By Rohit & Anirudh A modified 'Modernization of State Police Forces' scheme was started by the central government in 2000-01. One of the objectives was to help police forces in meeting the emerging challenges to internal security in the form of terrorism, naxalism etc. The scheme aims to modernize police forces in terms of:
Under this scheme, States have been clubbed into different categories and Centre-State cost sharing is category specific. Since 2005-06, States have been categorized as category ‘A’ and ‘B’ with 100% and 75% Central funding respectively. All the North Eastern States, namely Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Tripura and Sikkim have been placed in category ‘A’ and thus, are entitled to receive 100% Central assistance for implementation of their annual approved plans. Recently, CAG decided to evaluate the working of the scheme and commissioned ‘performance audit’ reviews covering select general category and special category States. Each review covers a contiguous five year period between 2000 and 2007, but varies across selected states. For the periods under review, each state had a plan outlay (the total amount proposed to be spent in modernizing the state's police forces). However, in most cases, the actual release of funds fell significantly short of this outlay - in some cases the Centre did not contribute its share, in others the States lagged behind. For instance, in the case of Bihar, the Centre released only 56% of its share; while in the case of Rajasthan and West Bengal, the States did not release any funds at all. The graph below shows the actual releases by the Centre and the States (as percentages of their share in the proposed outlays): 
Further, even the funds that were released were not fully utilized. Thus, the amount finally spent fell significantly short of the initial proposal. The graph below shows the actual expenditure by State: 
Following are some of the other main findings from the CAG report:
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Table 1: Summary of main findings in the CAG audit for different states for Modernisation of State Police Forces |
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Purpose for which money was sanctioned |
Summary of CAG Findings |
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Planning (Every state has to propose an Annual Action Plan every year. The plan is approved by the Ministry of Home Affairs and money is released as per the plan.) |
§ Submissions by the states to the MHA were delayed. § There were also delays in the clearance granted by the MHA. § In various states such as, a) Andhra Pradesh – the government spent money on works not covered by the Annual Action Plan. b) Bihar – Persistent delays in preparation of the Plan by the state police. c) West Bengal – the plans drawn up by the state did not include items covered under the scheme. |
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Mobility |
§ Overall shortage of vehicles was observed. Most of the new vehicles replaced the old ones. § The police response time was too long in some states. § To give examples from some states: a) Andhra Pradesh – 58 percent of vehicles procured were utilised for replacing old vehicles. b) Bihar – the shortage of vehicles was 43 percent. c) Uttar Pradesh – 2400 vehicles were procured against a shortage of nearly 10,000 vehicles. |
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Residential and non-residential buildings |
§ There were considerable delays in construction of buildings in most states. Consequently, police forces’ own security was in jeopardy. § In states such as: a) Andhra Pradesh – 53 percent of staff quarters and 43 percent of official buildings were not completed (2007). b) Bihar – The total requirement of housing was nearly 60,000. Only six percent of this were included in the Plan. c) Jharkhand – District Control rooms remained non-functional because of shortage of manpower. |
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Weapons |
§ Police force in states continue to depend on outdated weapons. § Shortages of weapons also happened as acquisition from ordnance factories was very slow. § The weapons that were procured were mostly kept in the district headquarters. § In some states such as, a) Bihar – AK-47s were kept at the disposal of bodyguards of VIPs. b) West Bengal – Adequate weapons were not supplied to extremist prone police stations. |
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Communication |
§ Police Telecommunication Networks were not set up successfully in some states. In others, network was functional only up to the district level. § Shortages of various communication equipments were also observed. § In some states such as, a) Bihar - The Police Telecommunication Network system (costing Rs. 4.96 crore) remained non-functional due to non-construction of tower. b) Maharashtra – Of the 850 purchased Remote Station Units, 452 were lying in stores. |
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Forensic Science Laboratory/ Finger Printing Bureau |
§ In most States the Forensic Science Laboratories lacked adequate infrastructure. § In the absence of automatic finger print identification systems, investigation was being done manually in some States. § In some states such as, a) Maharashtra - There were significant delays in receipt and installation. There was also shortage (284 vacant posts) of technical manpower. b) West Bengal - Performance of the Forensic Science Laboratory was poor and in some cases, the delay in issue of investigation reports was as high as 45 months. |
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Training |
§ It was observed that the percentage of police personnel trained was very low. § Training infrastructure was also inadequate. § In some states such as, a) Bihar - Only 10 per cent of total force was trained. b) West Bengal - Live training was not imparted for handling useful weapons and this severely affected the performance of police forces. |
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Sources: CAG Compendium of Performance Audit Reviews on Modernisation of Police Force; PRS. Note: The audit has been done broadly from 2000 to 2007. Consequently, the period of audit for different states may vary. |
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Table 1: Summary of main findings in the CAG audit for different states for Modernisation of State Police Forces |
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Purpose for which money was sanctioned |
Summary of CAG Findings |
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Planning (Every state has to propose an Annual Action Plan every year. The plan is approved by the Ministry of Home Affairs and money is released as per the plan.) |
§ Submissions by the states to the Ministry of Home Affairs (MHA) were delayed. § There were also delays in the clearance granted by the MHA. § In various states such as, a) Andhra Pradesh – the government spent Rs 32 crore on works not covered by the Annual Action Plan. b) Bihar – Persistent delays in preparation of the Plan by the state police. c) West Bengal – the plans drawn up by the state did not include items covered under the scheme. |
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Mobility |
§ Overall shortage of vehicles was observed. Most of the new vehicles replaced the old ones, and no additions were made. § The police response time was too long in some states. § To give examples from some states: a) Andhra Pradesh – 58 percent of vehicles procured were utilised for replacing old vehicles. b) Bihar – the shortage of vehicles was 43 percent. c) Uttar Pradesh – 2400 vehicles were procured against a shortage of nearly 10,000 vehicles. 203 ambassador cars were procured, though only 55 were approved by the MHA. |
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Residential and non-residential buildings |
§ There were considerable delays in construction of buildings in most states. Consequently, police forces’ own security was in jeopardy. Satisfaction levels with the housing provided were also very low. § In states such as: a) Andhra Pradesh – 53 percent of staff quarters and 43 percent of official buildings were not completed (2007). b) Bihar – The total requirement of housing was nearly 60,000. Only six percent of this were included in the Plan, and only 1045 units were completed by 2006. c) Jharkhand – District Control rooms remained non-functional even after spending Rs 2 crore because of shortage of manpower. |
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Weapons |
§ It was observed that the police force in states continue to depend on outdated weapons. § Shortages of weapons also happened as acquisition from ordnance factories was very slow. § The weapons that were procured were mostly kept in the district headquarters. § In some states such as, a) Bihar – AK-47s were kept at the disposal of bodyguards of VIPs. b) West Bengal – Adequate weapons were not supplied to extremist prone police stations. |
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Communication |
§ Police Telecommunication Networks were not set up successfully in some states. In others, network was functional only up to the district level. § Shortages of various communication equipments were also observed. § In some states such as, a) Bihar - The Police Telecommunication Network system (costing Rs. 4.96 crore) remained non-functional due to non-construction of tower. b) Maharashtra – Of the 850 purchased Remote Station Units, 452 were lying in stores. |
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Forensic Science Laboratory/ Finger Printing Bureau |
§ In most States the Forensic Science Laboratories lacked adequate infrastructure. § In the absence of automatic finger print identification systems, investigation was being done manually in some States. § In some states such as, a) Maharashtra - There were significant delays in receipt and installation. There was also shortage (284 vacant posts) of technical manpower. b) West Bengal - Performance of the Forensic Science Laboratory was poor and in some cases, the delay in issue of investigation reports was as high as 45 months. |
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Training |
§ It was observed that the percentage of police personnel trained was very low. § Training infrastructure was also inadequate. § In some states such as, a) Bihar - Only 10 per cent of total force was trained. b) West Bengal - Live training was not imparted for handling useful weapons and this severely affected the performance of police forces. |
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Sources: CAG Compendium of Performance Audit Reviews on Modernisation of Police Force; PRS. Note: The audit has been done broadly from 2000 to 2007. Consequently, the period of audit for different states may vary. |
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The National Medical Commission (NMC) Bill, 2017 was introduced in Lok Sabha in December, 2017. It was examined by the Standing Committee on Health, which submitted its report during Budget Session 2018. The Bill seeks to regulate medical education and practice in India. In this post, we analyse the Bill in its current form.
How is medical education and practice regulated currently?
The Medical Council of India (MCI) is responsible for regulating medical education and practice. Over the years, there have been several issues with the functioning of the MCI with respect to its regulatory role, composition, allegations of corruption, and lack of accountability. For example, MCI is an elected body where its members are elected by medical practitioners themselves, i.e. the regulator is elected by the regulated. In light of such issues, experts recommended nomination based constitution of the MCI instead of election, and separating the regulation of medical education and medical practice. They suggested that legislative changes should be brought in to overhaul the functioning of the MCI.
To meet this objective, the Bill repeals the Indian Medical Council Act, 1956 and dissolves the current Medical Council of India (MCI) which regulates medical education and practice.
Who will be a part of the NMC?
The NMC will consist of 25 members, of which at least 17 (68%) will be medical practitioners. The Standing Committee has noted that the current MCI is non-diverse and consists mostly of doctors who look out for their own self-interest over larger public interest. In order to reduce the monopoly of doctors, it recommended that the MCI should include diverse stakeholders such as public health experts, social scientists, and health economists. In other countries, such as the United Kingdom, the General Medical Council (GMC) responsible for regulating medical education and practice consists of 12 medical practitioners and 12 lay members (such as community health members, and administrators from the local government).
How will the issues of medical misconduct be addressed?
The State Medical Council will receive complaints relating to professional or ethical misconduct against a registered doctor. If the doctor is aggrieved by the decision of the State Medical Council, he may appeal to the Ethics and Medical Registration Board, and further before the NMC. Appeals against the decision of the NMC will lie before the central government. It is unclear why the central government is an appellate authority with regard to such matters.
It may be argued that disputes related to ethics and misconduct in medical practice may require judicial expertise. For example, in the UK, the GMC receives complaints with regard to ethical misconduct and is required to do an initial documentary investigation. It then forwards the complaint to a Tribunal, which is a judicial body independent of the GMC. The adjudication and final disciplinary action is decided by the Tribunal.
What will the NMC’s role be in fee regulation of private medical colleges?
In India, the Supreme Court has held that private providers of education have to operate as charitable and not for profit institutions. Despite this, many private education institutions continue to charge exorbitant fees which makes medical education unaffordable and inaccessible to meritorious students. Currently, for private unaided medical colleges, the fee structure is decided by a committee set up by state governments under the chairmanship of a retired High Court judge. The Bill allows the NMC to frame guidelines for determination of fees for up to 40% of seats in private medical colleges and deemed universities. The question is whether the NMC as a regulator should regulate fees charged by private medical colleges.
A NITI Aayog Committee (2016) was of the opinion that a fee cap would discourage the entry of private colleges, therefore, limiting the expansion of medical education. It also observed that it is difficult to enforce such a fee cap and could lead medical colleges to continue charging high fees under other pretexts.
Note that the Parliamentary Standing Committee (2018) which examined the Bill has recommended continuing the current system of fee structures being decided by the Committee under the chairmanship of a retired High Court judge. However, for those private medical colleges and deemed universities, unregulated under the existing mechanism, fee must be regulated for at least 50% of the seats. The Union Cabinet has approved an Amendment to increase the regulation of fees to 50% of seats.
How will doctors become eligible to practice?
The Bill introduces a National Licentiate Examination for students graduating from medical institutions in order to obtain a licence to practice as a medical professional.
However, the NMC may permit a medical practitioner to perform surgery or practice medicine without qualifying the National Licentiate Examination, in such circumstances and for such period as may be specified by regulations. The Ministry of Health and Family Welfare has clarified that this exemption is not meant to allow doctors failing the National Licentiate Examination to practice but is intended to allow medical professionals like nurse practitioners and dentists to practice. It is unclear from the Bill that the term ‘medical practitioner’ includes medical professionals (like nurses) other than MBBS doctors.
Further, the Bill does not specify the validity period of this licence to practice. In other countries such as the United Kingdom and Australia, a licence to practice needs to be periodically renewed. For example, in the UK the licence has to be renewed every five years, and in Australia it has to renewed annually.
What are the issues around the bridge course for AYUSH practitioners to prescribe modern medicine?
The debate around AYUSH practitioners prescribing modern medicine
There is a provision in the Bill which states that there may be a bridge course which AYUSH practitioners (practicing Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) can undertake in order to prescribe certain kinds of modern medicine. There are differing views on whether AYUSH practitioners should prescribe modern medicines.
Over the years, various committees have recommended a functional integration among various systems of medicine i.e. Ayurveda, modern medicine, and others. On the other hand, experts state that the bridge course may promote the positioning of AYUSH practitioners as stand-ins for allopathic doctors owing to the shortage of doctors across the country. This in turn may affect the development of AYUSH systems of medicine as independent systems of medicine.
Moreover, AYUSH doctors do not have to go through any licentiate examination to be registered by the NMC, unlike the other doctors. Recently, the Union Cabinet has approved an Amendment to remove the provision of the bridge course.
Status of other kinds of medical personnel
As of January 2018, the doctor to population ratio in India was 1:1655 compared to the World Health Organisation standard of 1:1000. The Ministry of Health and Family Welfare stated that the introduction of the bridge course for AYUSH practitioners under the Bill will help fill in the gaps of availability of medical professionals.
If the purpose of the bridge course is to address shortage of medical professionals, it is unclear why the option to take the bridge course does not apply to other cadres of allopathic medical professionals such as nurses, and dentists. There are other countries where medical professionals other than doctors are allowed to prescribe allopathic medicine. For example, Nurse Practitioners in the USA provide a full range of primary, acute, and specialty health care services, including ordering and performing diagnostic tests, and prescribing medications. For this purpose, Nurse Practitioners must complete a master’s or doctoral degree program, advanced clinical training, and obtain a national certification.
