Good health for the people of the country is the necessity for the overall development and the growth of the country. Our constitution under Article 47 of Directive Principles of State Policy (DPSP) thrust the responsibility to the State “to raise the level of nutrition and the standard of living and to improve public health”. India has also committed to Sustainable Development Goals[i] and SDG III aims to achieve “Good health and well-being” for everyone.
Developing an effective healthcare system and ensuring a universal healthcare system depends on the nature and quality of the medical manpower of the country[ii]. Not only the quality but also the shortage in the quantity of medical manpower is very acute in India. India has one doctor per one thousand seventeen hundred population, which is less than the international standards of one doctor per thousand[iii]. In fact, this ratio is lesser in rural areas of the country. India’s medical manpower is not up to the mark due to various reasons as medical education and profession are unregulated, iniquitous and corrupt. In fact, the Parliamentary Standing Committee Report[iv] of March 2016 noted that medical education and profession in the country was at its ‘lowest ebb’ and suffering from ‘total system failure’ due to corruption and decay within MCI.
On the face of it, National Medical Commission Bill was envisaged to overhaul and restructure the regulatory system for medical education and the medical profession in the country thereby creating an institutional mechanism for the overall development of the healthcare sector in the country. The Bill was passed by parliament in 2019 replacing the archaic Indian Medical Council Act 1956. It has also replaced Medical Council of India (MCI).
SALIENT FEATURES OF THE BILL [v]:
- NMC with 25 members to regulate medical education and practice.
- It will establish four autonomous boards to focus on undergraduate and postgraduate medical education, assessment and rating and ethical conduct.
- Setting up of Medical Advisory Council by the Centre to act as a channel through which the States/Union Territories can convey their concerns and views to NMC.
- Uniform NEET test for admission to undergraduate medical education in all medical institutions.
- NEXT (National Exit Test), a common final year undergraduate examination for students graduating from medical institutions to obtain the license for the practice.
- Fees of 50% of seats of private and deemed universities will be regulated.
- Limited license to community healthcare providers connected with the modern medical profession to practice medicine.
ANALYSIS OF THE BILL:
The enactment of this bill is a much-needed reform to usher into a new era in the healthcare system. It will help in creating a cadre of qualified medical professionals to deal with India’s healthcare challenges. Creating a uniform standard of admission, training, regulation, and standards will help in establishing a robust framework for medical education and profession in the country. The bill will also curb the phenomenon of commercialization of medical education by regulating the fees charged by private medical colleges. Medical Advisory Council will create a platform for states to share their best practices as well as concerns to the NMC.
Criticism against the provision of Section 32 of the bill which allows 2.5 lakh Community Health Providers (CHP) in the villages to prescribe drugs to patients is not fair as there are various examples of community health providers playing the role of game-changer in improving the healthcare indicators in rural areas. In fact, various studies have shown that poor largely seek health services from informal service providers. For instance- ASHA[vi] workers under the National Rural Health Mission (NRHM) played an important role in improving maternal mortality rate and neo-natal mortality rate and similar experiences in the state of Chhattisgarh and Assam have improved the quality of healthcare in the rural areas of these States. Many developed and developing countries have adopted the concept of community healthcare providers (CHPs) and mid-level healthcare providers. In fact, India needs community healthcare providers and mid-level healthcare providers in several forms to bridge the gaps of access and quality of healthcare services in our country.
Despite bringing a structural change in the form of overhauling the medical education system of the country through this bill, addressing the complex and multiple healthcare challenges of the country will be insurmountable in recent times due to various reasons. The public expenditure on health is still abysmally low. As per the National Health Profile[vii] 2019, India’s public expenditure on health as a percentage of GDP is far lower than Lower-Income Countries of the world. The healthcare system is poorly regulated and accessible to those who have better income level. Urban-rural imbalance in healthcare services had failed those people living in rural areas. There is a huge reliance on private sector with the help of insurance model after the launch of Ayushman Bharat[viii] to provide healthcare services and the problem is that these private players are not regulated properly. Therefore, along with the institutional reform in terms of establishing National Medical Commission, there is need to adopt a holistic approach to create a conducive climate to achieve the goal of “right to health” for the people of the country.