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Unhealthy practices

We need political will to reform our ailing medical education system. Sujatha Rao writes.

india Updated: Jun 23, 2011 20:59 IST
Sujatha Rao
Sujatha Rao

There is dismay and concern among the medical fraternity regarding the membership of the reconstituted Medical Council of India (MCI). Rumo-urs are afloat that most members don't meet the capability or integrity criteria and that once again we are failing to ensure due diligence and adhere to procedures for filling up positions in statutory authorities.

The increasing number of instances of clinical incompetence, disturbing absence of professionalism in patient care and deficit in ethical values among health providers prove that there is a need for a strong regulatory system. There is also a growing concern that under-staffed and unequipped medical colleges are churning out incompetent doctors.

Often crisis accompanied by a loss of public trust propel governments to act. In 2000 and again in 2010, the Central Bureau of Investigation indicted MCI president Ketan Desai for corruption. After Desai's arrest, a body of professionals replaced the MCI and a bill was drafted to set up the National Commission for Human Resources for Health.

According to the bill, the Commission would replace the three regulators governing medical, nursing and dental education and would help in setting standards, accreditation and governance of medical practice.

In the the above context, Britain's example could be instructive. In 2000, the General Medical Council (the regulator) lost public confidence after the death of several children due to poorly trained doctors. After this incident a series of measures were undertaken to strengthen the regulatory system like earmarking half of the 24-member GMC with lay members, and more importantly, all 24 being appointed by the Public Appointments Service Commission (like our UPSC) to insulate the GMC from political control; tightening regulatory oversight on undergraduate and post-graduate education by instituting legally mandated officers as supervisors; laying down what the doctors need to know; revamping the UG/PG curriculum and the system of supervision/examination/evaluation. Thus while medical schools can innovate, draw up their curriculum and expand courses for undergraduate education, the GMC has the residual power to withdraw the power of granting degrees from deviant medical schools.

Moreover, the inspection teams now have members from different disciplines and such teams comprise deans of medical schools, general practitioners, hospital superintendents, public health specialists, students and people involved with health policy. In India, inspection teams comprise two or three persons selected by the MCI president. The Council for Health Regulatory Excellence (CHRE), an overarching body to oversee the functioning of the nine regulators governing healthcare, was also set up.

We need to learn from Britain's reform process. There must be institutional arrangements to oversee the quality of medical education. Moreover, experts and lay persons must be involved at every level since in this country all power is concentrated in the hands of the MCI (read president) who often operate in an authoritarian manner.

The GMC, on the other hand, functions through a professional team of administrators and over 14 committees constituted for various aspects of regulation.

The much-needed reform process in medical education has been a disappointing story in India thanks to well-entrenched vested interests. We need political consensus to reform this system. Till that is obtained and the hedge does not stop eating its own crop, India will continue to be treated by doctors who are below par.

Sujatha Rao is former secretary, ministry of health and family welfare.

The views expressed by the author are personal.

First Published: Jun 23, 2011 20:55 IST