It is a strange incongruity that in a democratic country with over 1.2 billion people, the systems of health-care delivery and medical education are poorly regulated, expensive, opaque and, by the government’s own admission, considerably corrupt. In December, the Centre acknowledged the need to modernise the Medical Council of India (MCI), the apex body that was temporarily superseded six years ago in the wake of a corruption scandal. The functioning of the MCI has been controversial on several counts, culminating in the arrest of its president in 2010 on a graft charge. Reviewing its record, the Standing Committee on Health and Family Welfare expressed shock in a recent report tabled in Parliament that a body like the MCI, which sets ethical norms for medical professionals, could itself be headed by someone who was arrested for corruption. The report is a severe indictment of the Council and the Centre, for failing to stop the sale of medical seats in private colleges for capitation fees going up to Rs.50 lakh, and allowing a single, all-powerful agency heavily influenced by corporate hospitals to provide accreditation to institutions and assess their quality, ignoring blatant conflicts of interest. Clearly, a thorough clean-up in the manner medical education and health-care institutions are regulated is overdue; no compromise should be made on transparency, public interest and the highest ethical standards in doing this.
Comprehensive reform of the MCI should begin with the separation of functions: approving standards and accreditation requirements for medical education, fixing norms to assess the competence of medical graduates and laying down ethical practice guidelines. Here, it is worth considering the suggestions made by the government-constituted committee of experts led by Ranjit Roy Chaudhary, notably the creation of a National Medical Commission to oversee education and policy, and separate boards for undergraduate and postgraduate training, assessment of institutions and medical ethics. It is certainly untenable for the Centre to retain the present structure of the MCI, which seems designed to benefit vested interests. Inducting non-medical professionals of integrity and community health experts to regulatory bodies would help advance public interest. The NDA government would also do well to follow up the demand of the parliamentary committee for a time-bound probe into the curious phenomenon of a large number of inspectors from Gujarat and Bihar being sent for visits during 2014, in the absence of clear guidelines on selecting evaluators. The larger goal of a revamp should be to produce medical professionals, especially postgraduates, in such numbers that would improve the doctor to population ratio and ensure their availability across the country. The possibility of having an exit test for medical graduates at the end of their course and before they start practising, as a measure of standardisation across States, is worth debating. The commercialisation of health education needs to be given a quick burial.
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