National Medical Commission Bill

Context:

The National Medical Commission Act 2019 has been passed by both Houses of Parliament is historic and path-breaking.

What is the NMC Bill?

The National Medical Commission Bill seeks to improve the medical education system in the country by ensuring the availability of adequate and high-quality medical professionals, periodic assessment of medical institutions, adoption of the latest medical research by medical professionals and an effective grievance redressal mechanism.

The Bill has the following key features:

1. The Bill proposes to set up a medical commission, both at the national and state level, within three years of its passage of the legislation.
2. The Bill also has a provision for setting up a Medical Advisory Council by the Centre. The council will act as a channel through which the states/Union Territories can convey their views and concerns to the NMC.
3. The legislation also talks of conducting a uniform National Eligibility-cum-Entrance Test (NEET) for admission to under-graduate medical education in all medical institutions regulated under the Bill.
4. The Bill proposes to hold the National Exit Test for the students graduating from medical institutions to obtain the licence for the practice. The test will also allow students to take admitted into post-graduate courses at medical institutions under this legislation.
5. The Bill says that the NMC will have the authority to grant a limited licence to certain mid-level practitioners connected with the modern medical profession to practice medicine.

NMC

1. The Bill aims to set up a National Medical Commission with 25 members.
2. These members will be appointed by the central government on the recommendation of a committee.
3. The members will include a chairperson, who must be a senior medical practitioner and academic with at least 20 years of experience, 10 ex officio members and 14 part-time members.
4. The ex officio members will include the presidents of the undergraduate and postgraduate medical education boards, the director general of Indian Council of Medical Research, and a director of one of the AIIMS, among others.
5. Part-time members, on the other hand, will include experts from the field of management, law, medical ethics, etc. and nominees of states and union territories.

Functions of NMC:

• The NMC will frame policies for regulating medical institutions and medical professionals, assessing the requirements of healthcare-related human resources and infrastructure, and ensuring compliance by the State Medical Councils of the regulations made under the Bill.
• Besides this, the NMC will frame guidelines for the determination of fees for up to 50 per cent of the seats in private medical institutions and deemed universities which are regulated under the Bill.

Why doctors are so much against it?

1. Section 32 of the bill authorises the government to allow non-medical degree holders to practice medicine as community health providers. This provision has been vehemently opposed by Indian Medical Association which says it will legalise quacks in the country.
2. This will allow anyone with limited exposure to modern medical system to recommend medicines.
3. Compared to the present 70 per cent figure of elected representatives in the Medical Council of India (MCI), only 20 per cent of members of the NMC will be elected representatives.
4. Unlike MCI, whose decisions were not binding on state medical councils, the NMC Bill allows the commission’s ethics board to exercise jurisdiction over state medical councils on compliance related to ethical issues.
5. Also, while action can be taken against the MCI president only on the direction of a court, the NMC Bill enables the central government to remove the chairperson or any other member of the commission.
6. National Exit Test (NEXT) has been conceptualised as a single test, which will act as a common final-year undergraduate medical exam and be used for granting medical licence as well as admission to postgraduate courses. It has been argued that a single exam is being accorded too much weightage, and it can have an adverse impact on the career of medical aspirants.
7. The Bill allows the commission to “frame guidelines for determination of fees and all other charges in respect of fifty per cent of seats in private medical institutions and deemed to be universities”. This increases the number of seats for which private institutes will have the discretion to determine fees. At present, in such institutes, state governments decide fees for 85 per cent of the seats.

Positive aspects of the bill:

Unlike MCI, the members of NMC will have to declare their assets at the time of assuming office and when they leave. They will also have to submit a conflict of interest declaration.

Need of the hour:

If the government wanted to improve the health services in the rural areas then it should strengthen the existing paramedics. Nurses and midwives are trained for administering injections and similar functions and the government should try to tap this trained manpower. Primary care can be taken by these paramedics and only complex medical problems should be referred to a doctor with specialised knowledge. This kind of model has worked in other countries where doctors only treat complex problems.

Challenges ahead:

1. 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.
2. 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.
3. The fact that elected members to NMC 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.

Background:

India has a doctor-population ratio of 1:1456 as compared with the WHO standards of 1:1000. In addition, there is a huge skew in the distribution of doctors working in the Urban and Rural areas with the urban to rural doctor density ratio being 3.8:1. Consequently, most of our rural and poor population is denied good quality care leaving them in the clutches of quacks. It is worth noting that at present 57.3% of personnel currently practicing allopathic medicine does not have a medical qualification.