Medical Education Governance in India

[op-ed snap] Writing out a clean Bill on health

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : Analysis of NMC bill

CONTEXT

The last few days witnessed so many concerns being raised over a few clauses of the National Medical Commission (NMC) Bill. 

Concerns

There are five primary concerns:

  1. National Eligibility-cum-Entrance Test /National Exit Test
  2. Empowering of community health providers for limited practice
  3. Regulating fees for only 50% seats in private colleges
  4. Reducing the number of elected representatives in the Commission
  5. Overriding powers of the Centre.

Examinations

  1. For the past few years, a separate NEET is being conducted for undergraduate and postgraduate courses. In addition there are different examinations for AIIMS and JIPMER.
  2. This Act consolidates multiple exams at the undergraduate level with a single NEET and avoids multiple counselling processes.
  3. NEXT is the final year MBBS examination across India, an entrance test to the postgraduate level, and a licentiate exam before doctors can practise.
  4. It aims to reduce disparities in the skill sets of doctors graduating from different institutions. 
  5. Thus it implemented a ‘One-Nation-One-Exam’ in medical education.

Limited licence

  1. Though 70% of India’s population resides in rural areas, the ratio of doctors in urban and rural areas is 3.8:1. 27,000 doctors serve about 650,000 villages of the country.
  2. A recent study by the WHO shows that nearly 80% of allopathic doctors in rural areas are without medical qualification.
  3. NMC Act attempts to address this gap by effectively utilising modern medicine professionals, other than doctors in enabling primary and preventive health care. Evidence from China, Thailand and the United Kingdom shows such integration results in better health outcomes. Chhattisgarh and Assam have also experimented with community health workers. 

Fee structure

  1. Private medical colleges are capitation fee-driven and resort to a discretionary management quota and often have charges of corruption levelled against them.
  2. The Indian Medical Council Act, 1956 has no provision for fee regulation. 
  3. Until now, ‘not-for-profit’ organisations were permitted to set up medical colleges, involving enormous investments and a negotiation of cumbersome procedures.
  4. NMC Act removes the discretionary quota by using a transparent fee structure. It empowers the NMC to frame guidelines for determination of not only fees but all other charges in 50% of seats in private colleges to support poor and meritorious students.
  5. The Act also provides for rating of colleges. Reducing entry barriers for setting up medical colleges, along with their rating, is expected to benefit students.

Representation in the NMC

  1. The current electoral process of appointing regulators is saddled with compromises and attracts professionals who may not be best suited for the task at hand.
  2. Act provides for a transparent search and selection process with a mix of elected and nominated representatives, both in the search committee and the commission itself.
  3. The government added members from State medical councils and universities.
  4. Government should be able to give directions so that NMC regulations align with its policy.

Other features

  1. The Act establishes the Diplomate of National Board’s equivalence to NMC-recognised degrees.
  2. It also promotes medical pluralism.
  3. There is a paradigm shift in the regulatory philosophy from an input-based, entry barrier for education providers without corresponding benefits, to becoming outcome-focused. 
  4. Both the number of doctors and their skill sets are expected to improve. 
  5. Autonomy to boards and segregation of their functions will avoid a conflict of interest and reduce rent-seeking opportunities. 
  6. ‘Quacks’ are liable to face imprisonment or be fined or both.

Medical education needs continuous reforms in order to usher in improvements in health care. NMC Act is a serious attempt to meet the primary need of more medical professionals in the country.

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