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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.
Safety has been one of the biggest concerns in the Indian Railways system. While the number of accidents have gone down over the last few years, the number still remains over 100 accidents a year. In light of the recent train accidents in Uttar Pradesh (UP), we present some details around accidents and safety in the Indian Railways.
Causes of rail accidents
The number of rail accidents has declined from 325 in 2003-04 to 106 in 2015-16.[1] The number of rail accidents as per the cause are shown in the graph below. In 2015-16, majority of the accidents were caused due to derailments (60%), followed by accidents at level crossings (33%).1 In the last decade, accidents caused due to both these causes have reduced by about half. According to news reports, the recent railway accidents in UP were caused due to derailment of coaches.
Derailments
Between 2003-04 and 2015-16, derailments were the second highest reason for casualties.2 The Standing Committee on Railways, when examining the safety in railways, had noted that one of the reasons for derailments is defect in the track or coaches. Of the total track length of 1,14,907 kms in the country, 4,500 kms should be renewed annually.2 However, in 2015-16, of the 5,000 km of track length due for renewal, only 2,700 km was targeted to be renewed.2 The Committee had recommended that Indian Railways should switch completely to the Linke Hoffman Busch (LHB) coaches as they do not pile upon each other during derailments and hence cause lesser casualties.2
Un-manned level crossings
Un-manned level crossings (UMLCs) continue to be the biggest cause of casualties in rail accidents. Currently there are 14,440 UMLCs in the railway network. In 2014-15, about 40% of the accidents occurred at UMLCs, and in 2015-16, about 28%.2 Between 2010 and 2013, the Ministry fell short of meeting their annual targets to eliminate UMLCs. Further, the target of eliminating 1,352 UMLCs was reduced by about 50% to 730 in 2014-15, and 820 in 2015-16.2 Implementation of audio-visual warnings at level crossings has been recommended to warn road users about approaching trains.2 These may include Approaching Train Warning Systems, and Train Actuated Warning Systems.2 The Union Budget 2017-18 proposes to eliminate all unmanned level crossings on broad gauge lines by 2020.
Casualties and compensation
In the last few years, Railways has paid an average compensation of Rs 3.03 crore every year for accidents (see figure below).[2]
Note: Compensation paid during a year relates to the cases settled and not to accidents/casualties during that year.
Consequential train accidents
Accidents in railways may or may not have a significant impact on the overall system. Consequential train accidents are those which have serious repercussions in terms of loss of human life or injury, damage to railway property or interruption to rail traffic. These include collisions, derailments, fire in trains, and similar accidents that have serious repercussions in terms of casualties and damage to property. These exclude cases of trespassing at unmanned railway crossings.
As seen in the figure below, the share of failure of railways staff is the biggest cause of consequential rail accidents. The number of rail accidents due to failure of reasons other than the railway staff (sabotage) has increased in the last few years.
Accidents due to failure of railway staff
It has been noted that more than half of the accidents are due to lapses on the part of railway staff.2 Such lapses include carelessness in working, poor maintenance, adoption of short-cuts, and non-observance of laid down safety rules and procedures. To address these issues, conducting a regular refresher course for each category of railway staff has been recommended.2
Accidents due to loco-pilots2,[3]
Accidents also occur due to signalling errors for which loco-pilots (train-operators) are responsible. With rail traffic increasing, loco-pilots encounter a signal every few kilometres and have to constantly be on high alert. Further, currently no technological support is available to the loco-pilots and they have to keep a vigilant watch on the signal and control the train accordingly.2 These Loco-pilots are over-worked as they have to be on duty beyond their stipulated working hours. This work stress and fatigue puts the life of thousands of commuters at risk and affects the safety of train operations.2 It has been recommended that loco-pilots and other related running staff should be provided with sound working conditions, better medical facilities and other amenities to improve their performance.2
Actions taken by Railways with regard to the recent train accident
According to news reports, the recent accident of Utkal Express in UP resulted in 22 casualties and over 150 injuries.[4] It has also been reported that following this incident, the Railways Ministry initiated action against certain officials (including a senior divisional engineer), and three senior officers (including a General Manager and a Railway Board Member).
The Committee on Restructuring of Railways had noted that currently each Railway zone (headed by a General Manager) is responsible for operation, management, and development of the railway system under its jurisdiction.[5] However, the power to make financial decisions does not rest with the zones and hence they do not possess enough autonomy to generate their own revenue, or take independent decisions.5
While the zones prepare their annual budget, the Railway Board provides the annual financial budget outlay for each of them. As a result of such budgetary control, the GM’s powers have been reduced leaving them with little independence in planning their operations.5
The Committee recommended that the General Managers must be fully empowered to take all necessary decisions independent of the Railway Board.5 Zonal Railways should also have full power for expenditure and re-appropriations and sanctions. This will make each Zonal Railway accountable for its transport output, profitability and safety under its jurisdiction.
Under-investment in railways leading to accidents
In 2012, a Committee headed by Mr. Anil Kakodkar had estimated that the total financial cost of implementing safety measures over the five-year period (2012-17) was likely be around Rs one lakh crore. In the Union Budget 2017-18, the creation of a Rashtriya Rail Sanraksha Kosh was proposed for passenger safety. It will have a corpus of Rs one lakh crore, which will be built over a five-year period (Rs 20,000 crore per year).
The Standing Committee on Railways had noted that slow expansion of rail network has put undue burden on the existing infrastructure leading to severe congestion and safety compromises.2 Since independence, while the rail network has increased by 23%, passenger and freight traffic over this network has increased by 1,344% and 1,642% respectively.2 This suggests that railway lines are severely congested. Further, under-investment in the sector has resulted in congested routes, inability to add new trains, reduction of train speeds, and more rail accidents.2 Therefore, avoiding such accidents in the future would also require significant investments towards capital and maintenance of rail infrastructure.2
Tags: railways, safety, accidents, finances, derailment, casualty, passengers, train
[1] Railways Year Book 2015-16, Ministry of Railways, http://www.indianrailways.gov.in/railwayboard/uploads/directorate/stat_econ/IRSP_2015-16/Year_Book_Eng/8.pdf.
[2] “12th Report: Safety and security in Railways”, Standing Committee on Railways, December 14, 2016, http://164.100.47.193/lsscommittee/Railways/16_Railways_12.pdf.
[3] Report of High Level Safety Review Committee, Ministry of Railways, February 17, 2012.
[4] “Utkal Express derailment: Four railway officials suspended as death toll rises to 22”, The Indian Express, August 20, 2017, http://indianexpress.com/article/india/utkal-express-train-derailment-four-railway-officers-suspended-suresh-prabhu-muzaffarnagar-22-dead-4805532/.
[5] Report of the Committee for Mobilization of Resources for Major Railway Projects and Restructuring of Railway Ministry and Railway Board, Ministry of Railways, June 2015, http://www.indianrailways.gov.in/railwayboard/uploads/directorate/HLSRC/FINAL_FILE_Final.pdf.
