OPINION

Getting medical education on track

“In the U.K. and in many European countries, medical education falls under the government. It is time for the same in India.” Picture shows the Government Mohan Kumaramangalam Medical College Hospital in Salem.— Photo: E. Lakshmi Narayanan

“In the U.K. and in many European countries, medical education falls under the government. It is time for the same in India.” Picture shows the Government Mohan Kumaramangalam Medical College Hospital in Salem.— Photo: E. Lakshmi Narayanan  

At a time of pervasive cynicism, when politicians are perceived as uncaring of peoples’ welfare and Parliament is trending dangerously towards becoming irrelevant, the report of the Parliamentary Standing Committee (PSC) on the need to reform the Medical Council of India (MCI) has come as a glimmer of hope. The PSC has broadly agreed to all the recommendations of the many reports that have been submitted over the decades and that had, until now, fallen on deaf ears.

The MCI was established in 1934 under the Indian Medical Council Act, 1933, as an elected body for maintaining the medical register and providing ethical oversight, with no specific role in medical education. The Amendment of 1956, however, mandated the MCI “to maintain uniform standards of medical education, both under graduate and postgraduate; recommend for recognition/de-recognition of medical qualifications of medical institutions of India or foreign countries; accord permanent registration/provisional registration of doctors with recognised medical qualifications; and ensure reciprocity with foreign countries in the matter of mutual recognition of medical qualifications.”

The second amendment came in 1993, at a time when there was a new-found enthusiasm for private colleges. Under this amendment, the role of the MCI was reduced to an advisory body with the three critical functions of sanctioning medical colleges, approving the student intake, and approving any expansion of the intake capacity requiring prior approval of the Ministry of Health and Family Welfare.

Of late, the MCI has come to be seen as pushing and protecting the interests of the private sector. Its continued functioning, despite a public interest litigation filed in the Supreme Court questioning the allegedly brazen rigging of elections, is reflective of its political clout.

On grounds of corruption, the MCI faced the ignominy of being set aside by the Supreme Court in 2002 and again in 2010 by an ordinance issued by the government. Seizing the opportunity of the temporary suspension of the elected MCI, the Ministry of Health drafted a Bill to establish a National Commission for Human Resources for Health (NCHRH). This Bill sought to revamp the MCI to consist of nominated bodies to carry out the functions of human resource planning, curriculum development and quality assurance, with the elected body limited to register doctors and govern their practice in accordance with ethical standards. It was laid on the table of the Rajya Sabha in 2011.

The PSC returned the Bill with some observations to the Ministry in October 2013. In 2014, another committee under the chairmanship of Dr Ranjit Roy Chaudhury was appointed. This committee submitted its report in February 2015. The current report of the PSC is in near unanimity with this report.

Recommendations of the PSC

Explicitly acknowledging the deep tentacles of corruption and misgovernance that have consumed the MCI, the PSC has made the following recommendations: to provide a new architecture that is more in tune with current needs of the country; to replace the principle of election with nomination; to replace the existing MCI with an architecture consisting of four independent boards to deal with curriculum development, teacher training, and standard setting for undergraduate and post-graduate education; accreditation and assessment processes of colleges and courses for ensuring uniformity in standards; and the registration of doctors, licensing and overseeing adherence to ethical standards.

These reforms are expected to plan human resources required for primary care by promoting family medicine and general physicians alongside specialists; rationalise standards to make medical education affordable; and enforce a uniform national entry and exit examination — a recommendation that was overruled by the Supreme Court and is pending appeal. These are all critical recommendations that, if implemented, can have far-reaching consequences for the health sector.

Shortcomings of the report

However, the report falls short on three counts. The idea to upgrade district hospitals to government medical colleges was proposed to obviate the cost of establishing a 300-bed hospital for a new college, utilise existing specialists for teaching, and provide rural populations access to specialist services nearer their homes and at a lower cost. The Ministry of Health has recently sanctioned funds to 58 district hospitals for such upgradation. The PSC report has not provided any clear directions on this subject.

It is important to flag this issue as the experience of handing over government (district) hospitals to private entrepreneurs (for instance, in Bhuj to the Adani Group on a 99-year lease or leasing out the Raichur hospital to the Apollo Group and in 2015 the 300-bed Chittoor district hospital in Andhra Pradesh to Apollo for five years for establishing a medical college) have been controversial on grounds of the poor being denied access to free care. This policy of corporatising public assets in the name of establishing medical colleges and providing quality care is highly flawed and, as a remedy, worse than the malaise. The government needs to clearly state its policy on this issue to be consistent with the spirit and letter of the report that has strongly condemned the crass commercialisation of the health sector.

Another shortcoming is the failure to recommend that all the 400-plus existing medical colleges undergo a rigorous assessment by a high-level committee appointed for the purpose. A similar exercise done by Flexner in the U.S. in 1910 led to the recommendation that only 16 out of 155 medical schools function. Such an assessment is sorely needed to bring in the much-needed credibility to the system and stop the production of poorly trained doctors.

The PSC report has also given the Health Ministry power on the important issue of fee structure. It would have been advisable to allow the new system to evolve and regulate the fee structure within its mandate.

What next?

Parliament has done its duty. The onus is now on the government to demonstrate its commitment to bringing in ‘achche din’. Unlike its predecessors, it is not a prisoner of vested interests that control the MCI today and were allegedly behind the untimely transfer of a Union Secretary and the Cabinet Minister for Health in 2014.

The PSC has indicted the MCI and this alone is sufficient reason to set it aside with immediate effect. A group of eminent people should be appointed as a transition team to work out the new architecture, even as the Law Commission should be requested to draft an appropriate law with safeguards to ensure that the new body does not become overly centralised.

India has paid a huge price by sacrificing its traditional wisdom and not developing human resources suited to its needs. Given the disparities in the country, there is a need to guard against elitism. In the U.K. and in many European countries, medical education falls under the government. It is time for the same in India.

(Sujatha Rao is former Union Secretary, Health, and Sita Naik is former Member of the Board of Governors of MCI and also member of the Ranjit Roy Chaudhury Committee.)



Seen as protecting the private sector's interests, the MCI’s continuance is reflective of its

political clout



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