Last week, President Ram Nath Kovind signed into law the National Medical Commission (NMC) Bill amidst continued opposition from the medical fraternity. The NMC Bill earned approval from both the Lok Sabha and the Rajya Sabha in recent weeks. Its assent by President Kovind initiated one of the biggest healthcare reforms in Indian history, with a substantial overhaul of medical education and the replacement of the near 63-year-old Medical Council of India (MCI) with a mostly government-appointed body – the eponymous NMC.
The NMC Bill has elicited much criticism from the medical fraternity. The Indian Medical Association (IMA) had called for a national strike on August 8th, but did not proceed with it owing to a number of national issues including the ongoing flooding in northeast India; unrest in Jammu and Kashmir following the revocation of its ‘special status’ under Section 370 of the Indian Constitution; and the death of former Union Minister of External Affairs and Health and Family Welfare Sushma Swaraj.
Nonetheless, recent days and weeks have seen protests against the Bill by medical students in Tamil Nadu; by resident doctors in Maharashtra until the stir was deferred amidst the floods; and by medicos in Andhra Pradesh and Telangana. Some demonstrations have witnessed medical students create copies of the bill to publicly burn.
Even as it called off a national strike on August 8th, the IMA said in its statement that it was only “[deferring] its call for withdrawal of services to a later date of choice” and that “the struggle of IMA against the deleterious clauses of NMC Bill 2019 will continue till the medical education and the health of the nation are out of harm’s way.” Leading IMA officials have pledged to agitate against the Bill should the concerns of the medical fraternity not be reflected in amendments to the legislation.
Upon the Bill’s assent, Union Health Minister Dr Harsh Vardhan praised the reform as “progressive” and expounded upon its benefits, especially for medical students who would enjoy a streamlined process under the provisions of the Bill. These would include a national entrance exam and a National Exit Test (NEXT) – both common examinations, as well as standardising counselling for those studying for Bachelor of Medicine or Bachelor of Surgery (MBBS) degrees. This, Vardhan said, “will eliminate the need for students to approach multiple colleges and take part in multiple counselling processes for admission. This will save students and their families unnecessary physical and financial trauma.”
Further, Vardhan touted how the Bill would affect the costs of medical education. “The Act provides for regulation of fees and all other charges in fifty percent [of] seats in private colleges as well as deemed-to-be universities,” he said. “Nearly fifty percent of the total MBBS seats in the country are in government colleges, which have nominal fees. Of the remaining seats, fifty percent would be regulated by NMC. This means that almost 75 percent of total seats in the country would be available at reasonable fees. It must be stressed again at this point that not only fees, but fees and all other charges are being regulated.”
Vardhan also sought to allay other fears, concerning the allowance of some to practise medicine and also the alleged centralisation of power. The replacement of the MCI with the NMC has been described as vesting too much power in government bureaucracy and taking it away from doctors. Vardhan has responded by stating “there will be ten vice chancellors of state health universities and nine elected members of state medical councils in the NMC. Thus nineteen out of 33 members, which is more than half of the total strength, would be from states and only a minority of members will be appointed by the Central government thereby ensuring NMC is representative, inclusive and respecting the federal structure of Indian polity.”
In addition, the Health Minister has taken great pains to assuage fears that the Bill does not sponsor quackery. Vardhan has said that the Bill makes penalties more stringent for quacks, noting that “the punishment for quackery has been enhanced to up to one year imprisonment and up to Rs 5 lakhs fine from the existing Rs 1000.” Meanwhile, the Health Ministry has stated the appointment of individuals to fill medical posts as “community health providers” is only a temporary measure as the country aims to reach the optimal doctor-patient ratio. Only those “connected” with allopathic medicine can do so, the Ministry also stipulated.
With the NMC now signed into law, the Union Health Ministry and the Centre at large can mark a major victory in its efforts to reform healthcare. In the coming six months, Vardhan has said, the NMC and associated bodies will be constituted. Yet, despite assurances, opposition continues from the medical fraternity. Whether this opposition is sustained over a lengthy period of time remains to be seen.