Author: Explains

Context

• President Maithripala Sirisena sacked Mr Wickremesinghe, replacing him with former President Mahinda Rajapaksa.
• The President subsequently prorogued Parliament for over two weeks, deferring the possibility of a floor test until November 16.

INTRODUCTION

• The recent political turmoil in Sri Lanka brings to the surface the debate on domestic issues vis-à-vis South Asian geopolitics. The ongoing chaos has definitely gotten New Delhi worried, as Wickremesinghe was seen as close to India.
• In the last few years, the relationship between India and Sri Lanka had improved considerably and was looking positive after Wickremesinghe’s visit to India last month.

Background

Executive Power in Sri Lanka

• In Sri Lanka, the President is the most dominant political force. The Prime Minister’s role is limited to a deputy to the President, besides being the leader of Cabinet.
• However, in the latest development, the final call to decide whether the President has the power to straightway dismiss or replace a Prime Minister lies with the Sri Lankan Supreme Court.
• In 2015, Sri Lanka had amended its constitution to prevent the president from sacking any prime minister unless they had died, resigned or lost the confidence of parliament.

Constitutional provisions

1. The constitutional provision that Mr Sirisena has cited in the official letter to Mr Wickremesinghe does not grant the President authority to remove a Prime Minister from office
2. Section 42(4) of the Constitution merely enables the President to appoint a PM
3. The President has taken the position that since he is the appointing authority, he also has the implicit power to sack the PM
4. Mr Wickremesinghe has dismissed the constitutional validity of the presidential action and has argued that he still commands a majority in Parliament
5. His line of argument is that only Parliament has the constitutionally sanctioned authority to decide whether he could continue in office as PM or not
6. It also suggests that as long as there is no no-confidence motion passed in Parliament against him and the cabinet, his position as PM cannot be invalidated by the President at his will

19th Constitutional Amendment 

1. The argument seems to have derived its salience in the context of the 19th Amendment to Sri Lanka’s Constitution, passed in 2015
2. The 19th Amendment has restored the Westminster framework of the relationship between the head of state, the PM, and Parliament
3. It curtailed powers of the President under the 1978 Constitution (the original) as well as the 18th Amendment passed in 2010
4. Among the presidential powers taken away by the 19th Amendment, which is valid, is the one pertaining to the President’s powers over the PM
5. The 19th Amendment, which created a dual executive, made the PM’s position secure from the arbitrary actions of the President
6. Thus, the office of the PM falls vacant only under limited circumstances. Death, voluntary resignation, loss of support in Parliament, rejection by Parliament of the budget, and ceasing to be an MP are these circumstances
7. Sacking by the President is certainly not in this list

Speaker’s role in prorogation

• The Speaker of the Sri Lankan Parliament, Karu Jayasuriya, urged President Maithripala Sirisena to protect the rights and privileges of Prime Minister Ranil Wickremesinghe until his majority in the House was challenged by another member.
• Further, citing possible serious consequences of the President’s decision to suspend Parliament till November 16, he pressed Mr. Sirisena to reconvene the House.
• The prorogation should be done in consultation with the Speaker. Mr. Jayasuriya said the move would have serious and undesirable consequences for the country and urged Mr. Sirisena to reconsider the decision.
• Rajapaksa said he had accepted Mr. Sirisena’s invitation to assume charge as Prime Minister as he was aware that the people expected our leadership and protection, at this moment of national peril.
• In the statement, signed as the ‘Prime Minister of Democratic Socialist Republic of Sri Lanka,’ Mr. Rajapaksa said the primary objective of leaders and lawmakers who had joined him and Mr. Sirisena was to ensure early conduct of provincial and parliamentary elections.

What are the reasons for the replacement of PM?

• Sri Lankan President Maithripala Sirisena claimed that there is no constitutional violation in his recent appointment of former President Mahinda Rajapaksa in place of Prime Minister Ranil Wickremesinghe.
• In a televised address, Mr. Sirisena sought to justify his decision — to abruptly induct Mr. Rajapaksa as PM and then prorogue Parliament until November 16.
• He cited sharp political and cultural differences with Mr. Wickremesinghe, with whom he formed Sri Lanka’s first national unity government in January 2015, among the factors.
• Sirisena tied two main reasons to his falling out with Mr. Wickremesinghe — corruption related to the bond scam at the Central Bank and the alleged assassination plot targeting him.
• Sri Lanka police functions under the Law and Order Ministry, helmed by a Minister from Mr. Wickremesinghe’s United National Party. The manner in which authorities probed the assassination plot was the most proximate and powerful reason for appointing Mr. Rajapaksa.
• Meanwhile, Mr. Rajapaksa said that he accepted the invitation to assume charge as PM as he was aware that the people expected our leadership and protection at this moment of national peril.
• The primary objective was to ensure an early holding of provincial and parliamentary elections, he said in a statement that he signed off as the ‘Prime Minister of Democratic Socialist Republic of Sri Lanka’.

The aftermath of this crisis:

• Mr. Sirisena’s appointment of Mr. Rajapaksa even before voting out Mr. Wickremesinghe on the floor of Parliament is nothing but blatant abuse of his executive powers.
• Guided by narrow political interests, the President’s actions betray an utter disregard for the parliamentary process.
• In resorting to these emergency measures, he has not only put democracy in serious peril but also let down Sri Lankans, including a sizeable section of the Tamil and Muslim minorities that backed him in the critical 2015 election.
• The political crisis in the island nation triggered violence on October 28. One person was killed and two others injured as the bodyguards of Petroleum Minister Arjuna Ranatunga fired at the supporters of Rajapaksa when they surrounded the cabinet member.

India’s concerns

• India did not have a broad array of options regarding the situation. India should stay focussed on long-term priorities like bilateral and regional connectivity and trade ties with Sri Lanka, and allow the situation in Colombo to work itself out.
• India reminded Sri Lanka of the constitutional process, following the ongoing political crisis. India’s response came as both the leaders began an outreach to the global diplomatic community.
• This was the first time that India commented on the situation in Colombo which has turned into a stand-off between Mr. Sirisena and Mr. Wickremesinghe.
• The friction between Mr. Sirisena and Mr. Wickremesinghe began with a strong statement from the latter during his visit to Delhi, which seemed to target the President for delay in India-backed projects.
• Wickremesinghe met select Colombo-based diplomats. It is said to have included those from the European Union, the U.S., the U.K., Canada, Australia, Italy, France, Switzerland, South Africa and India.
• Many of the countries had put out similar sounding statements and tweets, underscoring the need to respect due constitutional process and democracy.
• The countries are loosely identifying themselves as being like-minded on this development

CHALLENGES FOR INDIA-

India has been struggling to maintain its influence in the neighborhood as many countries in the region (Pakistan, Nepal, Maldives and Sri Lanka) have shown increased leaning toward Beijing.

• The structural constraints on New Delhi’s strategic space in South Asia go deeper. India is in an unenviable position. It is a regional power that is large enough for the asymmetrical nature of its relationship with its neighbours to make them nervous.
• But it is also a status quo power that lacks the economic and military muscle of the extra-regional revisionist power its neighbours inevitably look to as a balancer. That makes the question of who is in power—or which political systems are in place—subordinate.
• India’s backseat approach to Sri Lanka drives home the point, that India cannot fully hope to counter China in its own backyard and elsewhere until it really doubles down on economic reforms, which the government of Prime Minister Narendra Modi has only embraced partially.
• India needs to foster local growth and economic interconnectivity in South Asia. It has a huge stake, geopolitically, in Sri Lanka, and cannot afford to let it drift away.
• The time is coming for India to follow the lead of the United States and Brazil’s president-elect, and grow beyond insisting publicly that it does not view China as a competitor, but as an economic and strategic rival and openly embrace relationships with other countries that seek to balance and contain China.
• The region that India has regarded as its natural sphere of influence is slipping out of its hands. This will provide a new wake-up call to New Delhi as it needs to rethink and reformulate its policies toward the South Asian region. China has successfully managed to gain greater influence and leverage by exploiting its financial strength.
• The question now is whether India needs to combine some hard power with its soft-power approach and establish its status as an important player in the Indian Ocean region and South Asia.
• The domestic turmoil in Sri Lanka has a greater geopolitical, regional, and political connotation. The current leaders are overtly pro-Beijing and have consistently worked toward using China to counter Indian influence.
• It was no surprise that days before Wickremesinghe’s visit to India, Sirisena even made claims to the cabinet that the Indian Research and Analysis Wing (RAW) was involved in a plot to assassinate him. Such accusations highlight the insecurity and mistrust harboured by the current Sri Lankan president toward India.
• The concerns of the Chinese having a forward military base in Sri Lanka that was projected by US Vice-President Mike Pence were countered by Wickremesinghe last month, but the recent developments give further strength to the US concerns.

INDIA-CHINA GEOPOLITICAL TUSSLE

• The crisis highlights the role of powerful Asian rivals, India and China. While Sirisena tried to free his country from Chinese debt, he was instead drawn back to China after being unable to do so, and
• He ended up giving “China a controlling equity stake and a 99-year lease for Hambantota port, which it handed over in December 2017,” a move which alarmed the United States and India, which fear its potential strategic applications.
• Nonetheless, the recent changes put in question the proposed Indian investments in Sri Lanka, primarily in Mattala Airport, the Port of Colombo’s East Container Terminal, the LNG (liquefied natural gas) plant in Kerawalapitiya, and Palaly Airport in Jaffna. They also cast a shadow on Indian-Sri Lankan relations.
• The United States and the European Union have also asserted the need for following the constitutional process, but China was quick to congratulate Rajapaksa. Cheng Xueyuan, the Chinese ambassador to Sri Lanka, personally called on the newly appointed PM.
• The promptness with which Beijing congratulated Rajapaksa underscores the arguments that he is a pro-China man. During his term as president, the Sri Lankan economy became riddled with Chinese debt that culminated with Beijing gaining control of the Hambantota Port for 99 years.
• It should come as no surprise that China is focused on its national interests, and is not just a benevolent, non-interfering state that wants to build infrastructure for the good of the world. What else could explain the haste by which Chinese President Xi Jinping congratulated Rajapaksa, before the resolution of the crisis?
• The reasons China is happy are quite obvious. In the last few years, some resistance was appearing in Colombo toward the incoming Chinese investments.
• The government was becoming more concerned about the long-term impacts on the domestic economy and financial stability. A number of projects had also witnessed some violence and opposition.
• The appointment of Rajapaksa as the new prime minister could change this direction of thought and give Beijing added leverage. This also provides a new lease on life for the Chinese Belt and Road Initiative (BRI) and makes way for more Chinese investments.
• Despite statements of neutrality, there are persistent rumors that China is favoring Sirisena and Rajapaksa. A deputy minister in Wickremesinghe’s administration, Ranjan Ramanayake, accused China of paying for Rajapaksa to buy legislators.
• It also shows that China has great sway in the domestic politics of South Asian countries.
• The crisis in Sri Lanka illustrates the role China can play in upsetting local political calculations elsewhere, even without direct interference.
• The New York Times quotes Brahma Chellaney, an analyst and critic of China, who often advises the Indian government as saying: “The political turmoil, more than Rajapaksa’s return to power, works to China’s advantage. In country after country, China has exploited internal disarray to advance its objectives.”
• In Sri Lanka’s case, China’s “deep pockets” have meant that even though the Sirisena government initially promised to re-evaluate Chinese investment, it was unable to because India and the United States were unable to provide an equivalent amount of money for its projects — or to get it out of Chinese debt.
• However, now that China’s “debt-trap” strategy has been demonstrated, other countries must do their most to avoid it, and richer countries like the United States should step up and offer alternative investment schemes.

CONCLUSION

India must avoid erring too much on the side of caution, however reasonable this may be, unlike in case of Maldives political crisis.

In Sri Lanka’s case, military intervention likewise ought to be on the table, one that is better than India remaining silent and watching a geopolitical noose be slowly drawn around it, especially if it is proven that the democratic and legal processes of the country are being thwarted with financial pressure, thuggish force, or extra-constitutional decisions.

Where India, Japan ties stand now and what is planned for the future

Context

• The 13th India-Japan annual summit commenced with Prime Minister Narendra Modi and his Japanese counterpart Shinzo Abe visiting a factory of FANUC Corporation, one of the largest makers of industrial robots in the world.
• The visit to the FANUC facility was important in the context of India’s move towards Industry 4.0 by leveraging developments in the fields such as AI, IoT, 3D printing and robotics.

Background

• Japan and India are partners in peace, with a common interest in and complementary responsibility for promoting the security, stability and prosperity of Asia as well as in advancing international peace and equitable development.
• At the beginning of the 21st century, Japan and India resolved to take their bilateral relationship to a qualitatively new level.
• Today, India and Japan share a global vision of peace, stability and shared prosperity, based on sustainable development. Shared democratic values and commitment to human rights, pluralism, open society, and the rule of law underpin the global partnership between the two countries.
• The global partnership between India and Japan reflects a broad convergence of their long term political, economic and strategic interests, aspirations, objectives and concerns.
• Japan and India view each other as partners that have responsibility for, and are capable of, responding to global and regional challenges in keeping with their global partnership.
• A strong, prosperous and dynamic India is, therefore, in the interest of Japan and vice versa.

Shared Universal Values and Vision

• 2017 holds special significance since it marks a decade of Japanese Prime Minister’s celebrated speech at the Indian Parliament— ‘Confluence of the Two Seas’, underscoring shared universal values and interests.
• Ten years down the line, India is envisioned as a critical strategic anchor in Abe’s latest ‘Free and Open Indo-Pacific Strategy’.
• India-Japan ‘Special Strategic and Global Partnership’, aimed at securing strategic stability and economic prosperity of the Indo-Pacific space, culminated into the Asia-Africa Growth Corridor (AAGC) this year.

Asia-Africa Growth Corridor

• The Asia-Africa Growth Corridor or AAGC is an economic cooperation agreement between the governments of India and Japan.
• It aims for Indo-Japanese collaboration to develop quality infrastructure in Africa, complemented by digital connectivity, which would undertake the realization of the idea of creating free and open Indo-Pacific Region.
• The AAGC will give priority to development projects in health and pharmaceuticals, agriculture and agro-processing, disaster management and skill enhancement. The connectivity aspects of the AAGC will be supplemented with quality infrastructure.
• Unlike OBOR, now BRI (Belt and Road Initiative), which entails development of both land corridor and ocean, AAGC will essentially be a sea corridor linking Africa with India and other countries of South-East Asia and Oceania by rediscovering ancient sea-routes and creating new sea corridors that will link ports in Jamnagar (Gujarat) with Djibouti in the Gulf of Eden and similarly the ports of Mombasa and Zanzibar will be connected to ports near Madurai; Kolkata will be linked to Sittwe port in Myanmar.

Action-oriented Partnership

• In keeping with ‘India-Japan Vision 2025’, robust bilateral relations have laid the foundation to expand the scope of cooperation in the Indo-Pacific theatre. Strong India–strong Japan will not only enrich two nations. It will also be a stabilising factor in Asia and the world.
• The 2016 India-Japan Joint Statement underscores the importance of coordinating bilaterally and with other countries to develop better regional connectivity and facilitating industrial networks.

Securing the Maritime Commons

• As maritime democracies, both nations have argued for rules-based international order, freedom of navigation and over flight, unrestricted lawful commerce, and peaceful settlement of disputes.
• India, US and Japan conducted the annual Malabar Exercise in the Bay of Bengal in July 2017 aimed at enhancing interoperability between the navies of the three democracies and strengthening trilateral cooperation in the Indo-pacific region.
• With the aim of augmenting cooperation, both India and Japan are considering incorporation of Anti-Submarine Warfare (ASW) training and exchanges by ASW aviation units such as P-3C in addition to mine-counter measures (MCM) training.
• The ‘shared responsibility’ in securing the regional SLOC (Sea Lines of Communication) as a ‘public good’ reinforces India-Japan maritime cooperation.
• Japan desires India’s cooperation in guarding the Indian Ocean SLOCs since it is critical for its energy shipments. With dependence on imports for 94 per cent of its primary energy supply, Japan is severely dependent on Middle Eastern oil imports, and the Indian Ocean is, therefore, vital for Japanese energy imports from the region.
• While Japan has depended on the US Navy for safeguarding critical SLOCs, it is increasingly cognisant of India’s capabilities in playing a productive role in defending the regional sea lanes.
• At the India-Japan shipping policy forum, launched in 2010, both countries focus on cooperation in the maritime sector such as the development of ship recycling facilities, ports and inland water transport, ship building and repair, and cooperation on International Maritime Organisation (IMO) issues.
• Besides, there is a 2+2 dialogue framework between the Foreign and Defence Secretaries of both countries since 2010, as mandated by the Action Plan to Advance Security Cooperation concluded in December 2009.

Special Strategic and Global Partnership

• There is a shared recognition that a stronger bilateral strategic partnership entails wider cooperation while responding to global and regional challenges and jointly contributing to the stability of the Indo-Pacific region.
• Both defence ministers stressed the value of deepening interaction between the respective governments and defence industries with the aim of enabling collaboration in defence and dual-use technologies.
• The difficult negotiation over cost and technology transfer with regard to the US-2 amphibious aircraft has not restricted the two countries from exploring and identifying specific items and future areas for cooperation.
• Building on the ‘Special Strategic and Global Partnership’, Indian navy has issued Request for Information (RFI) to six overseas manufacturers including Japanese Mitsubishi Heavy Industries and Kawasaki Heavy Industries to build six advanced submarines with air-independent propulsion (AIP) technology under the Project 75 (I) initiative.
• Two agreements signed in December 2015 — ‘Agreement Concerning Transfer of Defence Equipment and Technology Cooperation’ and ‘Agreement Concerning Security Measures for the Protection of Classified Military Information’, marked a new beginning in bilateral defence cooperation.

India-Japan relations in recent past

• The Japan-India Association was set up in 1903 and is one of the oldest international friendship bodies in Japan.
• As the 13th India-Japan annual summit got under way, Japan had pledged Rs 33,800 crore in government and private sector investments following the first Modi-Abe meeting in 2014.
• The two countries have signed a Comprehensive Economic Partnership Agreement (CEPA) in 2011 to facilitate growth in bilateral trade. This was described as the most comprehensive of all such agreements concluded by India covering trade in goods and services, movement of persons, investments, intellectual property rights, Customs procedures and other trade related issues.
• The CEPA envisages abolition of tariffs on over 94% of items traded between India and Japan over a period of 10 years.
• While Japan has been one of the biggest sources of investment flows into India, accounting for $28.16 billion in FDI between April 2000 and June 2018, trade engagements have been below potential. On the list of countries that India exports to, Japan is a lowly 18th; on the list of countries importing into India, Japan ranks 12th.

“Currency Swap Agreement” between India and Japan: How it will help India

• The big announcement was the decision to conclude a $75 billion bilateral currency swap agreement, which is expected to help stabilise fluctuations in the value of the rupee vis-a-vis the dollar, and bring down the cost of capital for Indian companies while accessing foreign capital markets.
• It involves the exchange of interest and sometimes principal in one currency, for the same in another currency. This facility will enable the agreed amount of foreign capital being available to India for use as and when the need arises.
• The facility will serve as a second line of defence for the rupee after the $ 393.5 billion of foreign exchange reserves.
• It would not only enable the agreed amount of capital being available to India, it will also bring down the cost of capital for Indian entities, while accessing the foreign capital market.

Big-ticket investments by Japan in India

• Japan has been extending bilateral loan and grant assistance to India since 1958, and is its largest bilateral donor.
• In the last five years, $90 billion has gone into the Delhi-Mumbai Industrial Corridor, which will see new towns, industrial parks, ports and airports alongside the 1,483-km high-speed rail and road line being developed between two of India’s top cities.
• Japan is also backing the Mumbai-Ahmedabad High Speed Rail (bullet train) service and has released the first tranche of Rs 5,500 crore. A pact for the second tranche was inked Monday.
• Approximately 81% of the cost of the project is to be funded through a soft loan from Japan’s government.
• Discussions have also taken place on the Dedicated Freight Corridor, a project of close to Rs 50,000 crore of which Japanese assistance has been of about Rs 38,000 crore.
• The first section of 190 km, from New Ateli to New Phulera stations, has been opened on the Western Dedicated Freight Corridor while the next segment of 492 km between Rewari and Marwar is likely to open early next year. Final completion is targeted for March 2020.
• Progress on some of the Metro projects being funded by the Japanese across Indian cities was taken stock of, including the Delhi Mass Rapid Transit System and Chennai Metro.

The China Factor

Evidence of Chinese factor in Indo-Japan Relations-

1. Both the countries have border (land/maritime) issues with China- a common ‘enemy’ for India and Japan.

• Border conflicts between India and China have been a long issue and it is evident from the recent dispute over the Doklam plateau in the Himalayas.
• Japan has the similar border issue with China. Both the countries have the simmering territorial dispute over islands in the East China Sea are known as the Senkakus in Japan and the Diaoyu in China.
• At present, both the island is administered by Japan but are claimed by China. The conflict has been on rising in the last few years is because of increasing China’s maritime mightiness in the region.

2. Alliance with the USA, and its Pivot to Asia Policy in the Asia-Pacific Region.

• In the last few years, India has strengthened it’s diplomatic, economic as well as the military ties with the USA in a view to check growing China’s growing influence in Asia.
• India and USA, both the countries using each other’s military facilities that is evident from the last year’s Logistics Exchange Memorandum of Agreement (LEMOA) and other foundational agreements like CISMOA and BECA have been a headache for China.
• India’s ‘Act East Policy’ (AEP) admirably waning the influence of China in the region. Through AEP, India has imparted greater vigour to its ties with ASEAN.
• So, India has a great opportunity if she able to align its AEP with the USA .India should seek to expand its geo-strategic space to contend with China’s growing assertiveness and foster balanced relations.

3. The dominance of China in the South China Sea and the Indian Ocean and Pacific Region. The threat to commercial and strategic interests of both the nations.

• India has already shown its genuine concern over South China Sea and sought to firmly articulate its principled position of freedom of navigation, maritime security.
• The expeditious resolution of the dispute according to international law and the UN Convention on the Law of the Sea, developing a Code of Conduct, and settlement through dialogue and peaceful means.
• India’s more than 40 percent of total trade volume traverses through the South China Sea, and on account of its interest in harnessing fossil resources in the region.

Challenges Ahead

• A challenge for Modi is to correct the lopsided trade and calibrate China’s market access to progress on bilateral political, territorial and water disputes, or else Beijing will fortify its leverage against India.
• After all, China does not shy away from making efforts to block the rise of India and Japan, including by stepping up military pressure on them and opposing the expansion of the UN Security Council’s permanent membership.

Way Forward

• The two sides also decided to start negotiations on the crucial Acquisition and Cross-Servicing Agreement (ACSA), which will enhance the strategic depth of bilateral security and defence cooperation.
• Another new area where India is likely to make a pitch is for greater synergy or integration between the Ayushman Bharat project and the Japanese programme called Asia Health and Wellbeing Initiative, including how to leverage Japan’s strengths in areas such as medical equipment and hospitals.
• The two leaders shared their view that in order to achieve shared vision, India and Japan must endeavour to work together for a rules-based and inclusive world order that fosters trust and confidence by enhancing communication and connectivity to ensure rule of law, unimpeded trade and flow of people, technology and ideas for shared prosperity.
• 21st century will be Asia’s century and Indo-Japan ties will play a key role in shaping it. Both have agreed to start the 2+2 dialogue. It’s objective is to promote peace and stability in the world.”

Conclusion

• Japanese ODA supports India’s development in sectors such as power, transportation, environmental projects and projects related to basic human needs.
• Recently, a ‘Cool EMS Service’ was started, under which Japanese food items permissible under Indian regulations are transported in cool boxes from Japan to India through postal channels.
• Both sides are striving to push a digital partnership, with the NITI Aayog being the nodal point on the Indian side and the Ministry of Economy, Trade and Industry on the Japanese side. Areas of potential collaboration include AI, IoT, and big data.

Why in news?

• The Union Cabinet has cleared the National Medical Commission Bill, which does away with the Medical Council of India (MCI)
• The bill replaces MCI with a regulator that will do away with “heavy-handed regulatory control” over medical institutions

Present structure

1. Presently Medical education in India is regulated by the MCI
2. The Medical Council of India (MCI) was established in 1934 under the Indian Medical Council Act, 1933.The Act was repealed and replaced by the Indian Medical Council Act, 1956

Functions

• Maintenance of uniform standards of medical education,
• Recognition/de recognition of medical qualifications and medical colleges,
• The registration of doctors
• Members: The MCI has elected members from the medical fraternity

Why this bill?

• The Bill is aimed at bringing reforms in the medical education sector which has been under scrutiny for corruption and unethical practices.
• Over the years, the Medical Council of India has become a seat of corruption and has fallen into the hands of a small lobby of private medical practitioners.
• Instead of attracting professionals of high calibre, it is run by a coterie secure in the belief that they will be protected by politicians and bureaucrats at the highest levels.

Key provisions of the original bill

1. The Bill sets up the National Medical Commission (NMC).  The NMC will regulate medical education and practice.  It will determine fees for up to 40% seats in private medical institutions and deemed universities.
2. The NMC will consist of 25 members.  A Search Committee will recommend names to the central government for the post of Chairperson, and the part time members.
3. Four autonomous Boards have been set up under the supervision of the NMC.  These Boards will focus on undergraduate and postgraduate medical education, assessment and rating, and ethical conduct.
4. There will be a National Licentiate Examination for doctors to obtain a licence to practice after graduation.  This examination will also be the basis for admission to post-graduate medical courses.
5. State Medical Councils will receive complaints relating to professional or ethical misconduct against a doctor.  If the doctor is aggrieved of a decision of the State Medical Council, he may appeal to successively higher levels of authority.

Amendments approved in Bill

In April 2018, Centre amended the National Medical Commission (NMC) Bill, which will now be tabled in Parliament.

Key features of the amended bill

• Final MBBS Examination and exit test: The final MBBS examination will be held as common exam throughout country. It will serve as exit test to be called National Exit Test (NEXT). It will ease burden on medical students as they will not have to appear in separate exam after MBBS to get license to practice. NEXT will also serve as screening test for doctors with foreign medical qualifications in order to practice in India.
• Provision of Bridge course: It removes provision dealing with bridge course for AYUSH practitioners to practice modern medicine to limited extent. Now state governments have been empowered to take necessary measures for addressing and promoting primary health care in rural areas.
• Fee regulation:  The maximum limit of 40% seats for which fee will be regulated in private medical institutions and deemed universities has been increased to 50% seats. The fee will also include all other charges taken by colleges.
• Number of nominees from States/UTs in NMC: The nominees of States and UTs in National Medical Commission (NMC) have been increased from 3 to 6. TNMC will comprise of 25 members of which at least 21 will be doctors.
• Monetary penalty for medical colleges: It adds provision providing different options for warning, reasonable monetary penalty, reducing intake, stoppage of admission leading up to withdrawal of recognition on medical college non-compliant with norms. Earlier, wide range of monetary penalty, ranging from one half to ten times annual fee recovered from batch was to be imposed in a graded manner.
• Stringent punishment for quacks: It provides severe punishment for any unauthorized practice of medicine or by quacks with imprisonment of up to 1 year along with fine extending up to Rs. 5 lakhs.

The significance of the bill

NMC to be less draconian:

• Deterrence for non-compliance with maintenance of standards is in terms of monetary penalty
• The new commission will also have the power to frame guidelines for fees for up to 50% seats in private colleges and deemed universities

Checks and Balances:

• The NMC bill was floated to ensure transparency with the division of powers.
• Under the NMC  three independent boards-Search and Selection Committee (SSC), Medical Advisory Council, and the National Medical Commission- will operate with autonomy from the others, thereby creating a mechanism for check and balances.

Uniform quality of doctor throughout the country:

• The final MBBS examination would be held as a common exam across the country. This would serve as an exit test, called the National Exit Test (NEXT), and would be a prerequisite to practice Allopathy.
• The common exam is expected to ascertain uniform quality of doctors throughout the country.

Will expand the health workforce

• The first draft of the Bill proposes to streamline various AYUSH and Homeopathic practitioners and create an integrated healthcare model where the state governments decide the modalities of the provision.
• Under this mechanism, less specialised health workers are trained to strengthen and expand the health workforce. This will reduce the scarcity of doctors

Issues/challenges with the bill

1. Against democratic spirit:

• • The NMC Bill, aimed at replacing the existing Medical Council of India, will have a 25-member commission nominated by the Union government.
  • This will cripple the democratic functioning of the medical profession by making it completely answerable to the bureaucracy.

2. Dominance of doctors:

• Two-thirds of the members in the NMC are medical practitioners.
• Expert committees have recommended that the regulator should consist of more diverse stakeholders in order to reduce the influence of medical practitioners in regulating medical education and practice.

3. No full-proof protection against Corruption:

• It is not clear how the National Medical Commission, consisting of members who are all nominated in various ways by the government and the health bureaucracy, will be kept free of corrupting influences.
• If a system of democratic representation can be twisted to serve vested interests, there is no guarantee that a body consisting entirely of nominated members will be free of corrupting influences.

4. No requirement for renewal:

• There is no requirement for periodic renewal of the licence to practice.  Some countries require periodic testing to ensure that practitioners remain up to date, fit to practice, and give good care to patients

5. No provision of an appellate body:

• In cases of professional or ethical misconduct by medical practitioners, the practitioners can appeal a decision of the NMC to the central government.
• It is unclear why the central government, and not a judicial body, is the appellate authority.

6. Will promote Expensive Private medical education:

• The National Medical Commission Bill takes forward the move to legitimise profit-making in medical education by proposing that the fees in private medical colleges for 50% of the seats be regulated, thereby allowing the charging of exorbitant fees for the remaining 50% seats.
• Clearly, the Bill embodies a vision for medical education that does not include higher public investment but, rather, clears the way for converting medical education into a lucrative profit-making venture.

7. Anti-federal:

IMA has called the proposal of centrally-administered common exam anti-federal. It has asserted that the bill marginalises state governments, state medical councils and state health universities.

Way Forward

• Increase number of doctors more doctors and imparting proper training in their respective fields
• Presence of public and private healthcare to remotest of regions
• The problem of brain drain should be addressed. Emigration of doctors is a major factor contributing to shortage of doctors. Further, the issue of reluctance of serving in rural areas should be addressed.  NMC should limit emigration of newly graduated doctors.