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 The Medical Council of India (MCI) was established in 1934 under the Indian Medical Council Act, 1933.The Act was repealed and replaced by the Indian Medical Council Act, 1956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

Context

Since 2017, October 15 is celebrated as Rashtriya Mahila Kisan Diwas in India.

INTRODUCTION

• Economic Survey 2017-18, says that with growing rural to urban migration by men, there is ‘feminisation’ of agriculture sector, with increasing number of women in multiple roles as cultivators, entrepreneurs, and labourers.
• Globally, there is empirical evidence that women have a decisive role in ensuring food security and preserving local agro-biodiversity.
• Rural women are responsible for the integrated management and use of diverse natural resources to meet the daily household needs. This requires that women farmers should have enhanced access to resources like land, water, credit, technology and training which warrants critical analysis in the context of India.
• In addition, the entitlements of women farmers will be the key to improve agriculture productivity.

What is feminization of agriculture?

The term ‘Feminization of agriculture’ refers to increasing participation of women in agricultural activities. It can be interpreted in the following ways:

• An increase in the percentage of women who are economically active in agricultural sector either as self-employed or as agriculture wage workers or unremunerated family workers
• An increase in the percentage of women in agricultural labour force relative to men, either because of more women are working or because of fewer men are working in agriculture.
• The extent to which women define, control and enact the processes of agriculture

Women in Indian agriculture: Statistics

• Participation of both men and women in agriculture has declined, but the rate of decline has been faster among men than it has among women.
• Decline among women has been specifically in relation to their roles as cultivators, however their numbers as agricultural labourers have increased
• The Agriculture Census (2010-11) shows that out of an estimated 118.7 million cultivators, 30.3% were females. Similarly, out of an estimated 144.3 million agricultural labourers, 42.6% were females.
• According to Census 2011, there has been a 24% increase in the number of female agricultural labourers between 2001 and 2011.
• As per Census 2011, out of total female main workers, 55% were agricultural labourers and 24% cultivators.

Role of Women in Agriculture and Allied Activities:

Rural women are engaged in agricultural activities in three different ways depending on the socio-economic status: They are work as:

• Agricultural Labourers.
• Cultivator doing labour on their own land.
• Managers of certain aspects of agricultural production by way of labour supervision and the participation in post-harvest operations.

Functions performed:

• Agricultural Activities: Sowing, transplanting, weeding, irrigation, fertilizer application, plant protection, harvesting, winnowing, storing etc.
• Allied Activities: Cattle management, fodder collection, milking etc.
• Women play an important role in agricultural development, in ensuring food security and preserving local agro-biodiversity.
• Rural women are also responsible for the integrated management and use of diverse natural resources to meet the daily household needs.

Causes of Feminization of Indian Agriculture:

1. Poverty: Poverty is a major factor due to which women are women are forced to work as agricultural labourers to supplement the family’s income. Women also work as unremunerated workers in family fields.
2. Agrarian Distress and Shift of men to Casual work: Agrarian distress is a predominant factor for disruption of farm labour or de-pesantatization i.e. migration of males from agriculture towards casual work. According to a 2013 report published in The Hindu, between 2001 and 2011, a total of 7.7 million farmers left agriculture. With rising shift of men from farm to non-farm activities, women have got absorbed in agricultural and allied activities.
3. Migration to Urban Areas: According to the Economic Survey 2017-18, with growing rural to urban migration by men, there has been ‘feminisation’ of agriculture sector; there has been an increase in participation of women as cultivators, labourers and entrepreneurs.
4. Mechanization of agriculture: With increased mechanisation of agriculture, men have moved to other non-farm activities while women have been confined to traditional roles such as winnowing, harvesting, sowing seeds and rearing livestock.
5. Mobility: The upward mobility of women for employment is restricted and is further constrained by gender wage differentials. As per Census, about 33.7% of rural males migrate for reasons of employment and better economic opportunities. However, in the case of females, it is as low as 3.6% for rural females.

Issues:

1. Access to land: Lack of access to land is the major challenge faced by women in Indian agriculture. As per Census Agricultural Census (2015-16), out of a total 146 million operational holdings, the percentage share of female operational holders is only 13.87%.
2. Access to credit: A lack of ownership of land does not allow women farmers to approach banks for institutional loans as banks usually consider land as collateral.
3. Access to agricultural inputs: When compared to men, women generally have less access to resources and modern inputs (seeds, fertilizers, pesticides) to make farming more productive.
4. Access to technology: Mechanization of agriculture has resulted in confinement of women in low paying traditional works. Further, most farm machinery is difficult for women to operate.
5. Access to education, training and extension services: Access to education, agricultural training and extension services for women has been predominantly low as compared to men.
6. Managing different roles: In addition to intensive work on the farm all day, women are also expected to fulfil domestic obligations like cooking, child rearing, water collection, fuel wood gathering, household maintenance etc.
7. Wage: Despite more work for longer hours when compared to male farmers, women farmers have lower wage rates and at times remain unpaid.
8. Marketing: Small and marginal farmers in India lack adequate access to marketing facilities due to lack of basic infrastructure like market yards, roads and transportation, and storage including freezers and presence of middlemen. Additional constraints for women include seclusion, lack of literacy, knowledge and information. Further, women have no representation in agricultural marketing committees and other similar bodies.
9. Feminization of poverty: Women lack viable livelihood alternatives, and are forced to undertake farm activities that have been left by men due to agrarian distress. According to scholars, feminization of agriculture in India is actually “feminization of agrarian distress” or can also be termed as “feminization of poverty”.
10. Violence: Violence and sexual harassment at workplace is a major issue faced by women agricultural labours and cultivators in India which mostly goes unreported.
11. Health and Occupational Hazards: Women face health hazards in the cultivation of many crops and plantations due to lack of training, lack of protective gears and long working hours. Lack of nutritional security further perpetuates health issues.

Government efforts

The following measures have been taken to ensure the mainstreaming of women in agriculture sector:

1. The government has earmarked at least 30% of the budget allocation for women beneficiaries in all ongoing schemes/programmes and development activities.
2. Women centric activities have been initiated to ensure benefits of various beneficiary-oriented programs/schemes reach them.
3. The government has been focusing on women self-help group (SHG) to connect them to micro-credit through capacity building activities and to provide information and ensuring their representation in different decision-making bodies.
4. Since, most farmers including women farmers are marginal farmers, the government has proposed that crop land holdings must be consolidated to reap the benefits of agricultural mechanisation including enhanced productivity, promote the rental model of farm machinery and reduce the cost of operations.
5. Recognizing the critical role of women in agriculture, the Ministry of Agriculture and Farmers Welfare has declared 15th October of every year as Women Farmer’s Day.

Way Forward:

1. A gender analysis is important for development policies and programs directed at agriculture. The Economic Survey (2017-18) recommended that there is an urgent need for ‘inclusive transformative agricultural policy’ aimed at gender-specific interventions.
2. The government should ensure access to secure land and property rights. A formal access to land will help increase productivity by facilitating investments and would ensure household food security and nutrition
3. Provision of credit without collateral under the micro-finance initiative of the National Bank for Agriculture and Rural Development should be encouraged
4. The training of rural women to help them adopt modern agricultural techniques that are tailored to local conditions and that use natural resources in a sustainable manner. Krishi Vigyan Kendras in every district can be assigned an additional task to educate and train women farmers about innovative technology along with extension services.
5. It is important to have gender-friendly tools and machinery for various farm operations. Manufacturers should be incentivised to come up with more women-friendly machineries.
6. Legal measures should be taken to ensure equal pay for work of equal value. Women should be made aware to help them negotiate equal wages and women organizations and unions can play an important role in this. The ILO has developed a program named Women’s Education for Integrating Women Members in Rural Workers’ Organizations with the objective of increasing empowerment of rural women in Tamil Nadu and Madhya Pradesh.
7. To achieve the full economic benefit from employment, rural women should be provided a greater choice over their occupations so that they are not forced to do the work left behind by men. It is thus important to have overall women empowerment through education, awareness and doing away with gender biases.

CONCLUSION

• With women predominant at all levels-production, pre-harvest, post-harvest processing, packaging, marketing – of the agricultural value chain, to increase productivity in agriculture, it is imperative to adopt gender specific interventions.
• An ‘inclusive transformative agricultural policy’ should aim at gender-specific intervention to raise productivity of small farm holdings, integrate women as active agents in rural transformation, and engage men and women in extension services with gender expertise.