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The National Medical Commission Act: Travesty Of Reform

Union Minister for Health and Family Welfare Harsh Vardhan hailed the passage of the National Medical Commission (NMC) Act as historic and path-breaking and claimed that the legislation represented a visionary reform in medical education and marked an important achievement under Prime Minister Narendra Modi’s leadership. The new Act repeals and replaces the Indian Medical Council (IMC) Act of 1956, under which the Medical Council of India (MCI) was constituted. The NMC will now be the apex body governing medical education in the country, instead of the MCI, which apparently followed corrupt practices.

Yet the new Act does not even begin to address the issues that it is avowedly meant to correct. The medical community has been protesting against the legislation, which it believes will legitimise quackery: the Act provides for community health providers (CHPs) who will fill the gaps in public health care caused by the shortage of registered doctors.

The NMC Act, which has been passed by both Houses of Parliament, is aimed at providing “a medical education system that improves access to quality and affordable medical education, ensures availability of adequate and high quality medical professionals in all parts of the country, that promotes equitable and universal health care that encourages community health perspective and makes services of medical professionals accessible to all citizens, that promotes national research health goals; that encourages medical professionals to adopt latest medical research in their work and to contribute to research; that has an objective periodic and transparent assessment of medical institutions and facilitates maintenance of a medical register for India and enforces high ethical standards in all aspects of medical services; that is flexible to adapt to changing needs and has an effective grievance redressal mechanism….”

It provides for the appointment of a full-time chairperson who would be a medical professional of “outstanding ability, proven administrative capacity and integrity, possessing a post-graduate degree in any discipline of medical sciences from any university and having experience of not less than twenty years in the field of medical sciences of which ten years would be as a leader in the area of medical education”. The chairperson can be, therefore, from any university, even a private one. The NMC will have 10 ex officio members and 14 part-time members from State governments. However, the number of part-time members was increased to 22 following interventions in Parliament regarding equitable representation for States. On the same ground, Clause 4(4) b was also amended. Originally, six part-time members were to be appointed on a rotational basis from among the nominees of the States and the Union Territories to the Medical Advisory Council (MAC), an advisory body constituted by the Central government whose chairperson would be the chairperson of the NMC. This number was increased to 10.

Under the NMC Act, the MAC is the primary platform through which States and Union Territories “may set forth their views and concerns before the Commission and help in shaping the overall agenda, policy and action relating to medical education and training”. The amendments also increased the number of nominees representing State Medical Councils from States and Union Territories from five to nine.

Prelude to NMC

The prelude to the NMC effectively began five years ago with the setting up of a committee headed by Professor Ranjit Roy Choudhary to examine the ills of medical education. The committee concluded that the MCI had become a highly corrupt body incapable of regulation as it was constituted from within the medical fraternity. It recommended that independent regulators be selected through a transparent process. A Parliamentary Standing Committee that looked into the issue noted the dismal state of the health infrastructure, the exorbitant out-of-pocket expenditure of patients and the corruption in medical education, and recommended that the MCI should be wound up. It also recommended that the deficit in health care and medical education be supplemented by private players. It did not recommend a pivotal role for the government in affordable and equitable health care or medical education and, instead, emphasised that the MCI should be replaced by a new body. The government wasted no time in coming up with a Bill to effectively replace the MCI. The Bill was placed before another Parliamentary Standing Committee whose recommendations, the government claims, have been more or less accepted. – Front Line

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