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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.
Between the last time Parliament met in March 2020 and the ongoing Monsoon session (a period of nearly six months), the government issued 941 notifications across sectors in response to the COVID-19 pandemic. It also announced a Rs 20 lakh crore economic package to improve the state of the economy and provide relief to those affected by the nationwide lockdown. In addition, the government also proposed long-term policy changes during this period in sectors such as agriculture, economy, and education.
One of the key roles of a Member of Parliament (MP) is to hold the government accountable for its policies and actions. Parliamentary questions are one of the key instruments MPs use to exercise this role. Questions help MPs seek information from the government on matters of public importance and on the status of implementation of its policies and programmes.
However, in view of the prevailing extraordinary situation due to COVID-19, both Lok Sabha and Rajya Sabha have suspended their Question Hour, which would have allowed MPs to seek oral responses from Ministers and ask follow-up questions. However, unstarred questions are admitted, for which written answers are provided.
This post provides an overview of the government’s response to some of the key questions raised by MPs during the first five days (September 14, 2020, to September 18, 2020) of the session.
Unstarred questions in the Monsoon session
A total of 1,950 unstarred questions have been asked in the first five days of the Monsoon session of the Parliament (1,150 questions in Lok Sabha and 800 questions in Rajya Sabha). The Ministries in focus for the questions were: Health (154 questions), Agriculture (127 questions), Education (104 questions), Finance (96 questions), and Railways (80 questions).
Questions ranged from the impact of the lockdown to strategy for vaccine procurement, to the status of the programmes announced to alleviate COVID related issues. Besides COVID-19, there were questions around India-China trade, locust attacks, and custodial deaths.
On COVID-19 testing and vaccine strategy
Testing data and Health infrastructure: In response to a question, the government informed that India is conducting nearly 10-11 lakh tests every day and so far, a total of 6.05 crore samples have been tested for COVID-19. Nearly 40% of the confirmed cases are persons between the age of 26-44.
To improve health capacity, as of Sep 15, a total of 15,360 COVID treatment facilities have been created with:
Vaccine development: The Central Drugs Standard Control Organisation has granted permission for conduct of clinical trials in the country to the following: (i) Bharat Biotech International Ltd. and Cadila Healthcare (these are in phase 1 and phase 2 of trials), and (ii) Serum Institute of India Pvt. Ltd (for vaccine developed by University of Oxford/AstraZeneca - this is in Phase 3, or advanced phase, of the trials).
The government is also exploring the possibility of cooperation with Russia for advancing the COVID-19 vaccine in India.
Health insurance: The Ministry noted that data on the number of healthcare workers who are infected by COVID-19 or who have lost lives during COVID duty is not maintained at the central level. As per data from the Pradhan Mantri Garib Kalyan Insurance Package, a total of 155 medical staff, including 64 doctors, have died due to COVID-19. The scheme provides an insurance cover of Rs 50 lakh (including loss of life) to healthcare providers, including community health workers, who may have come in direct contact of COVID-19 patients and who may be at risk of being impacted by this.
Under the Ayushman Bharat Scheme, a total of 4.03 lakh hospitalisations have been registered (and authorised) towards the treatment of COVID-19. Under Ayushman Bharat, the government provides health cover of five lakh rupees per family per year, for secondary and tertiary care to around 10.7 crore vulnerable families.
Impact on other health services: In light of COVID-19, that there has been a 19.4% drop in Hepatitis-B birth doses administered and a 31% drop in vaccination sessions held in health facilities and outreach sessions from April-June 2020 as compared to the same period last year. Similarly, there has been a drop of 23.9% in institutional delivery in the April-June 2020 quarter as compared to the same period last year.
Impact of COVID-19 on Indian economy
Trade: Responding to a question on the impact of COVID on exports, the government provided the following data:
India-China trade: Members also raised questions on the impact of COVID and the border issue with Ladakh on Indo-China trade. The government held that it has taken steps to balance the trade with China by increasing exports and reducing import dependence. The trade deficit with China during April-June 2020 was USD 5.5 billion as compared to USD 13.1 billion during the same period last year.
Table 1: Trade deficit with China (in billion dollars)
|
Year |
2016-17 |
2017-18 |
2018-19 |
2019-20 |
April - June 2019 |
April - June 2020 |
|
Export |
10.17 |
13.33 |
16.75 |
16.61 |
4.16 |
5.53 |
|
Import |
61.28 |
76.38 |
70.31 |
65.26 |
17.26 |
11.01 |
|
Total Trade |
71.45 |
89.71 |
87.07 |
81.87 |
21.42 |
16.55 |
|
Trade Deficit |
-51.11 |
-63.04 |
-53.56 |
-48.64 |
-13.1 |
-5.48 |
Sources: Unstarred Question No. 647, Lok Sabha, answered on September 16, 2020; PRS.
With regard to the import of Active Pharmaceutical Ingredients (bulk drugs), bulk drugs account for nearly 63% of total pharmaceutical imports in India as per government data. Of these, 68% of the bulk drugs imported by India in 2019-20 were from China.
Civil aviation: The government informed that the revenue of Indian carriers was down by nearly 86% during April-June 2020, as compared to the same period last year.
Table 2: Impact of COVID-19 on the civil aviation sector
|
Indicator |
Previously |
Now |
% Change |
|
Revenue related |
April-June 2019 |
April-June 2020 |
|
|
Revenue of Indian carriers |
Rs 25,517 crore |
Rs 3,651 crore |
-85.7% |
|
Revenue of Air India |
Rs 7,066 crore |
Rs 1,531 crore |
-78.3% |
|
Revenue of Airport Operators |
Rs 5,745 crore |
Rs 894 crore |
-84.4% |
|
Employment related |
March 31, 2020 |
July 31, 2020 |
|
|
Employment at airlines |
74,887 |
69,589 |
-7.1% |
|
Employment at airports |
67,760 |
64,514 |
-4.8% |
|
Employment at ground handling agencies |
37,720 |
29,254 |
-22.4% |
|
Employment at Cargo operators |
9,555 |
8,538 |
-10.6% |
|
Traffic related |
March-July 2019 |
March-July 2020 |
|
|
Total domestic traffic |
5,85,30,038 |
1,20,84,952 |
-79.4% |
|
Total international traffic |
93,45,469 |
11,55,590 |
-87.6% |
Sources: Unstarred Question No. 872, Lok Sabha, answered on September 17, 2020; PRS.
Vande Bharat Mission: The Vande Bharat Mission was launched on May 7, 2020 to facilitate the return of Indian nationals stranded in various countries. As of September 10, 2020, a total of 13,74,237 Indians have returned to India and the total cost incurred for this effort was Rs 22.5 crore. Of these, about 3 lakh people were working outside India. The government stated that SWADES (Skilled Workers Arrival Database for Employment Support) initiative has been launched to conduct a skill mapping exercise of the returning citizens under the Vande Bharat Mission.
Metro rail: Due to the lockdown, metro services in different cities came to a halt. This has led to a loss of Rs 1,609 crore for the Delhi Metro. The loss incurred due to the halting of the other metros was: Rs 170 crore for Bengaluru Metro, Rs 90 crore for Lucknow Metro, Rs 80 crore for Chennai Metro, and Rs 34 crore for Kochi Metro.
On Shramik special trains and Vande Bharat Mission
Railways revenue: As of August 2020, the total revenue of Railways was Rs 41,844 crore, which is a decline of 42% over the corresponding period last year. Of this, Rs 39,648 crore (95%) was freight revenue. During April to August 2020, the passenger traffic was 1.3% of the traffic in the corresponding period last year, and the freight traffic was 86.7% of the traffic seen in the corresponding period last year. The total amount of refund made to passengers due to cancellation of trains booked till April 14, 2020 (for the journey period between March 22, 2020 and August 12, 2020) was Rs 3,371 crore.
Special trains: Several members asked questions about the Shramik special trains, the number of migrant labourers who returned to their home states, and the loss of revenue to railways due to restrictions on travel and movement. The government responded that 4,621 shramik special trains were run from May 1 to August 31, 2020, which transported 63 lakh passengers across the country. Based on the data provided by states, 97 persons passed away while travelling on Shramik special trains (as of September 9, 2020). A total fare of Rs 433 crore was collected from the state governments for running these special trains.
The government also started other special trains (15 pairs of Rajdhani Express and special trains for examinations such as JEE and NEET). The average occupancy in these trains (from May 12 to August 31, 2020) was around 82%.
On Migrant labourers, relief measures and MGNREGS
A total of 1.05 crore migrant workers have returned to their home state till now (maximum to Uttar Pradesh, followed by Bihar, West Bengal, and Rajasthan). State-wise details are listed in the table below.
Table 3: Number of migrant workers who have returned to home-state (as of September 14, 2020)
|
State |
Workers who have returned to the state |
|
Uttar Pradesh |
32,49,638 |
|
Bihar |
15,00,612 |
|
West Bengal |
13,84,693 |
|
Rajasthan |
13,08,130 |
|
Madhya Pradesh |
7,53,581 |
|
Jharkhand |
5,30,047 |
|
Punjab |
5,15,642 |
|
Assam |
4,26,441 |
|
Kerala |
3,11,124 |
|
Maharashtra |
1,82,990 |
|
Tamil Nadu |
72,145 |
Sources: Unstarred Question No. 197, Lok Sabha, answered on September 14, 2020; PRS.
Responding to a question on whether free grains under the Aatma Nirbhar Scheme had reached the migrant workers, the government stated that no data on the number of migrants/stranded migrant persons across the country was available with the Department of Food Distribution and that the responsibility of identification of beneficiaries under this scheme was entrusted with states. The government informed that states have indicated about 2.8 crore migrant worker beneficiaries. As of August 31, 2020, food grains have been distributed to 2.67 crore of the identified beneficiaries for the months of June and July 2020.
MGNREGS: On whether the migrant labourers have been provided jobs under the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), the government said that there is no provision to register a job cardholder categorized as a migrant labourer in the card in the scheme. It stated that a total of 86.82 lakh new job cards have been issued this year so far, against a total of 64.96 lakh cards issued during the same period last year. The employment provided under the scheme was nearly 100% higher for the months of June and July 2020, as compared to the corresponding months in 2019. The total demand (from April 2020 to September 12, 2020) for employment under the scheme was 22.5 crore persons, a 39% increase from 16.2 crore persons for 2019-20 (during the same period).
EPF withdrawal: In March 2020, as part of the relief package, the government increased the withdrawal limit from the Employee’s Provident Fund (EPF) accounts. In areas declared to be affected by an epidemic or pandemic, members are permitted to withdraw three months’ salary or 75% of the amount lying in the member’s PF account, whichever is lesser. The government stated that a total of Rs 39,403 crore has been withdrawn from EPF from March 25, 2020 to August 31, 2020. The withdrawal was highest in the states of Maharashtra (Rs 7,838 crore), Karnataka (Rs 5,744 crore), and Tamil Nadu (Rs 4,985 crore).
Other questions
Locust attack: Several members sought to know whether the locust attacks caused damage to crops and whether the government has provided any compensation to the affected farmers. The Ministry of Agriculture responded that the locust incursions were reported in the 10 states of Bihar, Chhattisgarh, Gujarat, Haryana, Madhya Pradesh, Maharashtra, Punjab, Rajasthan, Uttarakhand, and Uttar Pradesh. The Rajasthan government has reported crop damage of 33% or more in nearly 3,400-hectare area. Haryana has reported below 33% crop damage in 6,166-hectare area. No damage was reported in Gujarat, Chhattisgarh, Punjab, and Bihar. On compensation, the government stated that pest attack has been notified as a natural disaster and states could provide relief under the State Disaster Response Fund. However, no state government has reported any data yet on the distribution of relief to affected farmers.
Functioning of virtual courts: The Ministry of Law and Justice informed that 11,93,046 hearings were done by video conferencing between March 24, 2020 and July 15, 2020 by district and subordinate courts across India. Further, it stated that to handle challenges related to COVID-19, the government has allocated nearly Rs 30 crore for providing video conferencing equipment and facilitating help desk counters for e-filing in various court complexes
Custodial deaths: The government informed that a total of 1,697 persons died under police/ judicial custody, and a total of 112 cases were registered as encounter deaths (from April 2019 to March 2020). State-wise details are noted below in Table 4 for select states (they comprise 75% of the total custodial and encounter deaths in 2019-20). On whether the government is considering a legislation to prevent the torture of individuals by police and public officials, the Ministry of Home Affairs informed that police and public order are state subjects and there is no proposal to bring a legislation in this regard.
Table 4: Custodial deaths and Encounter deaths across select states (April 2019-March 2020)
|
State |
Custodial deaths |
Encounter deaths |
|
Uttar Pradesh |
403 |
26 |
|
Madhya Pradesh |
157 |
3 |
|
West Bengal |
122 |
1 |
|
Bihar |
110 |
5 |
|
Punjab |
99 |
1 |
|
Maharashtra |
94 |
3 |
|
Rajasthan |
84 |
2 |
|
Haryana |
77 |
1 |
|
Tamil Nadu |
69 |
3 |
|
Chhattisgarh |
59 |
39 |
Sources: Unstarred Question No. 292, Lok Sabha, answered on September 15, 2020; PRS
