Reforming the regulation of medical education, professionals and practice in India

• Published in: BMJ global health Vol. 5; no. 8; p. e002765
• Main Authors: Keshri, Vikash Ranjan, Sriram, Veena, Baru, Rama
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.08.2020; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Colleges & universities; Committees; Community; Corruption; Councils; Curricula; Editorial; Education; Education policy; Entrance examinations; Federal government; Global health; Health administration; health education and promotion; Health policy; health services research; health systems; Human resources; Licenses; Local communities; Manpower; Medical personnel; Medical schools; Parliaments; Presidents; Private schools; Privatization; Professional associations; Professional ethics; Professional misconduct; Public health; Public sector; Regulation; Regulatory reform; State government; Task forces; Workforce; Workforce planning; India
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2020-002765

Context For many decades, the former MCI was accused of corruption and mismanagement, but also proved to be resistant to reform.8 The formal process of formulating the NMC began in 2016 but faced severe resistance from many quarters, including medical students, medical colleges and professional associations.9 10 In the meantime, when the NMC Bill was pending in Parliament, the existing MCI was superseded by a government-appointed Board of Governors (BoG) in 2018.11 The NMC Act was ultimately approved by the Parliament in 2019 (table 1). Estimated availability of human resources for health. 2007 Planning commission task force on human resources in health§ Provided report on assessment and future requirement. 2008 National Knowledge Commission—subcommittee on medical education¶ Recommended converting the MCI into a full-fledged professional body conducting examination and licensing of medical professionals only. 2011 The National Commission for Human Resources for Health Bill, 2011 (withdrawn)** Recommended reform in regulation of health professional education by dissolving the MCI, the Nursing Council, the Pharmacy Council and the Dental Council and replacing them with one comprehensive regulatory institution. 2011 High Level Expert Group on Universal Health Coverage†† Recommended establishing more medical institution in public sector in underserved area, reserving 50% seats for local communities in private institutions. Not approved by the Parliament and referred to parliamentary standing committee. 2017 The National Health Policy, 2017¶¶ Recommended recreating the regulatory mechanism for health professional education. 2018 The Indian Medical Council (Amendment) Ordinance, 2018*** Notified superseding of the MCI and replacing it by an interim Board of Governors. 2019 The National Medical Commission Act, 2019††† Approved by the Indian Parliament thus clearing the roadblock for constitution of new regulatory body for medical education, the NMC. *The medical council of India †Ministry of Health and Family Welfare, Government of India– Report of the medical education review committee, 1983 ‡National Health Portal, India – Report of expert committee for health manpower planning, production and management,1985 §Planning Commission, Government of India –Task force on planning for human resource in health sector, 2007 ¶National Knowledge Commission,Government of India – Recommendations on medical education, 2008 **PRS legislative Research- The National Commission for Human Resources for Health Bill, 2011 ††National Health Mission – Full report on highlevel expert group on universal health coverage, 2011 ‡‡NITI Aayog, Government of India - A Preliminary Report of the Committee on the Reform of the IndianMedical Council Act, 1956 §§PRS Legislative Research. Currently, while some members of the NMC have been nominated and the chairperson is appointed, the institution is yet to be functional.3 12 In the meantime, the interim BoG continues to make decisions in the realm of medical education.11 Table 2 Medical Council of India and National Medical Commission: major differences in governance and responsibilities Medical Council of India (MCI)* National Medical Commission (NMC)† GOVERNANCE Composition Council of members headed by president President and vice-president elected by the council of members Most of the members from medical fraternity Representation from each state, each state medical council and medical faculties of all universities Eight members nominated by the central government directly Seven members elected by medical doctors Organisation Executive committee headed by president with 7–10 members elected by council members Subcommittees of undergraduate committee, postgraduate committee and other committee constituted from time to time  GOVERNANCE  Composition  Commission headed by chairperson appointed by the central government from among medical person of eminence  10 ex officio members including head of four subcommittees of NMC and others nominated by central government  22 part-time members—10 members from among nominees of state governments, 19 members from states and 3 from other relevant fields such as law and ethics  Secretary of Central Ministry of Health to be convenor-member  Organisation  The National Medical Commission  The Medical Advisory Council—headed by the chairperson of NMC and includes members nominated by the state governments and universities  Autonomous boards—appointed by central government and function under the aegis of NMC.