Rajya Sabha MPs passed the NMC Bill yesterday. The law seeks to effect a major overhaul of medical education in India – most notably by replacing the Medical Council of India (MCI). “When history will be written… it will go down as one of the biggest reforms,” proclaimed Union Minister of Health and Family Welfare Dr Harsh Vardhan.
Earlier in the week, Lok Sabha MPs passed the bill by a voice vote despite significant criticism from opposition parties. MPs belonging to the Indian National Congress, Tamil Nadu’s Dravida Munnetra Kazhagam (DMK), and the All India Trinamool Congress staged a walkout in protest. The Lok Sabha is now set to vote on the Bill again, in order to approve two amendments proposed in the Rajya Sabha.
Even as the Bill has secured the support of most MPs, it continues to face significant opposition by India’s healthcare workforce and medical students. In recent weeks, protests against the NMC Bill have seen students create copies of the legislation in order to burn them in the street. Earlier in the week, doctors went on a 24-hour strike in protest of the Bill, forcing non-essential services to be shuttered. An indefinite strike is being threatened by aggrieved doctors should the Bill become law.
“This is an obsession with centralisation of power”
Criticisms of the Bill are varied. Its controversial replacement of the MCI with an appointed board of 25 governors to constitute a National Medical Commission has been a major issue of contention. At present, two-thirds of the MCI membership is elected by members of the medical fraternity. Steering away from this mechanism to a system of government appointments is being perceived by many as a means of centralising power. Fears have also been expressed about the potential for corruption – the weeding out of which is the ostensible purpose of supplanting the MCI.
“It is [a] complete abandonment of federalism and autonomy of medical education,” opined Professor T. Sundararaman, dean of the Tata Institute of Social Sciences’s School of Health Systems. Outlining the power which would be wielded by the government in this regard, Sundararaman observed that “the Centre would appoint everyone in all these important bodies and even adjudicate on dismissals. Bureaucracy will have a much upper hand.”
He also noted that power was being stripped from the states, with a Medical Advisory Council consisting of one member from each state and union territory being established, with Commission members also sitting on the Council in an ex officio capacity. This, Sundararaman said, means that “states have been reduced to mere advisory roles from being in governance mode. Why do all the members of the commission need to be ex-officio members of the advisory board? Just because they are appointed by [the] central government? This is an obsession with centralisation of power.”
“The issues at the heart of the NMC Bill cannot and should be ignored. Rooting out corruption from the medical fraternity is imperative. However, the question of whether centralising power in the hands of the government serves as the best avenue towards achieving this is a legitimate one.”
Similarly, the proposal to allow the likes of physiotherapists and alternative medicine practitioners to be assimilated into the mainstream healthcare workforce through six-month-long “bridge courses” has been extensively criticised. “If the government is looking to introduce [homoeopathic] and AYUSH [Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy] practitioners into mainstream healthcare, they shouldn’t go about it by introducing bridge courses which will allow these doctors to practice in the same way and prescribe the same medications as allopathic doctors,” said Dr Sanjeev Singh Yavad, president of the Hyderabad chapter of the Indian Medical Association (IMA). “That certainly is of concern to us.”
The so-called “bridge course” proposal has been a point of criticism ever since the NMC Bill was first announced. At the time, Health Issues India noted that it could lead to “a potential new generation of quacks” with the medical fraternity speaking out against the proposal in force. Despite the opposition, the “bridge course” is already in force in some parts of India such as Maharashtra.
Dr Vardhan has defended the Bill, including the replacement of the MCI. “A perception has set in in the last two decades that the MCI has been unsuccessful in discharging its duties and corrupt practices are prevalent in the regulatory body,” he has said. “The NMC Bill is the need of the hour.” It was alleged corrupt practises and non-compliance with oversight committees that triggered the NMC Bill being drafted in the first instance.
What cannot be denied, however, is that the NMC Bill lacks the support of doctors and medical students. Threats of indefinite strike action – and the inevitable detrimental effect on patients – should not be taken lightly. The issues at the heart of the NMC Bill cannot and should be ignored. Rooting out corruption from the medical fraternity is imperative. However, the question of whether centralising power in the hands of the government serves as the best avenue towards achieving this is a legitimate one – especially if it will be at the expense of the doctors’ own representation. Reform is clearly needed – but the vigorous national debate over whether the NMC Bill is the right path towards this reform shows no signs of abating soon.