Strong medicine

A new cure should not make health care suffer more

The National Medical Commission (NMC) Bill, now before a standing committee of Parliament, offers the chance to reform a critical area of social infrastructure in the world’s second-most populous country. The reference to the standing committee was principally in response to the threat of a nation-wide strike by the Indian Medical Association, a lobby of 300,000 doctors that fears the NMC, with which the Bill proposes to replace the 61-year-old Medical Council of India (MCI) as the regulatory body, will introduce a draconian regime. The self-serving concerns of a profession that has done little to enhance its reputation can be ignored, but there are genuine worries about whether the Bill addresses the corruption-ridden shambles that is health care in India in a constructive manner. To be sure, the Bill, which has been in the works since 2016, recognises the truth that self-regulation as practised under the aegis of the MCI has failed the medical profession on all counts.

The quality of primary and tertiary health care in India speaks for itself. Medical education is prohibitively expensive, scarce and its syllabi so inadequate that a former health secretary observed “the market is flooded with doctors so poorly trained that they are little better than quacks”. Inevitably, the process of regulation in a situation of a serious shortage of medical colleges has been riddled with corruption. The new Bill proposes to address these anomalies in several ways. 

First, the NMC will essentially be an umbrella regulatory body comprising 25 members appointed by the central government. It will include representatives from the Indian Council of Medical Research and the Directorate General of Health Services. It will oversee two bodies that will control undergraduate and postgraduate education (syllabus-setting, guidelines etc), a body that will monitor standards in medical colleges and grant permissions for new colleges, and an Ethics and Medical Registration Board. The NMC will also administer the National Eligibility cum Entrance Test and introduce a new licentiate examination for practitioners. This elaborate structure admittedly distributes powers more widely and has checks and balances built in to preclude corruption.

Whether it will address the key weaknesses of Indian health care remains an open question. Experience has shown that government appointments to regulatory roles do not necessarily imply better regulation. The standing committee will do well to find ways to ring fence the NMC from the cronyism in appointments that afflicts several key regulatory bodies in India. Also, the NMC’s power to effect deep-rooted change remains in doubt because of its umbrella status: According to the Bill, states will have to set up medical councils within three years, a move that suggests some abdication of responsibility. 

Perhaps most worrying is the committee’s recommendation allowing homeopathic and Ayurvedic doctors to do a “bridge course” to allow them to prescribe allopathic drugs. The result of a 2016 committee recommendation to bridge the poor doctor-patient ratio, this proposal betrays a fundamental misunderstanding of the basic principles on which these differing medical systems operate. The need for an overhaul of the medical regulatory system is unquestionable; a flawed replacement, however, will only aggravate the disease.