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ShareWhen the high priests have lost their sanctity and seminaries multiply without vision, it is time for a reformation in the temples of healing.
The Medical Council of India (MCI) is the oldest autonomous professional regulatory body in India, established by Act of Parliament in 1934. It is authorised to regulate the selection, training and certification of our future physicians and their competence and ethical behaviour when they become our care givers. But when we are told, for example, that an Indian woman is ten times more likely to die in childbirth than her counterpart in China, or 16 times more than in Russia, we cannot help wondering how well the MCI is fulfilling this regulatory authority.
A critical look at the MCI, and its siblings: At present, we have separate regulatory bodies for each of the health related professions such as medicine, nursing, and allied health sciences. They have gone their separate ways sometimes pulling in different, if not opposite, directions. The result is the present gross imbalance in the development of human resources among the different health professions. There is little synergy among these professions in resolving the health care crisis in the country.
The rampant illegal payments for admission to private colleges of these professions continue to shock the public. Behind it, there are recurrent allegations of lapses in the initial recognition and continued oversight of new colleges. Our primary and secondary level health centres languish due to shortage or default of doctors and other health professionals, which is greatly responsible for the maternal mortality mentioned above. There is severe shortage of medical specialists as well. MCI has been so remiss in disciplining the profession that this once noble profession had to be brought under the Consumer Protection Act. Suffice it to say that there has been progressive loss of confidence in the efficiency, integrity, sagacity and social commitment of the MCI and the other councils.
It is in this context that UPA government has made a radical proposal for replacing these councils with an "overarching" National Council for Human Resources in Health (NCHRH). We all have good reason to take a close look at this proposal. The legitimate concerns of individual professions are to be safeguarded by having separate sections under the National Council for each of the professions.
The other major change is the proposal to do away with the present jumbo sized inefficient councils, mainly made up of elected representatives from each profession. The sad truth is that these revered and so-called noble professions have failed in self-regulation. So it is proposed that the National Council is made up of just five members nominated by an appropriate collegium.
In the present proposals, the government can give directions to the National Council only where national policy is involved. This safeguards the autonomy and independence of the regulatory body. There is a welcome emphasis on all-India standardisation of qualifications and accreditation through national exit examinations. In order to overcome the severe shortage of specialists, a pattern of specialist training similar to that in the US is proposed.
The way forward: These proposals are not perfect. But they can be built upon to bring about a well-conceived reformation. To avoid undue concentration of power and ensure a wide range of necessary expertise, the proposed five member NCHRH could be enlarged to seven or nine full time members. Apart from educational and professional expertise and organisational competence, a sound reputation for incorruptibility must be a basic requirement for the selection.
Traditionally professional councils are set up to promote the welfare and progress of the concerned professions and professional education to that end, along with professional propriety. But in the case of the health professions and sciences, the very raison d'etre for privileging them in a special way is their crucial importance to the health and well-being of the public. So the proposed NCHRH must include persons with proven track record in two hitherto neglected areas: advocacy for the interests of patients and promotion of a universally accessible and effective health care system.
One singular failure of the present proposals is in perpetuating the bankrupt system for self-disciplining of the professionals, through elected boards from among themselves. The new disciplinary bodies must be so constituted that they will impartially and firmly discipline the professionals in matters of incompetence, negligence and unethical practices, all of which we encounter in our daily lives.
It is inevitable that such a startling restructuring of a venerable edifice will be firmly resisted by privileged interests. But the piteous state of the nation's healthcare demands a thorough reform of the regulation of health related professions.
