The National Medical Commission Bill, 2016, that was approved by the Union cabinet on December 15, aims to tackle corruption in the Medical Council of India, the organisation that regulates medical education and medical ethics in the country. However, while the Bill incorporates some useful mechanisms related to regulation, it also seeks to create an institution that centralises power within the government and the bureaucracy and provides major concessions to promote the privatisation of medical education.
Everyone agrees on the urgent need to reform the Indian Medical Council Act of 1956, which the Bill will replace. For example, a report of the Parliamentary Standing Committee on Health and Family Welfare last year had recommended that the functioning of the council should be completely overhauled.
“The committee takes note of the admission of the president of MCI that corruption is there when there is sanctioning of medical colleges or increasing or decreasing of medical seats,” the report said. It added: “It seems the MCI has become captive to private commercial interests, rather than its integrity in public interest.”
Response to corruption reports
Over the years, the Medical Council of India has become a seat of corruption and has fallen into the hands of a small lobby of private medical practitioners. Instead of attracting professionals of high calibre, it is run by a coterie secure in the belief that they will be protected by politicians and bureaucrats at the highest levels.
Some of the key proposals in the National Medical Commission Bill do address deficiencies in the Indian Medical Council Act, 1956. It is proposed that the twin functions of the Medical Council of India – regulating medical education and medical ethics – be separated. The Bill proposes the establishment of an apex body, the National Medical Commission, which would oversee the functioning of four separate boards. These boards would deal with under-graduate and post-graduate education (Under-Graduate and Post-Graduate Medical Education Boards), assessment and rating of medical institutions (Medical Assessment and Rating Board), and registration of medical practitioners and enforcement of medical ethics (Board for Medical Registration).
This proposal makes sense given that the principal source of corruption was located in the process of granting and renewing necessary permissions to run medical colleges, and vitiated the role of the Medical Council of India as an institution tasked with regulating medical ethics.
Some of the other proposals in the Bill are more contentious. Reforming the Medical Council of India could have led to democratising the apex body for regulation of medical ethics and education by making space for professionals, academics and social activists. Instead, the prescription offered in the National Medical Commission Bill is to create a structure that is packed with ex-officio members nominated by the government. This is a major departure from the way the Medical Council of India was constituted, where all registered medical practitioners had the opportunity (at least theoretically) to vote and elect most of the council’s members.
It is true that the process was captured by a small lobby that faced serious charges of corruption and nepotism. However, it is not clear how the National Medical Commission, consisting of members who are all nominated in various ways by the government and the health bureaucracy, will be kept free of corrupting influences. If a system of democratic representation can be twisted to serve vested interests, there is no guarantee that a body consisting entirely of nominated members will be free of corrupting influences.
What appears to have been entirely missed is the fact that it is the phenomenal rise in private medical colleges since 1990 that has driven corruption in the Medical Council of India. In 1980, there were 100 government-run medical colleges and just 12 private colleges, accounting for 16,570 and 1,770 under-graduate seats. By 2016, there was an almost cataclysmic shift in this ratio – 205 government-run medical colleges with 27,490 under-graduate seats as against 221 private colleges with 24,690 under-graduate seats. Instead of advocating for much enhanced public investment in medical education, the National Medical Commission Bill has actually relaxed regulatory measures designed to ensure that medical colleges adhere to notified standards. Thus, the new Bill does not require already registered colleges to seek prior permission before increasing seats in under-graduate and post-graduate education.
The broader context
The proposals regarding private medical colleges in the Bill need to be understood in conjunction with the steps undertaken in the past years to ease the entry of for-profit organisations, including corporations, in the medical education sector. In 2012, in a departure from earlier practice, companies registered under the Companies Act were permitted to set up medical colleges. However, a caveat was added that the colleges could not “resort to commercialisation”, meaning that these could not be profit-making ventures.
In 2016, a committee set up under the aegis of the government think tank Niti Aayog said, “Currently, only ‘not-for-profit’ organisations are permitted to establish medical colleges… the committee recommends delinking the condition for affiliation/recognition from the nature of the promoter of the medical college.” The Health Ministry, acting on this proposal, had subsequently written to the Medical Council of India to substitute Sub Clause (6) of the eligibility criteria to remove the reference to commercialisation.
The National Medical Commission Bill takes forward the move to legitimise profit-making in medical education by proposing that the fees in private medical colleges for 40% of the seats be regulated, thereby allowing the charging of exorbitant fees for the remaining 60% seats. Clearly, the Bill embodies a vision for medical education that does not include higher public investment but, rather, clears the way for converting medical education into a lucrative profit-making venture.
It is to be seen, whether in balance, the proposed National Medical Commission will prove to be more effective than the existing Medical Council of India.
Amit Sengupta is national convenor, Jan Swasthya Abhiyan.