Quantity Over Quality? How The NMC Bill Will Dilute Public Healthcare In India

For the past nine years, the need for a more transparent governing body has been a sentiment echoed throughout the medical community in the country. The Medical Council of India was first constituted in 1934 to oversee medical education and its implementation throughout the country. It was eventually disbanded in 2010 following proven charges of corruption against then-president Ketan Desai. Seven years after the MCI was dissolved, the National Medical Commission (NMC) Bill was introduced in the Lok Sabha in 2017, as a replacement to the MCI.

Doctors and members of the medical community have been outraged by the bill since its introduction. Will the new governing body be able to fix the gaps in public healthcare, or will it merely dilute existing services?

‘Bridging’ the gap in healthcare

To begin with, it’s important to address one of the biggest changes which the NMC Bill will bring about, and that is the “bridge courses.” Taking cognisance of the fact that several rural areas lack adequate staff or facilities at the local health centres, the government proposes that dentists, AYUSH and homeopathic practitioners, paramedical students and others, be allowed to take a six-month crash course in practical medicine. Upon completion, the students could be allocated the post of the doctor at these healthcare facilities. While it certainly would fill the gaps in the system and ensure that a staff member was available at these centres, it comes at the cost of the quality of the service provided. Take for example the extremely tragic incident reported from Nampally, Telangana earlier this year. Thirty-four infants were wrongly given an opioid painkiller tablet instead of paracetamol, which resulted in the death of two children. The drug was distributed by a non-medical staff member at an urban healthcare centre who confused the similar packaging of the two medications. And this is not the only such incident.

India is home to such a wide spectrum of medical care services: from private hospitals, which offer services which can only be termed as luxuries, to overflowing ICUs in state-run centres which lack even the most basic of necessities and there exists an extremely large gap between the two. While the “solution” to this proposed by the NMC would certainly ensure that public healthcare centers are more efficiently staffed, it would come at the cost of quality of care of the services. How will a mere six months of a course be enough to compensate for the years of study and extensive hours of clinical exposure which medical students undergo before becoming full-fledged consultants? It most likely will not.

NEXT vs NEET

The National Eligibility cum Entrance Test (NEET) was first held in 2013. It has managed to replace the AIPMT as the entrance exam to several medical courses (UG and PG) in India. However, it too has come with a lot of controversies. In the recently-held Parliamentary elections, the role of NEET played a significant role in the outcome of Tamil Nadu’s elections, after several incidents from the state had left people outraged about the mandatory implementation of the exam in the state. Several noted that the introduction of NEET placed students of marginalised communities at a significant disadvantage as they didn’t have access to the same coaching material and preparation centres as other students. With so much confusion and anger towards the existing exam, the Bill now wants to introduce the National Exit Test (NEXT). Students will be required to clear the NEXT exam in lieu of final year exams. Students who have completed a medical course abroad would also be required to take NEXT prior to being allowed to practice in the country. It also will act as an entrance exam for postgraduate courses. This again puts several thousands of students at a disadvantage, who would’ve otherwise been able to secure medical seats based upon their PUC marks.

Concerns about ‘legalised quacks’

With the introduction of the NMC, doctors are worried that more unqualified doctors would be legally recognised by the government as being able to provide allopathic treatment following the training period.

In addition, the Bill makes it harder for those from marginalised communities to be able to access or afford the same care available to someone who had easy reach, access and affordability to private healthcare services. The Bill will effectively cut off all access to quality healthcare services in a public healthcare stream, and will force more doctors to jump into the private sector.

By keeping quality healthcare unavailable to everyone, the Bill does nothing but encroach upon an individual’s basic right to avail standard healthcare services.  – The News Minute