Gaps in medical reforms remain
Despite its best intentions to introduce sweeping reforms in medical education in India, the National Medical Commission (NMC) Act, 2019 seems to fail in addressing the larger issues plaguing the medical education and health sector.
The Act aims to improve access to quality and affordable medical education, and ensure availability of adequate and high quality medical professionals in all parts of the country. The Act in practice repeals the Indian Medical Council Act, 1956 and replaces the scam-tainted Medical Council of India (MCI), which was dissolved in 2010 following corruption charges against its president Ketan Desai by the Central Bureau of Investigation (CBI).
In place of the MCI, the government is now setting up an NMC that will have responsibilities ranging from approving and assessing medical colleges, conducting common MBBS entrance and exit examinations and regulating medical course fees.
While the NMC has merely organizational differences from its predecessor MCI, the provisions of the Act don’t show a way of bringing in any fundamental change in the way the medical education in India is imparted, though it certainly changes the process of admissions, awarding of degrees and licencing for practice.
“The NMC Act is unlikely to harbinger a fundamental change in the way medical education is provided in India or effectively address the rural–urban imbalance. The issue of variable duration of ‘bonds’ arbitrarily enforced by the states and medical institutes needs to be redressed on a priority and logically standardized. It is unfair on a young doctor to have grossly different policies in different states under the garb of federalism or institutional immunity. Emoluments to interns, residents, and fellows also vary severely and need to be made more uniform,” said Santosh G. Honavar, former associate director at L.V. Prasad Eye Institute in Hyderabad.
Academicians and health experts claim that although the bill has taken into account undergraduate medical education (MBBS), it has completely ignored post graduate studies. “The Act does not address the ills of postgraduate education at all. Standard national curriculum and uniform teaching, surgical training and infrastructure standards for residency training, and a postgraduate board examination or a national exit examination to ensure uniform standards can be governed by the empowered subspecialty boards. The abolishment of 2-year postgraduate diploma and awarding of a uniform 3-year postgraduate degree is a crying need,” Honavar said.
A paper published in 2018 the Indian Journal of Medical Ethics, titled The National Medical Commission: More of the Same, stated that replacing the unwieldy MCI with a more compact NMC does not guarantee the end of corruption. And having a number of nominated members does not guarantee excellence, it said, adding that regulatory capture by private colleges which are ready and able to pay bribes will continue to be a threat.
The paper said that if India really wants to provide high quality medical care service for every citizen, it urgently needs to have a clear idea about the health human resources required, decide how to set up the requisite number of training institutions, have clear policies for employment and remuneration of the graduates of these institutions, decide on the resources required to make this possible in a realistic time scale and take the states along in planning.
“There is a major urban and rural divide when it comes to availability of doctors. The doctor population is concentrated in the urban areas. While there are several private practitioners in urban areas, rural areas are devoid of basic health facilities. It is not clear as to how these issues will be addressed. NMC can also involve in corruption. Even when people are excellent, there can be serious corruption issues,” said Arup Mitra, professor, Health Policy Research Unit (HPRU) at the Institute of Economic Growth in Delhi.
The Act doesn’t have any provision to equalize or improve the doctor-patient ratio. Instead, it proposes a controversial idea of bringing in community health providers to combat quackery. According to the Act, the Community Health Provider may prescribe specified medicine independently, only in primary and preventive healthcare. But in cases other than primary and preventive healthcare, the provider may prescribe medicine only under the supervision of medical practitioners registered under sub-section (1) of section 32. The provision has drawn flak from the medical fraternity and triggered nationwide strikes.
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