National Medical Commission Bill, 2019 may have taken 20 months to get cleared by the Parliament, the turnaround time is still faster compared to other bills in the past that sought to make fundamental changes in Indian healthcare. While the bill introduces some path-breaking provisions, not all are happy. A section of doctors is out on protest already. Most who have been tracking the development in relation to medical regulations appear in favour of a system that replaces the Medical Council in its existing structure.
The bill focusses on separating the three functions - syllabus and curriculum, accreditation, and medical ethics - that the Medical council handles currently. The primary issue in Indian healthcare is availability of doctors. Bulk of 78,000-odd doctors that pass out of medical colleges seem to find greater attraction in metros, not remote locations where trained, qualified and specialist clinicians are most needed. The second challenge involves addressing the issue of standardisation and high quality with uniformity across the country. While the bill seeks to address some of these issues, there remain unanswered questions on the design, definition and the transparent execution of the bill and some of its provisions.
For instance, Section-32 of the bill that is about offering licences to community health providers to practice medicine is a major bone of contention among many doctors. The fact that a private medical college has the right to fix fees for 50 per cent of seats is going to be debated and is seen as a problem area. Besides, the definition of community health provider is vaguely defined and requires more details. The fact that elected members (to the National Medical Commission itself and to its three principal bodies - committees on syllabus and curriculum, accreditation and medical ethics - can be inefficient, if not bad, there is still no guarantee that nominated persons will be any better. One needs to ensure there is adequate transparency in the way people are chosen. Some suggestions include public advertisements issued in advance and disclosures made on who all have applied or perhaps have a system on the lines of the UPSE (Union Public Service Commission). Many medical practitioners give the example of Medical Council of India that was dissolved in 2010, following the arrest of its president Ketan Desai on corruption charges. A six-member board of governors was put in place, but nobody found fault or criticised the move.
Among provisions of the bill, the idea of an exit exam for students at the end of the course before they begin practice is praiseworthy. It could address the issue of standardisation of teaching and uniform quality across medical colleges. The proposed exit examination is expected to be much like the entry examination today (NEET) that ensures that the class 12 teaching of CBSE, State board, ICSE or the open school model equip students sufficiently well to appear for the entrance.
K Sujatha Rao, former Union health secretary says the imbalance of doctor availability across the country, is a serious issue. There is lot more needed to give doctors incentives to go to remote locations. She emphasises on ensuring quality so that all 78,000 medical graduates know how to practise medicine. The exit exam is seen as a way out of this problem but according to Rao, focus must be given on the design of the exit exam. "It should not be a simple multiple choice question paper; practical skills should be tested too," she says.