Regulating the regulators

By: |
June 08, 2016 7:05 AM

The Supreme Court’s decision in end May to mandate a single national entrance exam for UGH and PG medical seats from next year, has merely postponed the debate on medical education

201606ehm02The Supreme Court’s decision in end May to mandate a single national entrance exam for UGH and PG medical seats from next year, has merely postponed the debate on medical education. Many state governments, some emboldened by recent poll wins like in Tamil Nadu, have already made it clear that they would oppose implementation of the National Educational Eligibility Test (NEET) as it put students from their states at a disadvantage, both from a syllabus as well as linguistic point of view.

It was the Medical Council of India (MCI) that first suggested the idea of a NEET. But the MCI has been fighting a battle of credibility for many years. The latest salvo was a hard hitting Standing Committee Report (SCR) submitted on March 8, focussing on the functioning of the MCI.

The changes recommended by the SCR are so sweeping that many experts have called for a scrapping of the MCI and a fresh start. The report itself recommends that the Ministry should take measures to amend the present statute or ‘enact a new legislation’ which allows the government to intervene in matters of corruption.

With a three member committee now in place to oversee the functioning of MCI till it is reformed, the end is still nowhere in sight. In most such cases, public interest dies a natural death, but could it be different this time? The clamour for change shows signs of escalating since the SCR was tabled in the Parliament. An editorial in the British Medical Journal (BMJ) lauded the report “for its thorough analysis of the state of healthcare in the country and paving the way for radical reform” but also warns that it overlooks “the complicity of ruling politicians, many of whom own private medical colleges.” (BMJ 2016;352:i1731)

In an acknowledgement that political will must flow from the top, former policy makers and doctors have now joined forces to request Prime Minister Modi’s direct intervention in the revamping of the MCI. In a letter to the PM, the group reportedly asks him to implement the SCR’s recommendations without delay and that the current MCI be replaced by a “transition team of experts.” According to media reports, the letter suggests that this transition team would work out the reform agenda over the next two years and enable the implementation of a revised architecture of a new body whose creation will require a bill to be enacted by the Parliament.

The fact that the letter is signed by five former health secretaries (Sujatha Rao, Keshav Desiraju, Javid Choudhury, Prasanna Hota and K Chandramouli) and leading doctors like Dr Samiran Nundi, Dean of Sir Ganga Ram Institute for Postgraduate Medical Education and Research and senior gastrointestinal surgeon (one of the authors of the BMJ editorial cited above), Dr Srinath Reddy, cardiologist and President, Public Health Foundation of India, Dr Maharaj Kishan Bhan, paediatrician and Former Secretary, Department of Biotechnology, Dr Gautam Sen, cardiothoracic surgeon and founder of Healthspring, a chain of clinics focussing on family health, and clinical immunologist Dr Sita Naik speaks for itself. Some of these doctors have served on the Board of Governors of the MCI so they probably have first hand experience of the misgovernance and corruption in the Council.

In fact, Rajendra Pratap Gupta, President & Board Member, Disease Management Association of India goes a step further and calls for reform of all regulatory bodies in the healthcare sector, like the Pharmacy Council of India, Nursing Council of India, Homeopathic Council etc. His letter dated May 9 to the Chief Justice and the bench of five Supreme Court Judges hearing this matter points out that all these bodies exist to ‘protect their own turfs, and no one ‘really’ cares for the ‘patient’ for whom the entire healthcare system should operate.’ He has offered to meet the Chief Justice or the bench to discuss his ideas of going beyond ‘doctors’ and a ‘treatment based’ healthcare system rather than focusing on ‘Population Health’.

There will be no doubt many more such requests and offers of help to the government and the bench of judges. Which prove that there is no dearth of advisors and experts available to help the government. It is high time that there is a new blueprint for healthcare regulatory bodies which have not evolved in tune with current socio-economic and industry realities.

But, how long will this process take? Dr Arvind Panagariya, Vice Chairman, Niti Aayog who heads a panel looking into the reform of the MCI, has gone on record to say on May 28, that major changes would happen in the next few months. With the BJP government using its second anniversary to remind the electorate of its achievements, with an eye clearly on the 2019 polls, will healthcare finally become one of the top three election issues? Or will it be swept under the carpet, yet again?

Viveka Roychowdhury

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