need a caesarean. That means nearly 5.2 million caesareans per year. To do that, we need 2 lakh gynaecologists. We have 50,000, if not less. We need two to three million additional nurses. The attrition rate among the nurses across the country is 45 to 50 per cent. There are only about 2,000 cardiac surgeons for a population of 1.3 billion. The lack of adequate manpower in the health care sector at present is a result of private medical colleges being sanctioned by the government two decades ago. The government has practically withdrawn from medical education.

It is true that the increasing government control over the medical profession is a result of the failure to self-regulate. The NMC bill is being touted as a solution for the ills of medical education and practice. However, it is more likely to make medical education more elitist, depriving candidates from poor economic backgrounds the opportunity to join the medical field.

The author is former convener, ethics committee, Medical Council of India.

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