he NITI Aayog has sent its draft of a new
National Medical Commission (NMC) Bill 2016, which seeks to reform
medical regulation in India. It is important that in participatory
democracy we should have professionals self regulating them. The NITI
Ayog, in this bill, is mentioning about replacing the current Medical
Council of India (MCI) with a primarily nominated team with bureaucrats
ruling the roost. Let us examine the arguments advanced by the NITI
Aayog for this change.
It says that the medical council has given
recognition to private medical colleges which are distributing degrees
for money. This is because the Government allowed mushrooming of private
medical colleges in the last three decades to supplement its efforts to
increase the seats of medical graduates for capacity building. The
permission to grant license to run medical colleges is given by the
State governments, and then by the Central government. It is also said
that the private medical colleges do not pay attention to merit, and
enroll students to earn capitation fee. This also has been overtly
helped by mushrooming of deemed universities, which hold their own
examinations and indulge in unfair means to take candidates. These
deemed universities are the crux of the whole problem, and they are
given permission not by the medical council but by the University Grants
Commission (UGC). In fact majority of the medical colleges and deemed
universities are owned and run by politicians. It is pertinent to point
out that changing from an elected model to a nominated model may not
cure the problem, but may actually worsen it. We know that there is
rampant corruption in all departments of the government, but does that
mean we replace the elected Prime Minister and the Parliament by a
nominated one. Also, the whole system has become gutless and spineless
with very few bureaucrats having the wherewithal for out-of-the-box
thinking and ability to resist the pressures.
The reforms in medical education have been long
overdue. We need to examine that meritocracy takes the front seat.
Towards this end, the introduction of National Eligibility cum Entrance
Test (NEET) will make a tremendous change, but then it has to be
implemented with a missionary zeal and not piece meal. There should be
no ifs and buts about admissions through the NEET. This will ensure that
the graduates who come out of all institutions are of the same caliber.
Also, minimum standards should be maintained and not lowered in any
circumstance even on the request of the government.
There is an urgent need to beef-up the public health
system. For long, the public health system has languished and the space
abdicated by the government has been occupied by the private players. We
need to realize that the quality of care delivered in the public system
is far from desirable. The government should increase the budget spent
on health and education so that fewer people need to access the private
facilities. If the primary care is good, there will be less need for
tertiary care centers.
The NMC Bill proposes a new authority to register and
monitor doctors, and regulate medical education; the argument being that
with the MCI mired in controversy and accusations of corruption for
years, this is a much-needed reform. This argument is fascicle as it is
like throwing the baby out with the bath water. What we need is tougher
regulations and more funding for the medical education. We need more
postgraduate seats and more seats in branches like family medicine. The
new bill has not suggested any solutions but has just debunked the MCI
and replaced it with a new set of people. No proper consultation was
done involving various professional organizations, and picking their
brains for coming out with credible solutions. The report has no
insights of the regulatory systems of other countries and provides no
clues to the way forward. In our country, discretionary quotas and
nominations have always led to corruption and nepotism. Thus, the
process of electing representatives is far more transparent and
participatory. The qualifying criteria are nebulous and ambiguous that
makes the case for misuse in the future easy. As far as regulatory
mechanisms and ethical issues are concerned, we need to be more open to
suggestions and all proceedings should be held in a transparent and open
way.
There is another myth being propagated that the
doctors are not ready to go to rural areas. It is important that we
incentivize the young doctors for going to the rural area. There are
hardly any posts advertised for the doctors, and we have a huge number
of educated unemployed doctors – running to over a hundred thousand –
who are preparing for their post graduate examinations. It is quite
evident that the Government has failed to provide healthcare for large
chunks of the population. The out-of-pocket expenditure on the health of
the community is one of the major factors for the circle of poverty in
our country. The government should provide healthcare and security to
each and every citizen in the country, and then only things will
improve.
The commercialization of health is due to the
inability of the government to provide basic health care. Let us hope
that with the new government we will have more allocation to health
budget and better support to the crumbling public health system, and the
need for commercial and private facilities will come down. Another thing
the government should realize that the Ministry of Health is the
ministry for both the private and public sector, and it should sit down
with the private sector to find out-of-the-box solutions to improve the
health system in the country.