Let’s give new healthcare Bill a chance
Those opposing the NMC Bill must rise to the occasion, see its merits and help improve it than stopping its passage in toto. Actual implementation and functioning of the Bill cannot be determined now; only time will tell
The overhauling of the Medical Council of India (MCI) is underway in earnest. The Union Cabinet has approved the successor body, the National Medical Commission (NMC), which now stands the scrutiny of the Rajya Sabha Standing Committee on Health and Family Welfare. This later protracted debate, agitation and bitter contentions on the Bill from the entire spectrum of stakeholders.
The most strident voice against the NMC has come from the Indian Medical Association, the largest conglomerate body of doctors of India. Their objections include a loss of autonomy for running the profession, an ill-thought bridge course proposal for alternate medicine practitioners to get licenses for allopathic practice, Government intrusion and opacity in decision-making that will embody the NMC as a result thereof. While most objections carry merit in their contentions, equally so, many are also fears that are being propounded prematurely.
The advent of the NMC must be taken into historical context. The Medical Council of India, established in 1933, was the statutory body responsible for regulating medical education and professional licensing for doctors in India. The body was envisaged to be a self-regulating entity that was run by doctors for the interest of doctors and medical education in the country. The sordid unfolding of scandal, scams, corruption and the stark fall in standards of medical education has left a legacy that needed urgent and widespread reforms. While many may disagree on the nature of the successive body, there is unanimity on the need to dissolve the MCI in its current avatar.
Initial piecemeal steps at reform were attempted by successive Governments but to little avail. The need for radical reform was deemed to be the only suitable way forward. Prof Ranjit Roy Chaudhury Expert Committee Report became the basis of the NMC — a larger umbrella body with an expanded mandate. The mandate now includes licensing of doctors, regulating undergraduate and postgraduate medical education through separate bodies, entrance and exit examinations, assessment of medical colleges, monitoring professional conduct and exerting appellate authority powers over State medical education boards. This onerous mandate was rightfully divided over multiple bodies which ensured that the NMC was more nimble and its decision-making not left to any monolithic power centre or cabal.
The NMC is contoured to create a widely representative and consensus-driven organisation. The NMC will have a secretariat and Medical Advisory Board (constituted by States and Union Territories, comprising of doctors). Each of the four boards —Under-Graduate Medical Education Board, Post-Graduate Medical Education Board, Medical Assessment and Rating Board and the Board for Medical Registration — will find representation in the NMC.
Nominees (of rank no less than Joint Secretary) from the Health Ministry, Human Resource Development Ministry and the Directorate General of Health Services, five members to be nominated by the Union Government and five rotating members from the Advisory Council. Qualification criteria for the NMC Chairman and Board heads are stringent and nominees can only be doctors. With a clear intent, NMC is envisioned as an inclusive body made up of a mix of members from the widest possible institutions. However, the NMC architecture in the Bill and its actual implementation and functioning is one that only time can tell.
The NMC Bill will mark a radical move as it evolves from an elected body to a primarily nominated body. The ‘elected body model’ came under criticism, where the sanctity of the regulator, being made up of the regulated, was constantly under scrutiny. The new nominated model will take away some autonomy and equally, arbitrariness, that monolithic power centres in the erstwhile MCI came to embody.
Issues like bridge courses and Government oversight remain contentious. But amongst three broad reform options — piecemeal corrections, complete Government take over and a mixed model, the latter seems to be the most acceptable and is seemingly the essence of the NMC.
How this new body operates can only be determined with time. The Government has taken a consultative view of the final makeup of the body by asking for stakeholder representations on the Bill. One must use this avenue to get a better Bill, but not protest to stop the NMC in toto. This will not serve the interests of medical education and the fraternity but only ingratiate vested interests that have brought medical education to its nadir in the first place.
(The writer is general manager, Operation and Public Affairs, Indraprastha Apollo Hospitals. He can be reached at firstname.lastname@example.org)
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