With a single-page notification issued late last month, the Union Ministry of Health and Family Welfare (MOHFW) has finally repealed the Indian Medical Council Act 1956. The much-maligned Medical Council of India (MCI), which had been constituted under the Act, has thus been consigned to history. This marks a watershed moment in a long and tortuous process that began as far back as 2010.
Another notification published in the government of India Gazette the same day announced the members of the National Medical Commission (NMC), which is intended to replace the MCI as the main regulatory authority of the medical profession. This includes the entire gamut – practising doctors, undergraduate and postgraduate medical studies, opening of new medical colleges and maintenance of proper educational standards in existing medical colleges.
Until now, all these responsibilities were vested with the MCI, which had become vitiated and ineffective on account of corruption and malpractices at various levels. The impact of this change for the worse was felt right down the line, with dubious private medical colleges being recognised by the MCI. Hence, the MCI was severely criticised by the Supreme Court as well as the Parliamentary Standing Committee for Health & Family Welfare, both of which felt that the Council needed to be replaced.
The Union government’s efforts to revamp the MCI had begun in 2010, but assumed a concrete form only in 2016. That year, the government published a 35-page document setting out the structure of the National Medical Commission in considerable detail (see Editorials, Business India: August 15-28, 2016). Under the apex body, the NMC would comprise of four verticals: the Board of Undergraduate Medical Education, the Board for Postgraduate Medical Education, the Medical Assessment and Ratings Board and finally, the Board for Medical Registration.
Yet, the legislative document faced strong criticism from a number of professional bodies including the Indian Medical Association (IMA). In a November 2018 interview to Future Medicine magazine, the IMA secretary general, K.K. Agrawal said his main opposition to the proposed legislation was that it would replace a democratically elected body, namely the MCI! The intrinsic merit of the NMC held little meaning for the IMA chief.
Others have pointed out as well that the NMC would largely comprise of bureaucrats or medical professionals nominated by the government. Another was that most of its members would be drawn from the various cadres of government doctors, including professors of government medical colleges. An example of this is Suresh Chandra Sharma, the retired head of the department for ENT surgery at AIIMS, New Delhi, who has been named NMC chairman for the next two years.
Among the other members of the apex body are the Director General of Health Services, Director General of ICMR (Indian Council for Medical Research), Executive Director of AIIMS Gorakhpur, and Director of Tata Memorial Hospital, Mumbai. Leading lights from reputed private hospitals and professional bodies such as FOGSI (Federation of Obstetrics and Gynecology Societies of India) have been ignored altogether.
Interestingly, the presidents of nine state-level medical councils have been nominated as ‘part-time members’ of the NMC. This implies that while the MCI has been dissolved, its state counterparts are still in existence. There could be two reasons for this. Firstly, though the NMC has been constituted, the state-level medical commissions have not been formed.
Secondly, health is a concurrent subject, each state government would have to pass its own piece of legislation to match and support the central Act. As the experience with Ayushman Bharat has shown, several state governments may not cooperate with the Centre. Till that is sorted out, the new arrangement would become fully functional.
The last and final point is this. Bureaucrats and government doctors are as vulnerable to corruption as medical people elected to the erstwhile MCI. Hence, the government may soon have to amend the primary Act to build safeguards to prevent this from happening. The people responsible for recognition of medical colleges, for example would have to frame suitable rules and regulations.
Besides, the NMC will have to be allocated sufficient funds to appoint its own inspectors for medical colleges, both new and old. Otherwise, the NMC may soon suffer from the same deficiencies as the organisation it has replaced.
In such a case, the entire decade-long effort would be an exercise in futility.