MCI : NMC Bill Analysis

The National Medical Commission Bill was referred by the Lok Sabha to a Parliamentary Standing Committee for a re-look after countrywide protests by the Indian Medical Association, the Bill.
The issues with Medical education
  • Can India produce enough competent doctors to meet its evolving health-care challenges?
  • Can India minimise opportunities for rent-seeking in medical education and practice?
The problems of MCI
  • The Medical Council of India (MCI) was mired in allegations of bribery and going soft on unethical doctors.
  • Under its stewardship, the medical curriculum grew obsolete, resulting in a cadre of MBBS doctors who frequently couldn’t perform basic procedures.
  • This led to a rush among MBBS doctors to specialise, competing for a small number of post-graduation seats. Today, India neither has enough basic doctors, nor specialists.
How different is National Medical Commission from MCI ?
  • National Medical Commission (NMC), intended by policymakers to be a dynamic regulator responsive to India’s needs.
  • In contrast with the MCI, which does everything from advising universities on curriculum to disciplining errant doctors, the NMC distributes powers among four autonomous boards — those for undergraduate education, postgraduate education, medical assessment and rating, and ethics and registration.
  • Also, unlike the MCI, the commission includes non-doctors like patient-rights advocates and ethicists, in line with the medical regulators of the U.K., Australia and Canada. These are all steps in the right direction.
What are the issues with new body?
  • The problem with NMC bill is in how it chooses the members of the new regulator.
  • The authors of the NMC bill, a committee headed by ex-vice chairman of Niti Aayog, Arvind Panagariya, argued that the electoral process through which MCI members were picked was fundamentally flawed, because conscientious doctors tended to avoid such elections.
  • Because there was no bar on re-elections, this had created a revolving door through which the same group of members controlled the MCI for years.
Bad precedents
  • Sometime around 2008, Gujarati urologist Ketan Desai was elected MCI president, even though he had been prosecuted in the Delhi High Court for abusing power as president in 2001. Further, corruption charges against Dr. Desai and his team led to the MCI being disbanded in 2010.
  • The NMC Bill’s solution to the pitfalls of the electoral process is for the central government to select most of the commission’s members. But this would tip the scales towards bureaucracy, say experts.
  • Such political hold on the commission is especially problematic given the close ties that private medical colleges in southern India have with politicians.
Independence of the body
  • Another option to keep the NMC free from political influence is for an independent body like the Union Public Service Commission to select its members.
  • Such a model is followed in the U.K., where the Professional Standards Authority oversees the selection of members to the General Medical Council.
  • Whatever route the NMC takes, it is critical that its members are professionals of high integrity, something that isn’t ensured in the current Bill.
Does NMC Bill address rural health care needs?
  • The NMC Bill misses an opportunity to plan for India’s rural health- care needs in the coming decades. It eases regulations to set up private medical colleges; a move that will hopefully produce more doctors.
  • As of today, India has one doctor for 1,700 people, compared to the WHO norm of 1:1,000. Most of these doctors are in urban regions, while close to 70% of Indians live in rural provinces.
  • A 2015 Parliamentary Standing Committee report mentioned that even if India were to add 100 medical colleges per year for five years, it would take till 2029 to achieve the WHO prescribed ratio.
  • Even in States like Tamil Nadu, which has successfully attracted doctors to rural primary health centres (PHCs), tribal regions like Sittilingi are underserved and rely heavily on informal health-care providers.
  • India must think of quicker fixes to the doctor shortage instead of waiting for MBBS doctors to fill the gap.
Is training of non-doctors a good idea?
  • Several sub-Saharan countries have successfully addressed this problem by training non-doctors in basic medicine and even surgery. Such non-doctors include nurses, or even informal health-care providers, often referred to as quacks.
  • A 2016 study published in Science magazine showed that nine months of training led to a marked improvement in the ability of informal providers in West Bengal to correctly manage chest-pain, respiratory distress and childhood diarrhoea.
  • International organisations like Médecins Sans Frontières and Red Cross have endorsed training programmes for non-doctors to carry out critical surgical procedures like caesarians and intestinal resections.
  • Evidence from countries like Mozambique and Thailand shows that such training can be a safe, effective and cheap way to provide life-saving health care when no doctors are available.
  • Chhattisgarh attempted to create a cadre of rural doctors in 2001, through a three-year programme. Even though the Indian Medical Association has strongly opposed such ideas, they cannot be off the table, given the evidence backing them.
  • It is time to recognise that MBBS doctors may not be the best means of health-care delivery in isolated parts of rural India.

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