Blackboard and scalpel

Health ministry blunders again in regulating medical education


Sonal Matharu | November 19, 2012

When the central bureau of investigation (CBI) arrested the then head of the medical council of India (MCI) and the don of medical education in India, Ketan Desai, on corruption charges in 2010, the health ministry had a golden opportunity to bring in much-needed reforms in the system.

On the other hand, the health ministry also fought a hard battle with the human resource development ministry for not letting medical education slip from its hands.

But on October 30 the health ministry faced a major setback when the alternative it presented through the National Commission for Human Resources in Health (NCHRH) bill was rejected by the parliamentary standing committee on health and family welfare that was reviewing it.

Headed by Rajya Sabha MP Brajesh Pathak, the committee noted that the ministry should present a fresh bill including concerns of the states and other stakeholders. It is alleged that the ministry went ahead with the bill despite serious objections from the states. The state medical councils also expressed their displeasure publically on several occasions, but the undeterred centre went ahead its own way.  

Proposed in 2010, the NCHRH bill proposes setting up a national commission, an overarching body that would subsume the MCI and the councils for pharmacy, dentistry and nursing. Soon after the bill was introduced in the Rajya Sabha on December 22, 2011, it was referred to the standing committee.
Had the NCHRH bill sailed through, the states and the councils would have been left with no say in the matters of medical education, though medical education is a concurrent subject. They would have become mere dummies in the overarching decision making body left to do only clerical work like maintaining doctors’ registries and ensuring that the medical professionals follow medical ethics.

Inspecting and giving licence to medical colleges would have gone in the hands of the proposed commission. The problem here is that as per the existing Acts, the councils are bodies of elected representatives from states, medical universities and practising doctors, whereas the commission was proposed to include 12 members and a chairman and all of them would be nominated by the centre. This commission would have had the ultimate decision-making power. All state medical councils met in Delhi in February and unanimously opposed the bill saying it would bring bureaucratic intervention which is unwelcome.

Another major concern is that while the bill includes regulation of nursing, paramedics and pharmacy, it leaves out one of the most important branches of medicine – the Indian systems of medicine. AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) councils are not part of the NCHRH bill and the ministry’s excuse is that there will be a separate bill regulating them. As per the World Health Organisation (WHO), AYUSH caters to 65 percent of the healthcare needs in rural India. Meanwhile, criticising this piece of legislation the national councils for Indian systems of medicine are glad to be left out.
Tabled just months after MCI was exposed and found to be mired in corruption, the health ministry’s ambitious bill suggested measures for anything but fixing the loopholes in the system that encourage illegitimate practices. The structural changes in the bill are based on no analysis of what went wrong with the MCI. Instead, whatever little democratic system of operating MCI had would become history with the NCHRH bill.

One of the members of the standing committee, who doesn’t want to be named, had suggested to this writer earlier that there was no need to replace the elected councils with a nominated body. The problems that emerged in the MCI can be easily fixed by amending the existing Indian Medical Council (IMC) Act under which the MCI was functional before it was dissolved. The government only needs to fix the term of the council presidents and add a clause wherein the health ministry has the power to take things in its control when needed. “There can be a separate regulatory body over the councils, but that should not disturb the present structure and functioning,” the member had said.

The ministry has time till May 2013. The extended term of the body of governors of MCI will end on then and if the ministry does not find a workable replacement for regulating medical education, it may lose face in public again, leave aside the embarrassment in parliament.

In May this year when parliament was in session and the ministry had to present its case as to what action it has taken to put the MCI back in motion, it had no alternative but to plead with the MPs for an extension of the term of the body of governors till 2013 to run the show for the entire nation. Now with their alternative rejected, the ministry can either present a fresh bill that keeps everyone happy or it can revive the MCI with amendments in the IMC Act.
Till any decision is taken, medical education will continue to hang in limbo.




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