Over five years ago, when the National Commission for Human Resources in Health (NCHRH) bill, 2011, came before the Parliamentary Standing Committee on Health for review, one of the states that opposed the proposed legislation was Gujarat – then headed by chief minister Narendra Modi.
Deposing before the House panel, the Gujarat representative argued, "it would be better to modify, amend and expand the role of the existing mechanism (Medical Council of India) rather than to create a new structure". He observed that "the correct way to go about a change was to improve the existing structure, build in safeguards and have a democratic and more consultative dispensation."
Cut to 2018. The Narendra Modi-led NDA government at the Centre intends to do exactly what he opposed as chief minister – creating a new structure to replace the MCI, which is often accused of corruption. It is quite likely that when the National Medical Commission bill, 2017, comes to Parliament for approval, some of the questions raised by states like Gujarat, Tamil Nadu and West Bengal against the NCHRH bill will return to haunt the treasury benches.
The NCHRH bill was conceived by the Congress-led UPA government as an umbrella body for better management and administration of four professional healthcare bodies – Medical Council of India, Dental Council of India, Pharmacy Council of India and the Indian Nursing Council. The central idea was to establish a national commission to deal with all kinds of human resources in the health sector.
The proposed NMC would have three constituent bodies – National Board of Health Education; National Evaluation and Assessment Committee and the National Council, with distinct responsibilities for regulating educational standards, enforcing the standards and assuring quality, and governing medical practice and ethical norms.
Had the NCHRH bill become law, the MCI would have been left with just the task of maintaining the national register of doctors and dealing with ethics complaints against doctors.
There were several objections to the proposal. One of the key objections from the 31-member House panel was the almost negligible representation from the state governments in the proposed NCHRH even though health is a state subject and medical education figures in the Concurrent list.
While the members of these panels were to be selected by various selection committees, the MPs raised questions on the ambiguous nature of choosing the members, who would sit on those panels.
Mamata Banerjee's West Bengal government told the House panel it was not in favour of passing the bill as it proposed shifting self-regulation of professional bodies to a central and technocratic regulation.
West Bengal argued that the NCHRH bill was top heavy, with more emphasis on "expertise" rather than on "states' participation," which could lead to a purely technical, highly centralised, over-regulated approach to a sector that impinges on public welfare and is on the Concurrent list in the Constitution. Six years down the line, TMC has similar objections to the NMC bill, which the party argued would lead to increased privatisation of the health sector.
Tamil Nadu, under the late J Jayalalithaa, was another state that objected to a centralised regulatory structure for medical education. "The NCHRH bill effectively puts the leadership and decision-making process with regard to medical, dental and paramedical education in the hands of 25 persons, all of whom would be nominees of the central government. This would undermine the powers of the state government, which would be left with no role to play in policy issues," said the Tamil Nadu official.
Objections from state governments were one of the main reasons for the parliamentary panel to reject the NCHRH bill even after recognising the need for a better regulator for medical education, which lies at the core of India having a poor doctor-patient ratio.
That's the reason while introducing the NMC bill in the Lok Sabha, Union Health Minister J P Nadda said the new bill was drafted after taking into account the recommendations of the (previous) Standing Committee.
In fact the controversial provision of creating an interface between modern medicine and Ayurveda and Homoeopathy appear to have its roots in the same parliamentary committee report that observed that instead of having two governing structures for two streams of medicines, the government should create a single body.
The Union Health Ministry went a step ahead in the NMC bill to suggest that the practitioners of Indian systems of medicines and homoeopathy can prescribe modern medicines to some extent if they undergo a bridge course. While the contentious provision may have been introduced to help staff vacant sub-centres and primary health care centres in the countryside, it has opened a Pandora's Box.
What has remained constant for both NCHRH and NMC is steadfast opposition from the Indian Medical Association – India's largest group of doctors. IMA resisted a 2005 amendment to the Indian Medical Council Act, 1956, as well as another set of amendments proposed by the government after the NCHRH bill was rejected. It continued to preach self-regulation but did little to rid the medical sector of corruption.
Can the government stand up to all these challenges and deliver a clean and transparent regulator for the cash-rich sector?
