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The National Medical Commission Bill, 2017 was introduced in Lok Sabha recently and is listed for consideration and passage today.[1] The Bill seeks to regulate medical education and practice in India. To meet this objective, the Bill repeals the Indian Medical Council Act, 1956 and dissolves the current Medical Council of India (MCI). The MCI was established under the 1956 Act, to establish uniform standards of higher education qualifications in medicine and regulating its practice.[2]
A Committee was set up in 2016, under the NITI Aayog with Dr. Arvind Panagariya as its chair, to review the 1956 Act and recommend changes to improve medical education and the quality of doctors in India.[3] The Committee proposed that the Act be replaced by a new law, and also proposed a draft Bill in August 2016.
This post looks at the key provisions of the National Medical Commission Bill, 2017 introduced in Lok Sabha recently, and some issues which have been raised over the years regarding the regulation of medical education and practice in the country.
What are the key issues regarding the regulation of medical education and practice?
Several experts have examined the functioning of the MCI and suggested a different structure and governance system for its regulatory powers.3,[4] Some of the issues raised by them include:
Separation of regulatory powers
Over the years, the MCI has been criticised for its slow and unwieldy functioning owing to the concentration and centralisation of all regulatory functions in one single body. This is because the Council regulates medical education as well as medical practice. In this context, there have been recommendations that all professional councils like the MCI, should be divested of their academic functions, which should be subsumed under an apex body for higher education to be called the National Commission for Higher Education and Research.[5] This way there would be a separation between the regulation of medical education from regulation of medical practice.
An Expert Committee led by Prof. Ranjit Roy Chaudhury (2015), recommended structurally reconfiguring the MCI’s functions and suggested the formation of a National Medical Commission through a new Act.3 Here, the National Medical Commission would be an umbrella body for supervision of medical education and oversight of medial practice. It will have four segregated verticals under it to look at: (i) under-graduate medical education, (ii) post-graduate medical education, (iii) accreditation of medical institutions, and (iv) the registration of doctors. The 2017 Bill also creates four separate autonomous bodies for similar functions.
Composition of MCI
With most members of the MCI being elected, the NITI Aayog Committee (2016) noted the conflict of interest where the regulated elect the regulators, preventing the entry of skilled professionals for the job. The Committee recommended that a framework must be set up under which regulators are appointed through an independent selection process instead.
Fee Regulation
The NITI Aayog Committee (2016) recommended that a medical regulatory authority, such as the MCI, should not engage in fee regulation of private colleges. Such regulation of fee by regulatory authorities may encourage an underground economy for medical education seats with capitation fees (any payment in excess of the regular fee), in regulated private colleges. Further, the Committee stated that having a fee cap may discourage the entry of private colleges limiting the expansion of medical education in the country.
Professional conduct
The Standing Committee on Health (2016) observed that the present focus of the MCI is only on licensing of medical colleges.4 There is no emphasis given to the enforcement of medical ethics in education and on instances of corruption noted within the MCI. In light of this, the Committee recommended that the areas of medical education and medical practice should be separated in terms of enforcement of the appropriate ethics for each of these stages.
What does the National Medical Commission, 2017 Bill seek do to?
The 2017 Bill sets up the National Medical Commission (NMC) as an umbrella regulatory body with certain other bodies under it. The NMC will subsume the MCI and will regulate the medical education and practice in India. Under the Bill, states will establish their respective State Medical Councils within three years. These Councils will have a role similar to the NMC, at the state level.
Functions of the NMC include: (i) laying down policies for regulating medical institutions and medical professionals, (ii) assessing the requirements of human resources and infrastructure in healthcare, (iii) ensuring compliance by the State Medical Councils with the regulations made under the Bill, and (iv) framing guidelines for determination of fee for up to 40% of the seats in the private medical institutions and deemed universities which are governed by the Bill.
Who will be a part of the NMC?
The NMC will consist of 25 members, appointed by the central government. It will include representatives from Indian Council of Medical Research, and Directorate General of Health Services. A search committee will recommend names to the central government for the post of Chairperson, and the part-time members. These posts will have a maximum term of four years, and will not be eligible for extension or reappointment.
What are the regulatory bodies being set up under the NMC?
The Bill sets up four autonomous boards under the supervision of the NMC, as recommended by various experts. Each autonomous board will consist of a President and two members, appointed by the central government (on the recommendation of the search committee). These bodies are:
What does the Bill say regarding the conduct of medical entrance examinations?
There will be a uniform National Eligibility-cum-Entrance Test (NEET) for admission to under-graduate medical education in all medical institutions governed by the Bill. The NMC will specify the manner of conducting common counselling for admission in all such medical institutions.
Further, there will be a National Licentiate Examination for the students graduating from medical institutions to obtain the license for practice. This Examination will also serve as the basis for admission into post-graduate courses at medical institutions.
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[1] The National Medical Commission Bill, 2017, http://www.prsindia.org/uploads/media/medical%20commission/National%20Medical%20Commission%20Bill,%202017.pdf.
[2] Indian Medical Council Act, 1933.
[3] A Preliminary Report of the Committee on the Reform of the Indian Medical Council Act, 1956, NITI Aayog, August 7, 2016, http://niti.gov.in/writereaddata/files/document_publication/MCI%20Report%20.pdf.
[4] “Report no. 92: Functioning of the Medical Council of India”, Standing Committee on Health and Family Welfare, March 8, 2016, http://164.100.47.5/newcommittee/reports/EnglishCommittees/Committee%20on%20Health%20and%20Family%20Welfare/92.pdf
[5] “Report of the Committee to Advise on Renovation and Rejuvenation of Higher Education”, Ministry of Human Resource Development, 2009, http://mhrd.gov.in/sites/upload_files/mhrd/files/document-reports/YPC-Report.pdf.
Recently, there have been reports of price crashes and distress sales in case of farm produce, such as tomatoes, mangoes, and garlic. In some cases, farmers have dumped their produce on roads. Produce such as fruits and vegetables are perishable and therefore have a short shelf life. Further, due to inadequate storage facilities and poor food processing infrastructure farmers have limited options but to sell the produce at prevailing market prices. This can lead to distress sales or roadside discards (in some cases to avoid additional cost of transportation).
Food processing allows raw food to be stored, marketed, or preserved for consumption later. For instance, raw agricultural produce such as fruits may be processed into juices, jams, and pickles. Activities such as waxing (for preservation), packaging, labelling, or ripening of produce also form part of the food processing industry.
Between 2001-02 and 2016-17, production of food grains grew annually at 1.7% on average. Production of horticulture crops surpassed food grains with an average growth rate of 4.8%. While production has been increasing over the years, surplus produce tends to go waste at various stages such as procurement, storage, and processing due to lack of infrastructure such as cold storages and food processing units.
Source: Horticulture Statistics at a Glance 2017, Union Budget 2018-19; PRS.
Losses high among perishables such as fruits and vegetables
Crop losses ranged between 7-16% among fruits and around 5% among cereals in 2015. The highest losses were witnessed in case of guava, followed by mango, which are perishable fruits. Perishables such as fruits and vegetables are more prone to losses as compared to cereals. Such crop losses can occur during operations such as harvesting, thrashing, grading, drying, packaging, transportation, and storage depending upon the commodity.
It was estimated that the annual value of harvest and post-harvest losses of major agricultural products at the national level was Rs 92,651 crore in 2015. The Standing Committee on Agriculture (2017) stated that such wastage can be reduced with adequate food processing facilities.
Sources: Annual Report 2016-17, Ministry of Food Processing Industries; PRS.
Inadequate food processing infrastructure
As previously discussed, perishables such as fruits and vegetables are more prone to damages as compared to cereals. Due to inadequate processing facilities in close proximity, farmers may be unable to hold their produce for a long time. Hence, they may be forced to sell their produce soon after harvest, irrespective of the prevailing market situations. Expert committees have recommended that agri-logistics such as cold chain infrastructure and market linkages should be strengthened.
Cold chain infrastructure: Cold chain infrastructure includes processing units, cold storages, and refrigerated vans. As of 2014, out of a required cold storage capacity of 35 million metric tonnes (MT), almost 90% (31.8 million MT) of the capacity was available (see Table 1). However, cold storage needs to be coupled with logistical support to facilitate smooth transfer of harvested value from farms to distant locations. This includes: (i) pack-houses for packaging and preparing fresh produce for long distance transport, (ii) refrigerated transport such as reefer vehicles, and (iii) ripening chambers to ripen raw produce before marketing. For instance, bananas which are harvested raw may be ripened in these chambers before being marketed.
While there are sufficient cold storages, there are wide gaps in the availability of other associated infrastructure. This implies that even though almost 90% (32 million tonnes) of cold storage capacity is available, only 15% of the required refrigerated transport exists. Further, the shortfall in the availability of infrastructure necessary for safe handling of farm produce, like pack-houses and ripening chambers, is over 90%.
Table 1: Gaps in cold chain infrastructure (2014)
| Facility | Required | Available | Gap | % gap |
| Cold storage (in million MT) |
35.1 |
31.8 | 3.2 |
9.3% |
| Pack-houses |
70,080 |
249 | 69,831 |
99.6% |
| Reefer vehicles |
61,826 |
9,000 | 52,826 |
85.4% |
| Ripening chambers |
9,131 |
812 | 8,319 |
91.1% |
To minimise post-harvest losses, the Standing Committee (2017) recommended that a country-wide integrated cold chain infrastructure network at block and district levels should be created. It further recommended that a Cold Chain Coordination and Monitoring Committee should be constituted at the district-level. The Standing Committee also recommended that farmers need to be trained in value addition activities such as sorting, grading, and pre-cooling harvested produce through facilities such as freezers and ripening chambers.
Between 2008 and 2017, 238 cold chain projects were sanctioned under the Scheme for Integrated Cold Chain and Value Addition Infrastructure. Grants worth Rs 1,775 crore were approved for these projects. Of this amount, Rs 964 crore (54%) has been released as of January 2018. Consequently, out of the total projects sanctioned, 114 (48%) are completed. The remaining 124 projects are currently under implementation.
Transport Facilities: Currently, majority of food grains and certain quantities of tea, potato, and onion are transported through railways. The Committee on Doubling Farmers Income had recommended that railways needs to upgrade its logistics to facilitate the transport of fresh produce directly to export hubs. This includes creation of adjoining facilities for loading and unloading, and distribution to road transport.
Mega Food Parks: The Mega Food Parks scheme was launched in 2008. It seeks to facilitate setting up of food processing units. These units are to be located at a central processing centre with infrastructure required for processing, packaging, quality control labs, and trade facilitation centres.
As of March 2018, out of the 42 projects approved, 10 were operational. The Standing Committee on Agriculture noted certain reasons for delay in implementation of projects under the scheme. These include: (i) difficulty in getting loans from banks for the project, (ii) delay in obtaining clearances from the state governments and agencies for roads, power, and water at the project site, (iii) lack of special incentives for setting up food processing units in Mega Food Parks, and (iv) unwillingness of the co-promoters in contributing their share of equity.
Further, the Standing Committee stated that as the scheme requires a minimum area of 50 acres, it does not to promote smaller or individual food processing and preservation units. It recommended that smaller agro-processing clusters near production areas must be promoted. The Committee on Doubling Farmers Income recommended establishment of processing and value addition units at strategic places. This includes rural or production areas for pulses, millets, fruits, vegetables, dairy, fisheries, and poultry in public private-partnership mode.
