Amidst much opposition and criticism from political leaders, doctors, and medical students across the country, the National Medical Commission (NMC) Bill was passed by the Lok Sabha on 29 July, following modifications to its 2017 version. Subsequently, the Rajya Sabha passed the bill with minor modifications on 1 August.
The bill proposes to repeal the Indian Medical Council Act, 1956 and dissolve the Medical Council of India (MCI), amongst several other major reforms in medical education in the country. Protesting against these measures, the Indian Medical Association (IMA) and Resident Doctors' Association at AIIMS recently went on strike.
Why Are Doctors Disgruntled?
Much of the criticism has been towards certain provisions in the bill and towards the implementation of the bill. The NMC will likely replace the existing administrative setup of medical education and regulation in the country. It’ll set up a National Medical Commission that will be responsible for approving new medical colleges and assessing the existing ones; introduce a National Exit Test (NEXT) that will act as a licentiate examination for fresh graduates, and a screening test for post-graduation, and establish a cadre of community health providers with the ability to prescribe allopathic medicine.
While the intention of the government and policy makers is clear — that of formalising the system, bringing in transparency, untangling the existing public health crisis, and improving the dismal doctor-patient ratio — the major challenge lies in its implementation and lack of guidelines on it.
Questions Of Structure, Process & Accountability
For starters, there is no existing evidence that suggests that equipping untrained community health providers with the ability to prescribe allopathic medicine will solve any existing public health crisis. Even if there was any evidence supporting it, how will the government regulate these workers and ensure that these provisions are not taken advantage of?
For any major reform to be successful in public health, it has to be first tested in a pilot project, and systematically and gradually stepped up into bigger phases. Any sudden, populist moves like the current bill will only expose the vulnerabilities in the existing system, and may even aggravate the crisis to an unsolvable one.
Why The NEXT Faces Stiff Opposition
Quacks and allied health workers pretending to be legitimate doctors and prescribing allopathic medications with impunity, have already created a chaotic healthcare system. On top of that, how will the government ensure that these newly legitimised community health providers will not venture outside primary health care centres and exploit the responsibility given to them? Rich, educated and working professionals will continue visiting state-of-the-art private health facilities, while the poor will again be left at the mercy of a dilapidated health system.
Secondly, the National Exit Test (NEXT) has faced stiff opposition from medical students and junior doctors for the way in which it has been thrust upon them without consultation.
A uniform licensing examination for medical graduates in India is the need of the hour, but severe deficiencies lie in its implementation. A reform of this scale needs wise planning, pilot studies, investment on infrastructure, and phased-out laying out. This initiative will ensure that medical graduates are well-versed with the clinical application of knowledge and not just rote learning. But then again, how will the government ensure that the examinations are structure, unbiased, and evidence-based?
What Policy Makers & Govt Need To Do
The real challenge to India’s public healthcare problem today is the inability of the government to maintain uniform quality in medical education and healthcare provision across the country. The dubious stand by the government to scrutinise medical graduates with an additional exam, while simultaneously giving a free hand to ‘quacks’ and legalising ‘illegitimate’ medical care, is worrying.
The policy makers and government should reach out to major stakeholders of this bill, ie, current medical students and junior doctors, and discuss their issues directly.
The government needs to meet its impressive vision with an equally charged fervour in implementation and monitoring. An initiative, however honest and visionary, will not bring about change if its implementation is fragile. It remains to be seen where the healthcare system in India goes from here.
(Dr Ankit Raj is a junior doctor with interests in health policy and system strengthening. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)
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