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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 This Act was repealed and replaced with a new Act in 1956.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:

  • Maintenance of standards in medical education through curriculum guidelines, inspections and permissions to start colleges, courses or increasing number of seats
  • Recognition of medical qualifications
  • Registration of doctors and maintenance of the All India Medical Register
  • Regulation of the medical profession by prescribing a code of conduct and taking action against erring doctors

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!

In recent public discourse over lobbying, two issues that have underscored the debate are:

  1. Greater transparency in the policymaking process, and
  2. Equality of access for all stakeholders in engaging with the process.

There is a need to build linkages between citizens and the policy making process, especially by strengthening scrutiny before a Bill is introduced in Parliament. Currently, there is no process established to ensure pre-legislative scrutiny by the citizenry. Other democracies incorporate several measures to enhance public engagement in the pre-legislative process. These include:

  • Making all Bills available in the public domain for a stipulated period before introducing them in the legislature. This includes, publishing these Bills in forms (language, medium etc) that are accessible to the general public.
  • Making a report or Green paper on the legislative priorities addressed by the Bill available for citizens.
  • Forming adhoc committees to scrutinise the Bill before it is piloted in the House.
  • Having Standing Committees examine the Bill before introducing it in the House.
  • Providing a financial memorandum for each Bill, which specifies the budgetary allocation for the process/bodies created by the Bill.
  • Creating online fora for discussion. For the sections of the stakeholders who have limited access to the internet, efforts are made to proactively consult them through other media.
  • Expanding the purview of citizens’ right to petition their representatives with legislative proposals.

There are several instances, in the last few years itself, wherein civil society groups have played an active role in the development of pre-legislative scrutiny in India.

  • Public consultation with cross-section of stakeholders when drafting a Bill: The Right to Information Act is seen as a landmark legislation when highlighting the role of civil society actors in the drafting of a Bill.  It also serves as a prime example for how it the movement mobilised widespread public opinion for the Bill, bringing together different sections of the citizenry.
  • Public feedback on draft Bills: In several cases, after a Bill has been drafted the concerned ministry or public body publishes the Bill, inviting public comments. The Right to Education Bill, the National Identification Authority Bill and the Draft Direct Taxes Code Bill 2009 are recent cases in point. These announcements are made through advertisements published in newspapers and other media. For instance, the government has recently proposed to amend the rules of the RTI and has invited public feedback on the rules by December 27.
  • Engaging with legislators: It is important to expand engagement with lawmakers after the Bill has been introduced in Parliament, as they will determine what the law will finally contain.  This is done by approaching individual legislators or members of the committee which is likely to examine the legislation. Standing Committees invite feedback on the Bill through newspaper advertisements.  For instance, the Standing Committee examining the Civil Nuclear Liability Bill heard testimonies from journalists, civil society groups, thinktanks, public bodies and government departments.

The role of the media and channelising the potential of the internet are other key approaches that need to be explored. Other examples and channels of engagement with the legislative process are illustrated in the PRS Primer on Engaging with Policymakers