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Remedial measures for MCIBy Urvashi Prasad
Public Policy Specialist, Office of Vice Chairman, NITI Aayog

Twenty-four-year-old Ravi Rai woke up at Fortis hospital, Shalimar Bagh to find his left leg plastered instead of the right which he had fractured. Seven-year-old Adya lost her battle to dengue and as though that wasn’t enough her parents were subsequently handed over a massive bill running into lakhs of rupees.

Unfortunately, these instances of reported negligence or violation of medical ethics are not rare. The rot in the medical system runs deep and is epitomised by the Medical Council of India (MCI). The body has time and again been accused of corruption. On 23rd September, 2015, the Department-Related Parliamentary Standing Committee on Health and Family Welfare listed out the MCI’s multiple failures including the inability to maintain uniform standards of medical education as well as a non-transparent and ineffective system of inspecting colleges, among others.

In this context, the Union Cabinet’s nod to the National Medical Commission (NMC) Bill, 2016 and its subsequent introduction in the Lok Sabha is a significant step. The Bill was drafted by a four-member committee under the leadership of the Vice Chairman, NITI Aayog and subsequently modified by a Group of Ministers. The Bill broadly adopted the philosophy of a Report prepared by a Group of Experts under the leadership of the Late Ranjit Roy Choudhury, an eminent doctor. The Report was also endorsed by the Parliamentary Standing Committee.

A balanced and credible regulatory architecture

The MCI has been plagued by an inherent conflict of interest, with the regulated electing their regulators. This has also kept professionals who would be best suited for the job at bay.

Under the proposed NMC, regulators will be selected by a search committee chaired by the Union Cabinet Secretary. There will be representation from both medical professionals as well as experts from associated fields who can guide medical education in India towards global excellence. Further, in the spirit of federalism, a Medical Advisory Council will be constituted making States and Union Territories equal stakeholders in the delivery of medical education.

There are several crucial functions expected of an apex body governing medical education. To ensure that each of these functions gets adequate attention, the NMC Bill proposes the creation of four mutually independent and autonomous Boards, the activities of which will be coordinated by the NMC. The Boards will be responsible for regulating undergraduate education, postgraduate education, accreditation and assessment of institutions as well as ethics and registration.

A fundamental shift in regulatory philosophy and end of the Inspector Raj

The regulatory philosophy adopted by MCI is deeply flawed. Institutions are assessed based on their compliance to a pre-determined set of criteria focused largely on infrastructure or human resource inputs such as teacher salaries, the casualties being quality of teaching and learning outcomes. As a result, even if institutions meet all the infrastructural requirements, it in no way implies that they are delivering high quality education.

Instead of a heavy handed top-down regulatory mechanism that in reality fails to ensure quality, the Bill proposes that institutions should be made more accountable to citizens through the publication of ratings at periodic intervals. This would empower students to make an informed choice while also signalling to institutions with poor rankings that they need to step up their game.

National Entrance and Exit Examinations

Common entrance examinations for admission to undergraduate and postgraduate institutions will put merit ahead of the ability to pay capitation fee. It has also been proposed that a National Licentiate Examination shall become operational within three years from the date on which the NMC Act, 2016 comes into force.

Objecting to the proposal of a National Licentiate Examination, the president of the Indian Medical Association (IMA), Dr. K. K. Agarwal has stated that it will only add to the burden of medical students who have to endure a “long and tortuous academic career chequered with highly competitive exams”.

It is important to appreciate, however, that only a common exam upon completion of the undergraduate course can ensure that all doctors in the country have a shared minimum standard of knowledge and skills for delivering healthcare as per the current needs of the population. Being required to adhere to certain basic standards in a profession that deals with human lives is perhaps not asking for too much.

Enhancing the supply of medical professionals

As of March 31, 2017, there were 10.23 lakh allopathic doctors registered with the MCI or State Medical Councils. Assuming 80% availability, it is estimated that around 8.18 lakh doctors may actually be available for active service. This gives a doctor-population ratio of 1:1613 against the World Health Organisation norm of 1:1000.

The NMC Bill includes several features that will provide more flexibility to medical institutions and increase the production of medical professions while also maintaining an unflinching focus on quality. Colleges will require only a one-time permission for establishment. They will also be able to increase the number of seats on their own up to a cap of 250 and start postgraduate courses. To encourage the entry of private colleges while balancing the interests of meritorious students who cannot afford the fees, the proposed Commission will be empowered to fix norms for regulating fees for up to 40% of the total seats.

The days of incremental reform are over. As the Bill navigates the legislative process it is imperative that the educated elite of the country vocalise their support for it. The IMA is already up in arms against the Bill and several other vested interests will also be at play. It is not good enough to express anger in our living rooms about the goings on at a Fortis or Max. We must use our citizen power and put our weight behind such reforms.
Disclaimer: The views expressed are personal.

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