In 2010, the Legislative Assistants to Members of Parliament (LAMP) Fellowship was conceptualised by PRS Legislative Research, creating a unique platform for young Indians to engage with policy making at the national level. The Fellowship, a first of its kind in India, provides an opportunity for youth passionate about public policy to work with a Member of Parliament. Launched in collaboration with the Constitution Club of India, the Fellowship began with 12 Fellows and has now grown to include more than 40 young men and women from across India working with MPs from across political parties.
The Work
The bulk of the Fellow’s work focuses on Parliament. On average, Parliament passes 60 Bills a year. These Bills, covering a wide range of issues from food security to criminal laws, represent the government’s policy choices. Informed debates on legislation are therefore critical. Parliamentarians also use the floor of the House to discuss and debate urgent matters of public interest. The LAMP Fellowship provides young Indians with the opportunity to do legislative work through a 11-month professional engagement with an MP. Fellows are exposed to critical issues in public policy through which they will acquire knowledge about policy, parliament and governance structures, develop analytical abilities and hone leadership skills.
The Fellow typically supports an MP by providing research inputs for: policy and legislative debates, parliamentary Questions, standing committee meetings, and framing private members’ Bills. Beyond Parliament, MPs have to focus on their constituency; LAMP fellows may work on issues at the constituency level. Many Fellows in the current cohort have also had a chance to visit the parliamentary constituencies, often travelling with the MP to meet district officials and engage with constituents. Visits usually include a trip to the site of a centrally-sponsored scheme, engaging with public health officials, or attending panchayat meetings. Some Fellows also assist their MPs with media-related work like drafting press releases and preparing research for public appearances.
Policy Exposure
The LAMP Fellowship is enriched by various workshops, seminars and discussions providing greater exposure to public policy. The current cohort have already engaged with experts like former Director General, CAG Amitabh Mukhopadhyay; social activists Reetika Khera and Harsh Mander; policy practitioners Nitin Pai of The Takshashila Institution, Laveesh Bhandari of Indicus Analytics and former Chairman of TRAI Nripendra Misra; and leading JNU academic, Niraja Gopal Jayal.
"At LAMP, there is no 'typical' day at work. Each day comes with new tasks, new challenges. My work for my MP has forced me out of my comfort zone to explore and understand an array of subjects." - Kavya Iyengar, LAMP Fellow 2012-13
Fellows also get the opportunity to interact with organisations from various sectors like Google India, UNHCR and BCG. For instance, this year’s Fellows participated in the iPolicy workshop for young leaders, organised by the Centre for Civil Society. Last year, the Indian School of Business (ISB) Hyderabad hosted LAMP Fellows for a 3-day residential leadership development workshop, led by professors and guest speakers, including former RBI Governor, Dr. YV Reddy.
The LAMP Fellowship provides policy exposure but also guarantees a truly distinctive year: no two LAMP Fellows have the same experience. Every MP will have different research demands; LAMP Fellows have to be flexible, self-motivated and hungry to learn. Work can be challenging but also hugely rewarding. Previous Fellows have used the Fellowship as a launch pad, pursuing further studies at top Universities like Yale, John Hopkins, and Oxford and embarking on careers in political consulting, public relations and think tanks. Some Fellows have even continued to support the work of parliamentarians, pursuing their area of interest like media, policy and constituency development projects.
India’s vibrant democracy is constantly confronted by complex, urgent and important challenges. The Fellowship provides a once in a lifetime opportunity to understand these challenges and, perhaps, even help overcome them. Be a part of the solution, be a LAMP Fellow.
Today, the National Medical Commission Bill, 2019 was passed by Lok Sabha. It seeks to regulate medical education and practice in India. In 2017, a similar Bill had been introduced in Lok Sabha. It was examined by the Standing Committee on Health and Family Welfare, which recommended several changes to the Bill. However, the 2017 Bill lapsed with the dissolution of the 16th Lok Sabha. In this post, we analyse the 2019 Bill.
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. Experts have 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 MCI.
The 2019 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 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 50% of the seats in the private medical institutions.
Who will be a part of the NMC?
The Bill replaces the MCI with the NMC, whose members will be nominated. The NMC will consist of 25 members, including: (i) Director Generals of the Directorate General of Health Services and the Indian Council of Medical Research, (ii) Director of any of the AIIMS, (iii) five members (part-time) to be elected by the registered medical practitioners, and (iv) six members appointed on rotational basis from amongst the nominees of the states in the Medical Advisory Council.
Of these 25 members, at least 15 (60%) are medical practitioners. The MCI has been noted to be non-diverse and consists mostly of doctors who look out for their own self-interest over public interest. In order to reduce the monopoly of doctors, it has been recommended by experts that the MCI should include diverse stakeholders such as public health experts, social scientists, and health economists. For example, in the United Kingdom, the General Medical Council which is responsible for regulating medical education and practice consists of 12 medical practitioners and 12 lay members (such as community health members, administrators from local government).
What are the regulatory bodies being set up under the NMC?
The Bill sets up four autonomous boards under the supervision of the NMC. Each board will consist of a President and four members (of which two members will be part-time), appointed by the central government (on the recommendation of a search committee). These bodies are:
How is the Bill changing the eligibility guidelines for doctors to practice medicine?
There will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-speciality medical education in all medical institutions regulated under the Bill. Further, the Bill introduces a common final year undergraduate examination called the National Exit Test for students graduating from medical institutions to obtain the license for practice. This test will also serve as the basis for admission into post-graduate courses at medical institutions under this Bill. Foreign medical practitioners may be permitted temporary registration to practice in India.
However, the Bill does not specify the validity period of this license to practice. In other countries such as the United Kingdom and Australia, a license to practice needs to be periodically renewed. For example, in the UK the license has to be renewed every five years, and in Australia it has to renewed annually.
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 medical practitioner. If the medical practitioner is aggrieved of a decision of the State Medical Council, he may appeal to the Ethics and Medical Registration Board. If the medical practitioner is aggrieved of the decision of the Board, he can approach the NMC to appeal against the decision. It is unclear why the NMC is an appellate authority with regard to matters related to professional or ethical misconduct of medical practitioners.
It may be argued that disputes related to ethics and misconduct in medical practice may require judicial expertise. For example, in the UK, the regulator for medical education and practice – the General Medical Council (GMC) receives complaints with regard to ethical misconduct and is required to do an initial documentary investigation in the matter and then forwards the complaint to a Tribunal. This Tribunal is a judicial body independent of the GMC. The adjudication decision and final disciplinary action is decided by the Tribunal.
How does the Bill regulate community health providers?
As of January 2018, the doctor to population ratio in India was 1:1655 compared to the World Health Organisation standard of 1:1000. To fill in the gaps of availability of medical professionals, the Bill provides for the NMC to grant limited license to certain mid-level practitioners called community health providers, connected with the modern medical profession to practice medicine. These mid-level medical practitioners may prescribe specified medicines in primary and preventive healthcare. However, in any other cases, these practitioners may only prescribe medicine under the supervision of a registered medical practitioner.
This is similar to 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.
