Dr. Arun Mitra
Even though dissolution of Medical Council of India (MCI) was on the cards, that it would be done so unceremoniously through an ordinance bypassing Parliament was not expected. It is unfortunate that such exercises have become routine with the government. Till date the MCI has been the regulatory body which decided about the admission process to the undergraduate as well as postgraduate classes; set basic minimum standards required to open a medical college and carried out regular inspections of the colleges to check the status of education. It also maintained the registry of doctors around the country. The MCI could derecognize any medical college that did not fulfill the required standards. It also decided the medical curriculum. Whereas the Government’s nominated members were there in the MCI, it had elected members as well, which gave it a partial democratic structure. Unfortunately, the MCI lost its reputation as there have been allegations of corruption against some of its higher-ups, particularly the past president Ketan Desai.
The Supreme Court of India had taken cognizance of the irregularities in the council and recommended restructuring of the system so as to make it more transparent to curb corruption and maintain high standards of medical education. The government had some time back proposed a National Medical Commission instead of the MCI, which was put in public domain for suggestions. The structure of NMC has 25 members, all of whom will be nominated by the Government. This makes the regulatory body totally undemocratic with outright bureaucratic control without the involvement of various stake holders.
In the last few years the majority of medical colleges have come up in the private sector. From 1990 to 2017 medical colleges opened in private sector numbered 238, while only 115 were set up in the state sector. Many of these were made deemed universities with their own examination and admission system and fee structure. In the proposed NMC, the government will exercise control over the tuition fee of only up to 40% of seats, which means tuition fees in 60% plus seats will be at the mercy of private managements. Thus the cost of medical education, which is already very high in the private sector, will further rise and will be virtually reserved for the rich classes. Since there will be no regular inspections, check on the standard of medical education will be compromised. Already the low standard of education in many medical colleges which are notoriously known to hire the faculty and patients during inspection will further go down.
There will be exit exam for the undergraduate students. This is being done because difference in the standard of education in various medical colleges is glaring. Instead of meeting its responsibility to standardize education, the Government is working on the approach to judge ranking of the colleges by the performance of the students.
There is also effort to mix the various systems of medicine and permit the AYUSH to practice modern medicine. This will further jeopardize the whole healthcare delivery process.
It is obvious that medical education will become totally unregulated and go into the hands of business interests. It would be naïve to expect a person who has spent crores on getting education to have social interest and service attitude towards healthcare. The already over-privatized healthcare in our country will further get expensive and out of reach of majority of citizens, who are already devoid of quality healthcare due to the high cost of out of pocket expenditure.
The standing committee on health headed by Ram Gopal Yadav had called various stake holders to put forward their viewpoints on the National Medical Commission. The Alliance of Doctors for Ethical Healthcare (ADEH) in its submission before the standing committee on 13th February had clearly given its viewpoints on various issues, but in the final recommendations there are hardly any changes to meet the expectations. That corruption will end in the NMC is difficult to believe. It has been observed that bureaucratic structures can be more corrupt as they are not directly answerable to the people. Time is still not lost. The government should review the final draft of the NMC; otherwise worse may come out of dissolving the MCI. (IPA)
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