Improve, don't abandon, MCI

The medical system needs an integrated regulator

An ordinance was promulgated last week that empowers the government to dissolve the Medical Council of India (MCI). As a first step, the government has now created a seven-member board that will take over the functioning of the MCI. The ordinance will be effective for a year during which time the government is likely (if reports are to be believed) to dissolve the MCI. It intends then to separate the two functions of the MCI — education and licensing — and hand them over to new institutions. Education will come under the ambit of the National Commission for Higher Education and Research (NCHER), which, in turn, will be overseen by the Ministry of Human Resource Development (MHRD), and the licensing of medical practitioners under the National Council for Human Resources in Health (NCHRH), to be overseen by the Ministry of Health and Family Welfare.

The MCI had become dysfunctional. It has been found wanting on several counts: licensing new medical colleges, ensuring quality education and training, maintenance of a list of registered medical practitioners, ensuring ethical practices in the profession, etc. The government’s focus on MCI’s affairs is, therefore, quite welcome. But creating new institutions is not necessarily the best way of correcting the manifold problems of the health sector.

The health sector, it is well known, requires an overall perspective and answerability that only a single entity devoted to the sector can provide. Instead, the health ministry has been progressively weakened. The divestment of water supply and sanitation to the ministry of rural development is one example, and of pharmaceutical pricing to the ministry of chemicals and fertilisers another. If education and training in the health sector are now to be sliced away to the MHRD, the health ministry will become even weaker and, therefore, less answerable.

One should not forget that there was a reason why the MCI was formed as an independent, professional regulator. The health sector requires the creation of in-depth expertise which, if not available, has life-threatening ramifications. Only health sector experts have the necessary understanding of the nuances of health care to design and implement appropriate regulations. This is well recognised and consequently, all over the world, it is professionally-run medical associations that are in charge of such matters. Also, the NCHER under the MHRD will be working across different sectors; there is the ever-present danger that generalists from India’s large bureaucracy will be put in charge of a technical area, so that the cure becomes worse than the original malady. The world over, the trend is to provide greater powers to sector experts who have the necessary understanding of their sector and profession.

The solution, therefore, would be to create within and outside the MCI (or in a new body run by medical professionals) the necessary checks and balances that enable organisations to function effectively and credibly. Auditing of its activities would be one method through which third parties can appropriately assess the performance of the regulator. Transparency in the grading and registration system of educational institutions is another. Publicly displaying information of complaints against medical professionals is a third. A regular and free election of key office-bearers is a fourth. There are many other means as well. There are many honest, efficient and public-minded health care professionals in the country. The role of the government should be to ensure that such people run bodies such as the MCI.