Sunday, June 24, 2018
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Medical Education
Time to reform, bill vital
By Dr Oishee Mukherjee
India is ailing, when it comes to its health sector. On a very conservative estimate the country is short of 35 lakh-odd doctors across the country. Thus, while it is aspiring to gain status as a developed nation, it is imperative that health should be accorded top priority. The big question then is whether the National Medical Commission Bill 2016, which proposes to revamp the Medical Council of India (MCI), will finally be brought this Parliament session.

Recall that last year, the Supreme Court curbed the powers of private medical colleges in admission matters to MBBS and BDS exams. It stated that the admission process would be in a centralised manner conducted by the State governments concerned even as the Association of Private Medical & Dental Colleges (APDMC) had opposed the move. The apex court's direction is well meaning to ensure that educational institutions cannot manipulate the selection process, thereby curbing money power transactions. As per available data, there are 11 lakh students chasing 55,000 seats in medical colleges.

The five-bench Constitution had passed the order on a petition filed by the Madhya Pradesh government seeking contempt proceedings against private colleges which, it said, were defying the SC order by holding their own counselling for admission in MBBS and BDS courses. Earlier, the apex court ruled that that single national eligibility entrances test would be conducted for admission to all medical colleges in the country.

The orders of the court, though belated, would go a long way in ensuring that only the meritorious students get admission and the people good medical help. As is well-known the private medical institutions in the country are notorious for demanding lakhs for rupees to see the names of students in the merit list of exams conducted by them. One estimate is that these colleges would ask for anything between Rs 60 and 80 lakhs for admission. The huge sum demanded obviously made it possible for only the rich to ensure admission for their wards.

A big lobby was instrumental in this admission game. There have been reports that political parties patronised these private medical institutions. In a few government colleges also, huge sums of money and influence at the top levels, helped a few get admissions, obviously through the back door.

Though the Central and State governments remained a silent spectator, possibly having vested interests, the situation is likely to see a drastic change once the National Medical Commission Bill 2016, becomes a reality. The Bill proposes to revamp the Medical Council of India by replacing the Indian Medical Council Act 1956. Based on the recommendations of Niti Aayog and an expert committee appointed by the Prime Minister last year, the bill proposes to establish National Medical Commission in place of MCI as the premier regulator of medical education.

This action is critical and much-needed as it no secret that medical education was mismanaged by the MCI, having allowed an admission system based on illegal capitation fees, apart from creating shortage of doctors and devalued merit and ethics. In this connection, the proposed bill is expected to revamp the admission process and take care of related problems.

Fortunately, a beginning has been made. The Government has already introduced the National Eligibility-cum-Entrance Test for both under graduate and post graduate medical and dental admissions. The draft bill proposes to regulate under graduate courses, post graduate, accreditation, and assessment board and a board for registration of medical colleges and monitoring ethics in the profession.

It is expected that the regulators would monitor how well the college performs in student learning. It is understood that a considerable number of seats would be on full scholarship for poor and meritorious students. What is more important is that freeing the curriculum will allow the best colleges to offer innovative courses. Regarding monitoring ethics, it needs to be pointed out that there are reports from across the country that, at the behest of nursing homes run for purely profit motive, the doctors fall a prey to high salaries and are thus forced to carry out unethical work.

Can the tendency be changed by focussing on the new generation of doctors? Perhaps, and it is sufficient reason for both Government and private medical colleges to be encouraged for common entrance test not just for MBBS and BDS but for MD and MDS courses too. Note should be made that the number of PG seats are very low - in the ratio of 1:30 or even more - and, in an age of specialisation, urgent steps need to be taken to increase these by at least a thousand in the coming years.

However, an influential section of doctors who virtually mint money do not want the number of post graduate seats to increase and keep the demand at high ebb. As specialists are needed across the country, the monopoly of this section must be stopped. At the same time, there are reasons to believe that passing the draft bill may not be easy.

Undoubtedly, the acute shortage of doctors is bound to remain future. However, some measures need to be taken where para-medical staff - trained through short-term medical course -- could be trained for working in the villages. There was some debate to start some course in this direction but fierce opposition forced the Government not to formulate any concrete plans.

Though the draft bill doesn't delve into this aspect, it should come under serious consideration. Sociologists and developmental experts believe that para-medics strength is vital in rural -- and even semi-urban areas - as the increase in seats for doctors alone would not match the requirement, more so keeping in view the growth in population.

The incidence of diseases have increased at a fast rate in the rural areas, not just due to lack of medical infrastructure but also due to lack of doctors. On the one hand, the poor and the economically weaker sections are deprived of medical care, and on the other, the middle class has to pay through their nose for treatment in private hospitals and nursing homes. For the rich, it doesn't matter. This anomaly cannot continue for long.

Both the Centre and State Governments need to give top priority to health education, thereby providing health facilities in the remotest areas. As a first step, perhaps it should be made mandatory for all gram panchayats or at least the panchayat samitis to appoint one or two doctors, from the next financial year? A proper action plan to develop medical education would obviously ensure better health facilities in the country. Law makers must note--a stitch in time saves nine. -


News Updated at : Friday, March 17, 2017
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