![](/images/main_logo.png)
The Medical Council of India (MCI) has seen a few major controversies over the past decade. In the latest incident, MCI President, Dr. Ketan Desai was arrested by the CBI on charges of accepting a bribe for granting recognition to Gyan Sagar Medical College in Punjab. Following this incident, the central government promulgated an ordinance dissolving the MCI and replacing it with a centrally nominated seven member board. The ordinance requires MCI to be re-constituted within one year of its dissolution in accordance with the provisions of the original Act. Background The Medical Council of India was first established in 1934 under the Indian Medical Council Act, 1933. This Act was repealed and replaced with a new Act in 1956. Under the 1956 Act, the objectives of MCI include:
Over the years, several committees, the most recent being the National Knowledge Commission (NKC) and the Yashpal Committee, have commented on the need for reforms in medical regulation in the country. The Ministry of Health and Family Welfare (MoH&FW) has recently released a draft of the National Council for Human Resources in Health (NCHRH) Bill for public feedback. (See http://mohfw.nic.in/nchrc-health.htm) Key issues in Medical Regulation Oversight Currently, separate regulatory bodies oversee the different healthcare disciplines. These include the Medical Council of India, the Indian Nursing Council, the Dental Council of India, the Rehabilitation Council of India and the Pharmacy Council of India. Each Council regulates both education and professional practice within its domain. The draft NCHRH Bill proposes to create an overarching body to subsume these councils into a single structure. This new body, christened the National Council for Human Resources in Health (NCHRH) is expected to encourage cross connectivity across these different health-care disciplines. Role of Councils Both the NKC and the Yashpal Committee make a case for separating regulation of medical education from that of profession. It is recommended that the current councils be divested of their education responsibilities and that these work solely towards regulation of professionals – prescribing a code of ethics, ensuring compliance, and facilitating continued medical education. In addition, it has been recommended that a national exit level examination be conducted. This exit examination should then serve the purpose of ‘occupational licensing’, unlike the prevalent registration system that automatically grants practice rights to graduating professionals. In effect, it is envisaged that the system be reconfigured on the lines of the Institute of Chartered Accountants, wherein the council restricts itself to regulating the profession, but has an indirect say in education through its requirements on the exit examination. A common national examination is also expected to ensure uniformity in quality across the country. Both committees also recommend enlisting independent accrediting agencies for periodically evaluating medical colleges on pre-defined criteria and making this information available to the public (including students). This is expected to bring more transparency into the system. Supervision of education – HRD vs. H&FW The Ministry of Human Resources and Development (MHRD) is proposing a National Council for Higher Education and Research (NCHER) to regulate all university education. However, MoH&FW is of the opinion that Medical Education is a specialized field and needs focused attention, and hence should be regulated separately. However, it is worth noting that both the NKC and the Yashpal Committee recommend transferring education overseeing responsibilities to the NCHER. Internationally, different models exist across countries. In the US, the Higher Education Act, 1965 had transferred all education responsibilities to the Department of Education. In the UK, both medical education and profession continue to be regulated by the General Medical Council (the MCI counterpart), which is different from the regulator for Higher Education. Composition of Councils In 2007-08, MCI, when fully constituted, was a 129 member body. The Ministry in its draft NCHRH Bill makes a case for reducing this size. The argument advanced is that such a large size makes the council unwieldy in character and hence constrains reform. In 2007-08, 71% of the members in the committee were elected. These represented universities and doctors registered across the country. However, the Standing Committee on H&FW report (2006) points out that delays in conducting elections usually leads to several vacancies in this category, thereby reducing the actual percentage of elected members. MCI’s 2007-08 annual report mentions that at the time of publishing the report, 29 seats (32% of elected category) were vacant due to ‘various reasons like expiry of term, non-election of a member, non-existence of medical faculty of certain Universities’. In November 2001, the Delhi High Court set aside the election of Dr. Ketan Desai as President of the MCI, stating that he had been elected under a ‘flawed constitution’. The central government had failed to ensure timely conduct of elections to the MCI. As a result, a number of seats were lying vacant. The Court ordered that the MCI be reconstituted at the earliest and appointed an administrator to oversee the functioning of the MCI until this was done. Several countries like the UK are amending their laws to make council membership more broad-based by including ‘lay-members’/ non-doctors. The General Medical Council in the UK was recently reconstituted and it now comprises of 24 members - 12 ‘lay’ and 12 medical members. (See http://www.gmc-uk.org/about/council.asp) Way ahead According to latest news reports, the MoH&FW is currently revising the draft Bill. Let's wait and see how the actual legislation shapes up. Watch this space for further updates!
Recently, there have been reports of price crashes and distress sales in case of farm produce, such as tomatoes, mangoes, and garlic. In some cases, farmers have dumped their produce on roads. Produce such as fruits and vegetables are perishable and therefore have a short shelf life. Further, due to inadequate storage facilities and poor food processing infrastructure farmers have limited options but to sell the produce at prevailing market prices. This can lead to distress sales or roadside discards (in some cases to avoid additional cost of transportation).
Food processing allows raw food to be stored, marketed, or preserved for consumption later. For instance, raw agricultural produce such as fruits may be processed into juices, jams, and pickles. Activities such as waxing (for preservation), packaging, labelling, or ripening of produce also form part of the food processing industry.
Between 2001-02 and 2016-17, production of food grains grew annually at 1.7% on average. Production of horticulture crops surpassed food grains with an average growth rate of 4.8%. While production has been increasing over the years, surplus produce tends to go waste at various stages such as procurement, storage, and processing due to lack of infrastructure such as cold storages and food processing units.
Source: Horticulture Statistics at a Glance 2017, Union Budget 2018-19; PRS.
Losses high among perishables such as fruits and vegetables
Crop losses ranged between 7-16% among fruits and around 5% among cereals in 2015. The highest losses were witnessed in case of guava, followed by mango, which are perishable fruits. Perishables such as fruits and vegetables are more prone to losses as compared to cereals. Such crop losses can occur during operations such as harvesting, thrashing, grading, drying, packaging, transportation, and storage depending upon the commodity.
It was estimated that the annual value of harvest and post-harvest losses of major agricultural products at the national level was Rs 92,651 crore in 2015. The Standing Committee on Agriculture (2017) stated that such wastage can be reduced with adequate food processing facilities.
Sources: Annual Report 2016-17, Ministry of Food Processing Industries; PRS.
Inadequate food processing infrastructure
As previously discussed, perishables such as fruits and vegetables are more prone to damages as compared to cereals. Due to inadequate processing facilities in close proximity, farmers may be unable to hold their produce for a long time. Hence, they may be forced to sell their produce soon after harvest, irrespective of the prevailing market situations. Expert committees have recommended that agri-logistics such as cold chain infrastructure and market linkages should be strengthened.
Cold chain infrastructure: Cold chain infrastructure includes processing units, cold storages, and refrigerated vans. As of 2014, out of a required cold storage capacity of 35 million metric tonnes (MT), almost 90% (31.8 million MT) of the capacity was available (see Table 1). However, cold storage needs to be coupled with logistical support to facilitate smooth transfer of harvested value from farms to distant locations. This includes: (i) pack-houses for packaging and preparing fresh produce for long distance transport, (ii) refrigerated transport such as reefer vehicles, and (iii) ripening chambers to ripen raw produce before marketing. For instance, bananas which are harvested raw may be ripened in these chambers before being marketed.
While there are sufficient cold storages, there are wide gaps in the availability of other associated infrastructure. This implies that even though almost 90% (32 million tonnes) of cold storage capacity is available, only 15% of the required refrigerated transport exists. Further, the shortfall in the availability of infrastructure necessary for safe handling of farm produce, like pack-houses and ripening chambers, is over 90%.
Table 1: Gaps in cold chain infrastructure (2014)
Facility | Required | Available | Gap | % gap |
Cold storage (in million MT) |
35.1 |
31.8 | 3.2 |
9.3% |
Pack-houses |
70,080 |
249 | 69,831 |
99.6% |
Reefer vehicles |
61,826 |
9,000 | 52,826 |
85.4% |
Ripening chambers |
9,131 |
812 | 8,319 |
91.1% |
To minimise post-harvest losses, the Standing Committee (2017) recommended that a country-wide integrated cold chain infrastructure network at block and district levels should be created. It further recommended that a Cold Chain Coordination and Monitoring Committee should be constituted at the district-level. The Standing Committee also recommended that farmers need to be trained in value addition activities such as sorting, grading, and pre-cooling harvested produce through facilities such as freezers and ripening chambers.
Between 2008 and 2017, 238 cold chain projects were sanctioned under the Scheme for Integrated Cold Chain and Value Addition Infrastructure. Grants worth Rs 1,775 crore were approved for these projects. Of this amount, Rs 964 crore (54%) has been released as of January 2018. Consequently, out of the total projects sanctioned, 114 (48%) are completed. The remaining 124 projects are currently under implementation.
Transport Facilities: Currently, majority of food grains and certain quantities of tea, potato, and onion are transported through railways. The Committee on Doubling Farmers Income had recommended that railways needs to upgrade its logistics to facilitate the transport of fresh produce directly to export hubs. This includes creation of adjoining facilities for loading and unloading, and distribution to road transport.
Mega Food Parks: The Mega Food Parks scheme was launched in 2008. It seeks to facilitate setting up of food processing units. These units are to be located at a central processing centre with infrastructure required for processing, packaging, quality control labs, and trade facilitation centres.
As of March 2018, out of the 42 projects approved, 10 were operational. The Standing Committee on Agriculture noted certain reasons for delay in implementation of projects under the scheme. These include: (i) difficulty in getting loans from banks for the project, (ii) delay in obtaining clearances from the state governments and agencies for roads, power, and water at the project site, (iii) lack of special incentives for setting up food processing units in Mega Food Parks, and (iv) unwillingness of the co-promoters in contributing their share of equity.
Further, the Standing Committee stated that as the scheme requires a minimum area of 50 acres, it does not to promote smaller or individual food processing and preservation units. It recommended that smaller agro-processing clusters near production areas must be promoted. The Committee on Doubling Farmers Income recommended establishment of processing and value addition units at strategic places. This includes rural or production areas for pulses, millets, fruits, vegetables, dairy, fisheries, and poultry in public private-partnership mode.