Abolish MCI, councils

Abolishing all health sector councils and replacing them by a single national council would perhaps be the best thing, given the nadir to which critical aspects of medical education have sunk. To cleanse the system, Government must act now without any further delay

The Ministry of Health’s Task Force proposes to discard the Medical Council of India and all other health sector councils and replace them with a single National Council for Human Resource in Health. Abolishing the elected bodies that have held sway for decades would perhaps be the best thing that could happen, given the nadir to which critical aspects of medical education have sunk. Unfortunately, the truth is that the running of professional medical and allied colleges is the uppermost Indian business interest, with the exception of cricket.

I had the somewhat dubious experience of dealing with all the councils in the medical sector for over seven years in the Ministry of Health. Those years stand out most in my memory because it was my maiden voyage into the machinations of big Government. It was also the only period when Chief Ministers knew me by name and rang me directly with ‘chhota kam’ .

It was August 1992. Mr Narasimha Rao was the Prime Minister. I was the newest Joint Secretary in the Health Ministry and had just been given charge of medical education. On August 27 morning I was sent for by the Health Secretary and told that an ordinance was to be promulgated that evening. I was dispatched to the Ministry of Law where the ordinance was dictated line by line by an Additional Secretary.

I came to know only through him that the ordinance was intended to thwart the Chief Minister of Andhra Pradesh for wantonly granting permission to establish around 20 medical colleges. This act of Mr Janardhan Reddy provoked judicial strictures to the point that the Chief Minister lost his chair. Bringing an ordinance was the brainchild of Prime Minister Narasimha Rao, a former Chief Minister of Andhra Pradesh. At 6 pm the legal officer handed over a typewritten draft to me and I rushed back to Nirman Bhavan every inch the cog in the wheel that I was. Late that night the President’s assent to promulgate the ordinance was obtained. I retired to bed much wiser.

Overnight, the Central Government had wrenched all powers from States to give permission to establish new colleges, increase seats or introduce post-graduate courses in medical colleges. It was an extremely well-intentioned move, but unfortunately the next 17 years have not been a happy experience. An unending tussle has gone on between the Ministry and the MCI. Colleges sans teachers or patients have managed to successfully manipulate both admissions and degrees with constant wrangling and countless court cases.

What is at stake for the common man? The conditions imposed by the councils in the name of setting standards are generally elitist and out of tune with India’s growing needs for professional manpower. The MCI makes short shrift of pressing requirements like public health and family health, driving graduates into specialisations which are lucrative but irrelevant, looking at India’s rural as well as a fast growing urban population and the twin challenges of communicable and non-communicable diseases that confront us.

At the root of the problem is the fact that all the councils are elected bodies and candidates spend huge money to get elected. Professionalism is not the primary concern of people who have to get a return on investment. The idea of an overarching council is fundamentally a good idea but it should also not be left to the States to grant approvals based on centrally dictated standards. That will delight them no doubt, but that would be leaving the door open for resurrecting the horror stories of 1992.

It is equally the constitutional duty of the Central Government to see that the standards are not just set but followed. For that an oversight mechanism has to be in place to see what is happening, otherwise we may well have sub-standard medical practitioners let loose on hapless citizens. The fact that medical graduates will need to pass a common centrally organised examination to practice in another State would hardly be a fair way of fulfilling a responsibility envisaged by the Constitution.

In a democracy the answer lies in appointing a nominated body for three years to fulfil the functions of medical and allied councils. But ultimately within that period the complexion of the electoral colleges given in the different Acts should be changed through an omnibus legislation so that each profession can be represented by a cross-section of stakeholders, not just a bunch of cronies. The criteria for individual nominations should also prescribe evidence of professional caliber and experience, not merely belonging to a specified category.

In the formative period an ordinance is the only way that can enable the Government to establish a nominated national council. Within a reasonable period the system for holding elections should be put into place as that obligation cannot be wished away forever. For the time being, however, only an ordinance can ensure safe passage in Parliament within six months. Otherwise the players involved being among the most influential in the country, and the wheels of Government and Parliament being so slow, a business as usual approach will be doomed to dust.