National Medical Commission: Moving Indian healthcare from the frying pan into the fire

Failure of a democratic MCI to regulate the medical industry does not justify a draconian body made up of babus.
National Medical Commission: Moving Indian healthcare from the frying pan into the fire
National Medical Commission: Moving Indian healthcare from the frying pan into the fire
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The Medical Council of India has failed in its duties and deserves to be scrapped, says the Committee appointed by the Government to study the Indian Medical Council Act and suggest reforms. It then agrees with the Parliamentary Standing Committee’s report that lists the MCI's failures:

1. Failure to create a curriculum that produces doctors suited to working in Indian context.

2. Failure to maintain uniform standards of medical education.

3. Devaluation of merit in admission, particularly in private medical institutions.

4. Failure to put in place a robust quality assurance mechanism.

5. Failure to produce any standardized summative evaluation of the medical graduates and post-graduates

6. Failure to create a transparent system of medical college inspections and grant of recognition or de-recognition

7.Heavy focus on nitty-gritty of infrastructure and human staff during inspections but no substantial evaluation of quality of teaching, training and imparting of skills.

On all these criteria, few can fault either Committee's observations. The MCI is as venal and corrupt as any government organization though it is an autonomous body. The MCI was once called a den of corruption by the Delhi High Court. Many of its members have faced graft charges. The private medical college lobby is thought to have a stranglehold on the MCI and its money power is believed to dictate the actions of the MCI. That the MCI has failed in its duties and needs major reform is something that most in the medical profession in India will agree.

But is the government's proposed National Medical Commission(NMC) Bill, 2016, the answer?

The Government constituted a Committee to study the Indian Medical Council Act and make recommendations for reform. How many Medial professionals did this committee have? None.

The Committee comprised of PK Mishra, Additional Principal Secretary to Prime Minister, Amitabh Kant, CEO, NITI Aayog and B.P.Sharma, Secretary, Department of Health and Family Welfare.

How this Committee of three IAS officers was qualified to recommend such radical changes on the workings of the healthcare industry and medical education without having a single medical member on the committee is beyond comprehension. (The government did something quite similar with the Committee on the New Education Policy as well and so this may well be a style of functioning where the views of IAS officers are given more importance that that of experts in the respective fields.)

Let us for a moment ignore the lack of medical representation on the government's expert committee and look at what is proposed in the draft NMC Bill. The most important recommendation is the scrapping of the MCI and replacing it with an NMC. The problem is that this is not an elected NMC. It is a government appointed, nominated NMC.

The fundamental reason to oppose the NMC Bill is that it takes away the healthcare and medical education industry's right to self-regulate. The right of self-regulation of healthcare and medical education by elected professionals belonging to the healthcare industry is sought to be usurped by the government.

Would the government similarly scrap the Bar Council of India and the Institute of Chartered Accountants of India and replace them with nominated bodies made up of its babus?

There is no denying that self-regulation through the MCI has largely failed and there is a need for radical reform, but is the solution taking away the right to self-regulate? And is there any evidence at all that a government organization made up of nominated bureaucrats will be more efficient or less corrupt than the MCI?

One of the Committees says that the MCI elections have involved the use of money and have allowed the wrong kind of people into the MCI. But then so have the Parliamentary and Assembly elections. Yet we do not seek to replace our election process with nominations to the Parliament and State Assemblies. If elections are not free and fair, the solution is to ensure they are, through the necessary reforms, and not replace them with a nomination process. Replacing a democratic process however flawed it is with an autocratic one with very few checks and balances where the regulated have no say in the matter is just wrong.

The Draft Bill says that the Committee that shall choose the Chairman of the National Medical Commission will have one doctor among 5 members. So the Government believes that 4 non-medical people will choose a better candidate to run healthcare in the country than medical experts can. (Cabinet Secretary, NITI Ayog Chairman, Health Secretary, one law/economics/management member and one medical member make up the selection committee.)

The draft NMC bill says that the Chairman of the NMC shall be a doctor and there shall be 4 boards envisaged. Shockingly, none of the presidents of these boards needs to be a doctor. Someone with a degree in public health or health research can be nominated to a board. So one can have a person who has never studied medicine sit as the President of the Under Graduate or Post Graduate Medical Education Board of the NMC. Similarly, a non-doctor could as President of the Board for Medical Registration decide on what is professional misconduct or who should be allowed to register himself as a doctor.

This is not merely an issue of having more doctors in the NMC. Even if they did include more of them the process of Government nominating all the members and controlling the functioning of the NMC means that it will end up as just another Department of the Ministry of Health.

There are issues related to the NEET exam, the exit exam for medical graduates, the removal of the fee cap on private colleges allowing them to charge what they want and many other matters in the draft NMC Bill on which there must be a wider debate. But the fundamental issue is not in what the brief of the National Medical Commission is. It is about whether a democratically functioning autonomous body made up of industry experts to regulate healthcare and medical education in India (however flawed it may be) should be replaced by a set of nominated government bureaucrats with very little Industry participation and say.

The MCI certainly needs radical change but the NMC Bill in its present form is unjust and discriminatory and violates the medical profession’s right to be regulated by his own. The government would do well to rethink the basic structure of the Bill. 

Note: The views expressed here are the personal opinions of the author. 

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