Catering to dissents

In an overwhelming mandate, which is hardly a surprise as far as Lok Sabha is concerned, the National Medical Commission Bill was passed in the Lower House on Monday. Terming it as one of the biggest reforms, Union Health Minister noted that the legislation was "pro-poor" and the basic intention of the government is to ensure and restore the utmost standard of integrity of medical education in the country. The bill seeks to replace the allegedly corruption-plagued Medical Council of India with the National Medical Commission (NMC) to regulate medical education and practices in India. While the government seemed quite content with their Bill clearing the first part (Lok Sabha), the 'people' that it was meant for did not seem to replicate the feeling. Terming it as anti-people, anti-poor, anti-students, anti-democratic as well as draconian in nature, the Indian Medical Association took the decision to stage a protest today against the passage of the bill. Numerous doctors, students and medical professionals staged a protest from AIIMS to Nirman Bhawan in New Delhi before it was called off after protestors were detained. While the Union Health Minister was of the opinion that the Bill is perhaps the biggest reform, the fact that protests were staged as soon as the very same day, followed by another round scheduled today, points at irregularities that the medical fraternity is having a hard time digesting. Such contrast in reception of the Bill outlines the point of dissent which is important to consider given the position of dissent in a democracy. The pro-people approach of Modi government which rests its governance on "Sabka Saath, Sabka Vishwas" does not quite fit in this situation since those who will be directly affected by such legislation have staged unanimous dissent, highlighting pain points in support for their dissent. The most crucial pain point in contention is Section 32 of the NMC Bill that provides for straight licensing of 3.5 lakhs unqualified non-medical persons to practise modern medicine. Unqualified non-medical persons have been dubbed by the government as Community Health Providers (CHPs) and the bill allows for anyone connected with modern medicine to get registered in NMC and be licensed to practice modern medicine. The Indian Medical Association, apprehensive of Section 32, said that this "would mean that all paramedics including pharmacists, nurses, physiotherapists, optometrists and others are becoming eligible to practise modern medicine and prescribe independently" and asserted that "this law legalises quackery". Inadequate training will not hinder a CHP from getting the license following which apprehensions of putting patients at risk besides degrading the quality of healthcare will be large, especially in rural India. Another controversial aspect was the replacement of elected members with nominated members on the Medical Council Board. While the existing MCI, an autonomous body, has two-thirds of its members (160+) directly elected by the medical fraternity, the new system proposes only 26 nominated members. This raises the question on the integrity of nominated members and thus the entire process. With NMC proposing four autonomous boards to take care of its different functions, the procedure of nominating board members has a lingering scope for corruption per se. Not just this but the introduction of National Exit Test (NEXT) envisaged under the Bill for giving both licenses for practice to MBBS graduates as well as for admission to post-graduate also does not fair well. The two objectives that NEXT is proposed to serve cannot be intertwined into one since both require different training and knowledge. A certain level of knowledge may be sufficient to practice medicine but higher knowledge remains a prerequisite for pursuing a further specialisation. Apart from these, the Bill seeks to provide the power to regulate fees and other charges for 50 per cent of the seats as against the 85 per cent which is allowed to be regulated by the state governments today. Discounting all other dissenting points, the aforementioned ones seem enough for fueling a dissident ideology. The Bill demands to be reviewed in the event of such protests by a consensus of medical personnel and requisite changes done to make the Bill a robust and welcoming one.

It is important to note that the wide criticism received on the Bill cannot be simply undermined. A doctor's strike is not something this country–in desperate need of round the clock medical attention–can afford. As it is the doctor to patient ratio is grossly inadequate and if the country's legislation starts hurting the medical fraternity, society will have to endure a lot. In the best interest of the country, a review of the clauses in the Bill will be a valuable recommendation to pursue. Though there are dissenting thoughts every now and then when it comes to legislation, however, given the fact that this bill concerns the medical fraternity which has highlighted severe inconsistencies, it would be prudent to give the benefit of the doubt to them and refurbish clauses in the larger interest of the country.