The healthcare system of India is always in the news for the wrong reasons. Most of our rural and poor population is denied good quality healthcare leaving them with the quacks. Despite being top in the area of pharmaceuticals, information technology, medical tourism, etc, India still lags when it comes to healthcare. Along with the quality and availability of healthcare, India is facing a shortage in the number of doctors as well. India has a doctor-patient ratio of 1:1596. This means, for every 1000 people seeking medical treatment, there is less than one doctor (0.62). The situation is worse in rural areas.

There must be equipment, manpower and other facilities to deliver good results in the medical field. But the corruption levied MCI, which was first constituted in 1934 to oversee medical education and its implementation throughout the country, has failed to provide and fulfil the needs of the medical community. For the past nine years, the need for a more transparent governing body has been a sentiment echoed throughout the medical community in the country. Now, with the introduction of National Medical Commission Bill, the government hopes to find a solution and bridge the gaps in the healthcare system of the country. Though the parliament and Rajyasabha have passed NMC bill, the practising doctors are still opposing the bill. What could be the possible reason? Will the new governing body be able to fix the gaps in public healthcare?

What is NMC Bill?

The NMC Bill provides for the formation of a National Medical Commission (NMC) to replace the Medical Council of India (MCI). The Bill seeks to improve the medical education system in the country by ensuring availability of adequate and high-quality medical professionals, periodic assessment of medical institutions, adoption of the latest medical research by medical professionals and an effective grievance redressal mechanism.

Main highlights

*National Medical Commission– As we mentioned earlier, the NMC bill accounts for the formation of a National Medical Commission, both at the national and state level, within three years of the passage of the legislation. The National Medical Commission will have 25 members, appointed by the central government. A Search Committee, which will have seven members, will recommend names to the Centre for the post of chairperson, and the part-time members of the NMC. All the seven members of the Search Committee, including the five experts, will be nominated by the Centre. The bill will frame policies for regulating medical institutions and medical professionals and frame guidelines for determination of fees for up to 50 per cent of the seats in private medical institutions and deemed universities which are regulated under the Bill.

*Medical Advisory Council – Apart from forming a Medical Commission, the bill also has a provision for setting up a Medical Advisory Council by the Centre. This council will act as a channel through which the states/Union Territories can convey their views and concerns to the NMC.

*Bridge course – One of the biggest changes which the NMC Bill will bring about is the introduction of “bridge courses.” It is a known fact that in India, several rural areas lack adequate staff or facilities at the local health centres. To ‘bridge’ this gap, the government proposes that dentists, AYUSH and homoeopathic practitioners, paramedical students and others, be allowed to take a six-month crash course in practical medicine. On completion, the trained students could be allocated the post of the doctor at these healthcare facilities. Would this fill the gap in the system? Yes. Would there be the quality which is needed? Doubtful.

*NEXT– First conducted in 2013, National Eligibility cum Entrance Test (NEET) managed to replace the AIPMT as the entrance exam to several medical courses in India. But, NEET has also come up with a lot of controversies. According to several people, the introduction of NEET placed students of marginalised communities at a significant disadvantage since they didn’t have access to the same coaching material and preparation centres as other students. Following the confusions and protests, the government has decided to introduce NEXT. NEET is to continue as the entry exam and even institutes like AIIMS. The bill has a provision for making uniform national standards in medical education. The Bill proposes final year MBBS exam as an entrance test for Post Graduation (PG) courses in the same field. This test will be a screening test for students got a graduation degree in medicine from foreign countries.

What is worrying doctors?

Though both the houses and president have given the nod to the NMC bill, doctors across the country are still expressing their concerns over the bill. The nation-wide protest against the bill has been the main headlines in the media over the past few months. Let us take a look at the concerns of doctors.

1) Section 32 of the bill authorises the government to allow non-medical degree holders to practice medicine as community health providers. This provision has been vehemently opposed by the Indian Medical Association. According to the IMA, this will legalise quacks in the country. The IMA claims that this will allow anyone with limited exposure to modern medicine in the country to prescribe medicines. Section 32 will allow 3.5 lakh Community Health Providers to practise modern medicine.

2) The doctors and the doctor bodies also raise concerns on the mode of electing the representatives in NMC. At present, 70% of representatives in MCI are elected members. But when it comes to NMC, only 20% of the members would be the elected representatives. Also, there was an allegation that the non-elected members will be government officials or those nominated by the government, giving the bureaucrats full control on the functioning of NMC.

3) Doctors have also concerns regarding NEXT, the single national-level exit exam to issue licenses for doctors. They claim that giving too much weightage for a single exam can harm the career of medical aspirants.

4) The doctors across the country also have counter-argument on the decision of the commission to “frame guidelines for determination of fees and all other charges in respect of fifty per cent of seats in private medical institutions and deemed to be universities”. They say that it increases the number of seats for which private institutes will have the discretion to determine fees. At present, in such institutes, state governments decide fees for 85 per cent of the seats.

What changes and what doesn’t?

The NMC has been introduced with a view that it will do away with the existing corruption in the Indian medical field. In comparison to MCI, NMC’S functioning differs in many ways, while there are few similarities as well. Here are some of the differences and similarities between NMC and MCI.

• Members- While MCI had 100+ members, NMC will only have 25 members in the committee.
• Re-nomination- MCI members could be re-nominated or re-elected. But NMC members nominated by the central government Cannot be renominated.
• Decision- In MCI fifteen of 100+ members were enough to make a meeting and its decisions valid while for NMC, it will be 13 out of 25.
• Tenure- The MCI tenure was five years, while the NMC tenure will be four years. MCI had to meet at least once a year while the commission has to meet every quarter.
• Appointment- Nearly 70% of the 100-plus member MCI were elected members were elected. But a majority of the representatives of the NMC would be nominated by the central government.
• Assets- Unlike MCI, the members of NMC will have to declare their assets at the time of assuming office and when they leave. They will also have to submit a conflict of interest declaration.
• No jurisdiction over AIIMS- Like MCI, NMC also will have no jurisdiction over the various AIIMS, JIMPER or PGI in almost all matters.

Implementation

Implementation of the bill is the most tricky phase. Implementing the clauses of the bill needs proper planning and timely interpretation. Here’s how the government is planning to implement NMC.

• The National Medical Commission will have four autonomous boards. Graduate Medical Education Board, Post Graduate Medical Education Board, Medical Assessment and Rating Board and Ethics and Medical Registration Board. These boards will ensure a dynamic and modern educational environment, decreasing the emphasis on physical infrastructure, achieving the norms in global standards and an effective grievance redressal mechanism.

• The Medical Assessment and Rating Board will grant permission for new medical colleges, starting of PG courses and increase of seats based on the standards set by the UG and PG boards.

• Greater representation to elected members through State Medical Councils has been provided in the Medical Advisory Council and the Commission. The strength of Autonomous Board has been increased from 3 to 5 and it includes 2 part-time members. One of them will be a doctor selected by the Government and the other will be an elected doctor from the State Medical Council.

• The annual renewal permission for new medical Colleges before recognition is being done away with.

There is no denying that medical education needs continuous reforms to usher in improvements in health care. There cannot be just one solution. The success of any legislation depends upon how it is implemented and interpreted. Last few weeks have been witnessing the battle between the government and the medical fraternity over the NMC bill. While at present, the doctors have announced the withdrawal of strikes, many issues remain unresolved, which means the future of the medical education and treatment of our country is still unclear.

Source: TOI, Indiatoday, ET Health, Insights on India, Citizen matters, The Hindu, The News Minute, In-Depth.