india

Updated: Aug 02, 2019 05:21 IST

The National Medical Commission (NMC) Bill, 2019, was passed with amendments by the Rajya Sabha on Thursday after a heated debate that lasted at least four hours and led to states’ representation being increased, taking the total number of commission members from the proposed 25 to 33.

Once the amended bill gets the Lok Sabha nod, most likely early next week, it will be set to replace the graft-tainted Medical Council of India (MCI), which regulated medical education in the country.

The NMC bill has been called a visionary reform by supporters and an assault on the medical profession by critics, almost all of whom are doctors and students of medicine.

“The misconceptions around the NMC bill are completely baseless and it was passed with minor amendments. It will actually benefit medical students by providing quality medical education at a lower fee and ending corruption,” said Union health minister Dr Harsh Vardhan, who is optimistic that the amended bill will be ready for ratification by the Lok Sabha by early next week.

“It’s a historic day for the medical profession. Some doctors are protesting because they are misinformed. The Delhi Medical Association has studied the bill and had some issues, such as the need for capping of fee structure in the seats decided by the states, but the suggested changes were incorporated by the health ministry. Elected representatives from the states have also been increased,” said Dr Girish Tyagi, past-president Delhi Medical Association and an elected member of the Delhi Medical Council.

The Indian Medical Association (IMA), which was opposing some provisions, has accepted the bill with amendments. “It’s a victory for IMA. So far, all the bills have been passed in Rajya Sabha without any amendments, and this bill went through with amendments proposed by IMA. Central and state nomination have been increased,” said Dr Santanu Sen, president, IMA.

The most contentious provisions are giving “certain mid-level practitioners connected with the modern medical profession limited licence to prescribe medicine”; the introduction of a common National Exit Test (NEXT) in the final year of medical studies and the nominated nature of the board, which they feel can threaten its autonomy.

Supporters say the provision of training nursing and allied health professionals as community health providers will make preventive and primary healthcare less dependent on doctors, who will then be freed up to provide secondary and advanced care. Around 3.5 lakh community health providers are being trained to work in Ayushman Bharat health and wellness clinics being set up for every 5,000 population across states. More than half of India’s population still has no access to primary health services, which can provide 80%-90% of healthcare needs of any given population across a lifetime, according to World Health Organisation (WHO).

“Section 32, which deals with community health providers (CHPs), is best accommodated in the Allied Health Professionals Bill that is to go to the standing committee. That will save the proposal to have mid-level health workers as needed, while meeting the concern of IMA that this category cannot be covered by NMC, which deals with medical education. The proposed Accreditation Council for Allied Health Professionals can include the CHPs and set standards for their education and competency based functions. That is a better fit. An amendment to the NMC bill in the Lok Sabha can enable this change and build accord between the government and IMA,” said Dr Srinath K Reddy, president, Public Health Foundation of India.

Medical students are against the common NEXT in the final year of MBBS, along the lines of the National Entrance -cum- Eligibility Test (NEET) for admission to undergraduate courses. NEXT results will be used to both select students for post-graduate courses and to provide graduates, including those who have studied medicine overseas, with a licence to practice in India. It will also be applicable to institutes of national importance, such as the All India Institutes of Medical Sciences, to ensure standardised selection criteria in the medical education sector across states.