False Claims And The Bleak Future Of The Public Health Sector
Ladeeda Rayya
The Government of India has recently passed the National Medical Commission (NMC) Bill 2019 which is believed to jeopardise both the public health sector and medical education in the country. Being introduced as a replacement for the autonomous Medical Council of India (MCI), the new body is set to overhaul the entire primary health sector in the interests of the corporate medical tycoons.
The main aspects of the bill are:
1. The Complete Upheaval of the Federal System in the Health Sector
The structure and functioning of NMC itself is problematic considering the Federal structure of the country’s administration. It comprises twenty-five medical experts chosen by the central government and is led by a chairperson with postgraduate medical degree and twenty or more years of working experience. Ten ex-official members and fourteen part-time members chosen by the government would comprise the rest of the body. There will be four independent boards under the NMC, and they respectively are:
- Under Graduate Medical Education Board (UGEMB)
- Post Graduate Medical Education Board (PGEMB)
- Medical Assessment and Rating Board (MARB)
- Ethical and Medical Registration Board (EMRB)
Each of these boards would have five member committees running it and four among them will be appointees of the central government. The last member is left out for the state councils in the country. This cold negligence is against the federal principles enshrined in the Constitution since health sector comes under the policy discretion of the states through the Concurrent List. The president of each board is given power to form another commission to pursue enquiries inside the board and it sheds light to the so called negligence by the centre. The advisory committee assisting the NMC comprises of a University Grants Commission (UGC) chairman, and four heads of various IIT/IIM/IISCs in the country chosen by the central government. All Vice Chancellors of various universities in the country, state medical council members and the twenty-five member NMC itself. The majoritarian representation given to the centre by including NMC limits the scope of the states to involve in the health policy making. This shows the large accumulation of power in a single body like NMC and the denial towards the states to raise concerns. It gives the centre all the freedom to impose Draconian policies in both the health sector and medical education filed.
2. The Collapse of Primary Health Services and Opening of New Avenues for Private Capital Exploitation
The BJP government at the centre has been claiming that the latest bill aims to provide better healthcare to its people. We will check how these claims are contradicting with the reality and how NMC is going to destroy the whole health system in India.
The bill’s proposal to permit alternative medical practitioners to provide medicines in Primary Health Centre (PHC)s show the alarming signs of a bad future. This move, made on the side-lines of the claims of decentralizing the health sector, is going to ruin the latter. Examples of progress made in Latin American countries and a state like Kerala show how the relevance of primary health sector. The aforementioned proposal is surely going to destroy the public healthcare and force people to choose private health sector. And it creates a huge platform for corporate monopolies to widely open multi-specialty health centres all around.
3. The Infiltration of Religious Fanaticism an Irrationality in Medical Education
The earlier draft of the NMC bill included a provision to initiate a two-year bridge course for AYUSH practitioners to distribute modern medicine. But it was removed after the recommendations of a parliamentary committee constituted after imminent furore. Though the new draft does not mention of AYUSH or bridge course, it cleverly smuggles the same logic with a mention of the term MEDICAL PLURALISM.
What really is MEDICAL PLURALISM?
The proposal is to form a three member group of experts from Homeopathy, Ayurveda and Modern Medicine to include MBBS lessons in AYUSH courses and vice versa. It is very clear from the composition of the group that the modern medicine representative would never get a say in the educational policy matters. This in turn opens new opportunities for the BJP government to strengthen their propagation of irrationality and religious fanaticism through education. And it is still alarming that the newly enrolled National Education Policy (NEP) clearly mentions the above said bridge course.
4. The Introduction of NEXT Exam May Lead to Largescale Corruption and Violation of Rights
The bill also proposes to set single graduation exam for MBBS degree, eligibility to get admission in the postgraduate course and license to practice. This exam, named National Exit Test or NEXT, will also be the screening test for foreign students to pursue medical education in India. Foreign students had to go through another test before this new proposed bill.
The NEXT will be combined with National Eligibility-cum-Entrance Test (NEET) or the NEET, and will be the basis for all admissions in the medical colleges including in those of national importance such AIIMS, which was formed by a separate law passed by Parliament. This proposal has not clarified about the modus operandi for the test with doubts arising on the evaluation of practical examinations and transparency in functioning.
5. The Increased Exploitation by Private Medical Colleges in Health Sector
The provisions in the bill about inspection and accreditation of the medical colleges pave ways for uncontrolled interventions and corruption by private parties. Instead of forming a comprehensive quality check including primary health facilities, the inspection will only be revolving around the financial status of medical institutions. The inspections will be conducted through third party rather than the MCI which make it easy for any private company to start a medical college. This immense freedom in turn will lead to huge corruption in the medical education field.
The bill also proposes to bypass the existing 85%-15% fees regulation in private medical colleges by granting permission to the latter for fixing fees in 50% of seats. It had been a norm set by the Supreme Court to fix a uniform fee structure for 85% of students getting admission in private institutions through NEET. This fixed fee set by the government and control over the admission will be taken over by the private parties to reap benefits for them.
It is quite clear from above how the new NMC bill is going to ruin the public health sector and medical education by liberalizing them for corporate interests. The grand claims by the government about the bill have been exposed here with substantial evidences and the students all over the country should rise to the occasion. We should raise our concerns without getting distracted in discussions on religion and intervene for policy changes if the NMC is going to be implemented.
It is our duty to constantly raise voice against the NMC bill in public and mobilise common people along with our own fraternity.
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