Amidst widespread protests from doctors and medical bodies, the National Medical Commission (NMC) Bill, 2019, was signed into a law by President Ram Nath Kovind on August 8, 2019. However, it will only be clear in the future if the new legislation is successful in bridging the gaps that exist in the public healthcare system in India or will it merely dilute existing medical services due to many ambiguous clauses.
The NMC has been set up to replace the 63-year-old Indian Medical Council Act. According to the government, it will contribute to the development and regulation of all aspects of medical education, profession, and institutions. Important functions of the NMC include framing policies for regulating medical institutions and medical professionals, assessing the requirements of healthcare related human resources and infrastructure, ensuring compliance by the State Medical Councils of the regulations made under the Bill, and framing guidelines for determination of fees for up to 50% of the seats in private medical institutions and deemed universities.
National Medical Commission
The Bill provisions the setting up of the National Medical Commission (NMC). The NMC will consist of 25 members, appointed by the central government. A search committee will recommend names to the central government for the post of Chairperson and other part-time members. The majority of the members in the committee will be representatives of the central government which questions the inclusiveness and the federal structure of the committee. Under the Bill, the central government will constitute a Medical Advisory Council. The Council will advise the NMC. The Bill also mandates setting up of autonomous boards under the supervision of the NMC.
Community Health Providers (CHPs)
Under Section 32 of the Bill, the NMC may grant a limited license to certain mid-level practitioners connected with the modern medical profession to practice medicine. These mid-level practitioners may prescribe specified medicines in primary and preventive healthcare. The CHPs are being introduced to address the acute shortage of medical professionals.
The Indian Medical Association (IMA) has expressed serious concerns regarding this provision. According to them, the bill will give license to 3.5 lakh non-medical professionals. The move is being seen as giving importance to quantity over quality in healthcare services. Dr. Raja Brahma, Tutor, ESI-PGIMSR and ESI Medical College and Hospital, told BE, “Allotting CHPs as a substitute is not the solution to the problem of shortages of doctors in India. You cannot expect the same efficiency from community health workers.”
The CHPs are being trained to meet the lack of doctors in rural healthcare centres. But who will guarantee that the CHPs will work in villages only? What will be there to stop them from practicing in urban centres, which do not have shortage of doctors or from prescribing advanced drugs? There has been no mention of the authority which will be sanctioning license and certificates to these CHPs.
A report in the Journal of Family Medicine and Primary Care states, “As of 2017, 1.33 billion of Indian population is being served by 1.8 million registered medical graduates. So, the ratio is 1.34 doctor for 1,000 Indian citizens as of 2017. This means that India has already reached WHO norm of 1:1,000 doctor population ratio.” The absence of doctors in the rural health centres is primarily due to lack of infrastructure. The government should focus on creation of medical infrastructure in rural areas.
The Bill proposes a common final year undergraduate examination - the National Exit Test (NEXT) - and aims to introduce a single licentiate exam for medical graduates across the world. This test will also serve as the basis for admission into post-graduate medical courses. For the past few years, a separate NEET is being conducted for undergraduate and postgraduate courses. In addition, there are different examinations for institutes such as the All India Institute of Medical Sciences and the Jawaharlal Institute of Postgraduate Medical Education and Research. This Bill proposes to consolidate multiple exams at the undergraduate level and avoid multiple counselling processes.
Dr. Debkishore Gupta, Head of Infection Control (CMRI & BM Birla Heart Research Centre), told BE, “Presently there are differences in examination patterns among medical universities and this adversely affects the quality of future doctors. The uniform examination system will definitely help in generating doctors with uniform basic knowledge and skill sets of an assured standard. Additionally, only one examination will automatically make the number of other entrances rudimentary and save resources and time.”
The Bill proposes to "frame guidelines for determination of fee and other charges" for 50% of seats in private medical institutions and deemed universities. Previously, the MCI did not have such powers. Currently, state governments determine fees for 85% of seats in such institutions and the rest are left for the management. According to medical professionals, this is further dilution of the power to fix fees where all 100% of seats may be available for the highest bidders, thereby increasing the cost of medical education. It is a reservation for the rich. For better quality healthcare professionals in India, the Bill should have introduced a feasible range of fees in private medical colleges.