The far-sighted vision for primary healthcare was well documented as far back as 1946 by the Bhore Committee in the pre-Independent India. While it had remained mainly latched on to reproductive and child health, including institutional deliveries, the parlous state of public health institutions, particularly the primary health centres both in the rural and in urban conurbations, is a dismal tale that needs to be seen to be believed. It is a paradox without parallel as are many instances manifest in India that while the country boasts of offering medical tourism to the needy and wealthy from abroad, a cursory visit and a glance at its own public hospitals would be an eye-opener and a reality check with patients crowding the corridors and doctors over-stretched to their limits! Still, serve they do in the teeth of many disabilities including the patchy provisions of basic infrastructure to keep the system going and the lot of the doctors is utterly unenviable. The plight of the poor who visit these hospitals is pathetic as there is no one coming forward to help them or tend to their ailments and infirmities. No doubt, the National Health Policy 2017 presaging a comprehensive primary health system is a laudable policy proposal but how far it would deliver results on the ground remains a grim reminder of the formidable difficulties that plague the medical system of the nation to the chagrin of all stakeholders including the serving doctors, a few of whom came to the profession not for the lucre but to offer their healing touch to those desperately deserve to be in succor.

Without digressing from the core provisions of the amendment NMC bill that seeks to replace the Medical Council of India (MCI), which had over the years sunk into the depth of low esteem for various acts of commission and omission as a regulatory body with National Medical Commission (NMC) as the apex medical education regulator, it is relevant to state a few harsh facts about how MCI had acquired notoriety over the years, aided and abetted by the regulatory capture disease. For instance, the insertion of Section 10 A in the Indian Medical Council Act led to the proliferation of private medical colleges. This was apparently justified due to the dearth of medics, even as the high capitation fees imposed by these colleges on the students had a baleful impact on the affordability of medical services to the public as those coming out of the portals of the mushrooming medical colleges were more interested in earning the loss they sustained in getting the professional degree than imbued with a sense of noblesse oblige. The regulatory authority MCI was unable to act notwithstanding the fact that over half the 60,000 medical students graduating every year came from private medical colleges. To compound the troubles, there were allegations of corruption in the issue of licence and laxity on regulatory requirements, warranting the authorities to review the role of MCI to replace it with NMC. This has been achieved after protracted deliberations with stakeholders in the extant system, though the latter remains unconvinced and are doing their damnedest to demur such a new body!

It is interesting the Bill codifies a mechanism to assess and rate medical colleges periodically with an exorbitant punitive fine for failure to comply with standards as three such failures would lead to de-recognition of a college. Alongside, there is withal a rider in the changes approved by the Cabinet in compliance with a House panel suggestion that the maximum limit of seats of 40 per cent for which fees would be regulated in private medical colleges and deemed universities would be increased to 50 per cent. Here a caveat by the Indian Medical Association (IMA) which went on a protest after the Cabinet decision on the NMC Bill partially disrupting services for a day is relevant to note. IMA noted that in many of the states, the fee of around 85 per cent of the medical seats is fixed by the state governments. NMC would now augment the quota of the private colleges from 15 to 50 per cent. “It is a dichotomy that on one hand the government speaks of doctors for rural areas and on the other hand the same government provides increased quota for the urban rich”, the IMA rued, adding that the Bill would shove the medical education away from the reach of deserving diligent common people. This takes the entire issue to square one where it all began in rendering the medical education a quite expensive proposition and out of reach to thousands of aspiring doctors who do not have the wherewithal to pursue their ambition to be of service to society through this noble calling. The glitz, glamour of white collar job is not there in medical profession as the people who get trained here have to deal with disease, open wounds and sore spots with missionary zeal to stay supportive of their patients with patience and through thick and thin in their terrible trauma. By making education of such a calling beyond the reach of ordinary people, the authorities have not woken up to the harsh reality that India’s pole position as a healthy nation would be in jeopardy if they play fast and loose with the medical education by depriving the poorer medical aspirants of the system for want of the ways and means to finance the whopping fees for unregulated seats!

The changes proposed in the Bill had met some of the critical concerns of the doctor community such as axing the contentious bridge course for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homeopathy (AYUSH) Practitioners so that allopathy trained doctors could breathe easy sans quacks muddying the water in the name of preventive cure and remedy of gullible patients. However, the NMC as a regulatory body would be totally controlled by the government as its proposed six members would be culled by a search committee headed by the Cabinet Secretary. It is time that the Government mulled over the vexatious concerns of IMA and other level-headed public policy wonks so that the country’s medical profession is put on a sound and sustainable pedestal for the weal of all. (IPA Service)