Among other legislations, the Parliament passed the National Medical Commission bill during the current session. What are the main features of this bill and why are doctors across the country protesting against this legislation? Here is an explainer.
On Monday, 29 July 2019, the Lok Sabha passed the National Medical Commission Bill. Even though it was initially tabled in the Lok Sabha in December 2017, it faced stiff opposition and was then sent for scrutiny to the parliamentary standing committee of Health and Family Welfare. The standing committee submitted its report in March 2018. The Bill finally lapsed with the culmination of the first term of the NDA Government (2014 to 2019). The Bill was again tabled by the Union Health Minister, Dr. Harsh Vardhan, in the current Lok Sabha following the resounding victory of NDA and was later passed. The Bill was then approved in the Rajya Sabha on 01 August 2019. The passing of the bill sparked widespread protests by the medical fraternity. But why is the medical fraternity protesting? We try to explore the pros and cons of the bill in this story.
This bill annuls the Indian Medical Council Act of 1956 and was introduced with an objective to make quality medical education more accessible and affordable. It also aims to attain universal health coverage by making healthcare equitable. Further, adoption of latest technology for medical research and conducting periodic and transparent assessment of medical institutions are also a part of the objectives.
25 Member National Medical Commission will replace the Medical Council of India
As per the bill, a 25 member National Medical Commission (NMC) will be superseding the Medical Council of India (MCI) to regulate the medical education in India and the profession. MCI was tainted with scams and there were charges of corruption pressed against its members. The MCI had also been accused of not being transparent. It was later dismissed and replaced by a Board of Governors appointed by the Union Government. The members of NMC will be appointed by the Union Government on the basis of the criterion listed in the bill. The members of the NMC should also declare their list of assets and liabilities at the time of taking charge and at the time of leaving the office. A Medical Advisory Council will also be set up as a part of this bill which will then function as the primary platform for representation of States and Union Territories and also make recommendations to the NMC.
NEET and NEXT are two important examinations proposed in the Bill
The Bill also proposes two important exams- National Eligibility cum Entrance Test (NEET) and National Exit Test (NEXT). NEET shall serve as the common entrance test for admission to the undergraduate medical education in India. NEXT on the other hand is a common final year undergraduate medical examination that will serve as the primary means for granting licence to practice as medical practitioners and for enrolment in the State Register or the National Register irrespective of the country from which the student has cleared their graduation. In other words, any person with a foreign medical qualification also has to qualify NEXT for the purpose of obtaining licence to practice medicine instead of the Foreign Medical Graduates Examination (FMGE).
NEXT will also be considered as the qualifying exam for postgraduate broad- speciality education while NEET will be considered for admission to post graduate super-speciality education. Further, it has also been mentioned in the bill that the NMC will frame guidelines for the determination of fees for half of the seats in private medical colleges.
Autonomous boards to recognize & monitor Medical Education
In order to monitor medical education and practice, the Bill proposes the recognition of four autonomous boards:
- Under Graduate Medical Education Board (UGMEB) – to regulate the undergraduate level of medical education including determining UG level education standard, framing curriculum, devising standards for the examinations and the course, training of faculty among other things.
- Post Graduate Medical Education Board (PGMEB) – to regulate the postgraduate level of medical education with duties similar to that of UGMEB but at the postgraduate level.
- Medical Assessment and Rating Board (MARB) – to ascertain a procedure to carry out assessments and rating of medical institutions in accordance to compliance with the standards which are laid down by the above education Boards, grant more medical seats as per the conditions mentioned in the bill and conduct inspections of medical institutions.
- Ethics and Medical Registration Board (EMRB) – to maintain National Register of licensed medical practitioners in the country, ensure compliance with code of professional and ethical conduct and promote the same.
Taking into consideration the recommendations made by the parliamentary standing committee, amendments were made to the bill that was introduced in 2017. One major amendment was the removal of bridge course between AYUSH and Allopathy. Instead, the bill leaves it to the State Governments to take necessary measures for addressing and promoting primary health care in rural areas and to enhance the capacity of the healthcare professionals.
Limited license given to Community Health Providers
In order to make healthcare more accessible and to increase the number of medical practitioners, the bill has introduces ‘Community Health Providers’ (CHPs) who will be given limited license to practice medicine. Regulations on the criteria for selection of CHPs will be framed under this act. The number of CHPs should not exceed one third of the total number of licensed medical practitioners in the country. To tackle the shortfall of qualified doctors, countries like USA & Canada, allow nurse practitioners and healthcare providers to practice primary healthcare for delivering better and improved access. Individuals have to typically complete a Masters course in these countries to be a nurse practitioner. It remains to be seen if the criteria for recognition of a CHP would also include such a requirement.
Why is the Medical fraternity Protesting?
The medical fraternity seems to be protesting for multiple reasons. Below are some of the important ones.
Objection 1: More power has been given to the Union Government
The bill has been claimed to be ‘poorly drafted’ and ‘draconian’ by doctors across the country. They also claim that the bill gives more power to the Union Government. They further claim that the Central Government has the power to override the decisions made by the NMC. The Indian Medical Association (IMA) has stated that NMC will not only be a bureaucratic body but will also function like a department of the government. Unlike in the MCI where doctors (registered medical practitioners) could elect and make up almost 75% of the members, in the NMC, only 20% of the members can be elected by them. The representation from states and union territories is also less than before. States get a chance only every two years to be represented in the NMC.
Government’s Response: In defence of the government, former Union Minister & Rajya Sabha member Suresh Prabhu during the discussion in the Rajya Sabha stated that interference of the Union government in health care is because there are many villages in the country where that do not have well-trained medical doctors and that the people haven’t received proper health care. He also said that the central government doesn’t wish to ‘wash off its hands’ by not making it a priority and just by stating health is a part of the state list. He also stated that at the time of emergency, what matters is not whether the hospital is private or public but the availability of healthcare.
Further, the government stated that the clause giving powers to the Central Government to give directions on policy matters to NMC and autonomous boards is part of many other acts (even IMC Act).
Objection 2: Community Health Providers not clearly defined
Another criticism raised by those opposing the bill is the granting of limited license to CHPs, who are expected to make up for the shortfall of doctors in the country .The CHPs have not been defined clearly in the bill. It has only been mentioned that he/she should be someone connected with modern scientific medical profession and is permitted to prescribe certain medicines in primary and preventive healthcare and in other cases, under the supervision of medical practitioners. This has raised concerns among many since there is possibility of quacks legally entering medical profession. Congress’s Jairam Ramesh raised this in the Rajya Sabha and asked the government if this is about ‘Institutionalising quackery’.
Government’s Response: The NDA government justified this by stating that under the new institution, unless and until someone’s name is mentioned in the State or National Registry, he/she is not allowed to practice and this move will in fact help in eliminating quackery. The Minister went onto state that there is a provision for imprisonment if such rules are violated. He added that CHPs are necessary so that the ideal doctor- population ratio can be reached and to make primary healthcare available even in the remotest parts of the country. He mentioned a list of countries where such a system exists and that definition of a health worker is also given in Lancet etc. He assured the house that the NMC will decide on the regulations and qualifications for CHP after studying everything and that there should be no misgiving about it.
Fees of only 50% seats in private and deemed universities will be regulated
Privatisation of medical education is another important issue raised by the opposition, the IMA as well as the protesting medical practitioners, since guidelines for fee determination and other charges in private and deemed universities has been made only for 50% of the seats. Nothing has been mentioned with regard to the regulation/criterion for increasing intake in private colleges. The unregulated fees might exclude those who cannot afford it and make medical education affordable to only the rich. Another issue raised is about NEET and NEXT exams which require rigorous coaching in coaching classes that charge an exorbitant fee.
Government’s Response: Though the government did not specifically address all these issues, it stated that since the requirement of doctors is large, private medical colleges along with government colleges need to be encouraged.
Details of NEXT examination not given
A major concern for medical students in the uncertainty regarding the NEXT exam. The requirement to qualify this examination itself contradicts the bill’s objective to make more medical practitioners available all over the country to improve healthcare. In case, the candidate does not clear this examination, he/she will not be eligible to practice medicine in India. Five years of efforts and hard work will go unrecognised.
Government’s Response: Regarding NEET and NEXT, the government stated that these exams are student-friendly and will help students appear for one instead of different exams for different universities. NEXT covers final year exam, PG entrance and is a licentiate exam as well.
Although the bill seems to have been introduced with a good intention of improving the medical education, there are a few loose ends as explained above which need to be looked into carefully while implementing it.
Featured Image: National Medical Commission Bill