The President addressed the Parliament after the 2009 Lok Sabha Elections on 4th June 2009. She also addressed Parliament on 22nd February 2010, as well as on 21st February 2011. The tables below highlight some items from the agenda of the central government as outlined in these speeches, as well as the initiatives undertaken with respect to these agenda items. Table 1: Some Items from the President’s Address to Parliament on 4th June 2009
| Agenda Items outlined in the President’s Speech | Current Status |
| Establishment of National Counter-Terrorism Centre | Proposed launch of NCTC in March 2011 on hold |
| Enactment of legislation for prevention of communal violence | Communal Violence Bill 2005 pending in Parliament. New bill drafted by NAC but not introduced in Parliament |
| Unique Identity Card scheme to be implemented in three years | Unique Identification Authority of India created under Planning Commission on 28 January 2009. Bill to give statutory status pending in Parliament |
| Establishment of a regulator for the pension sector | Bill introduced in Lok Sabha on 24 March 2011 |
| Convergence of NREGA with other programs; expansion of works permitted; independent monitoring and grievance redressal | |
| Rashtriya Swasthya Bima Yojana to cover all families below the poverty line in five years | |
| Enactment of Right to Free and Compulsory Education Bill | Bill passed in 2009 and brought into force on 1 April 2009 |
| Madhyamik Shiksha Abhiyan to universalize access to secondary education | Rashtriya Madhyamik Shiksha Abhiyan launched in March 2009 |
| National Mission for Female Literacy to make every woman literate in five years | National Literacy Mission recast in 2009 to focus on female literacy |
| Construction of 1.2 crore rural houses under Indira Awas Yojana in five years | |
| Introduction of Rajiv Awas Yojana for slum dwellers and urban poor | Phase I approved by Cabinet on 2 June 2011 |
| Enactment of National Food Security Act | Introduced in Lok Sabha on 22 December 2011 |
| Enactment of Amendment Bill to Land Acquisition Act and Rehabilitation and Resettlement Bill | Land Acquisition, Rehabilitation and Resettlement Bill 2011 introduced in Lok Sabha on 7 September 2011 |
| Enactment of Women’s Reservation Bill | Passed by Rajya Sabha, pending in Lok Sabha |
| Constitutional Amendment for 50 percent reservation for women in panchayats and urban local bodies | Two Bills introduced in Lok Sabha in November 2009; both pending in Parliament |
| Amendment of RTI to provide for disclosure by government in all non-strategic areas | |
| Model Public Services Law to be drawn up in consultation with states | Right of Citizens for Time Bound Delivery of Goods and Services and Redressal of their Grievance Bill, 2011 introduced in Lok Sabha on 20 December 2011 |
| Introduction of Goods and Services Tax | Constitutional Amendment Bill introduced in Lok Sabha on 22 March 2011 |
| National Council for Human Resources in Health | Introduced in Rajya Sabha on 22 December 2011 |
| National Council for Higher Education | Bill introduced in Rajya Sabha on 28 December 2011 |
*Note: Blank cells indicate that PRS has not been able to find official information in the public domain. Table 2: Some Items from the President’s speech to Parliament on 22nd February 2010
| Agenda Items outlined in the President’s Speech | Current Status |
| Introduction of legislation to ensure food security | Introduced in Lok Sabha on 22 December 2011 |
| Rural teledensity of 40 percent by 2014 | Rural teledensity of 33% as of February 2011 |
| Introduction of Rajiv Awas Yojana for urban poor and slum dwellers | Phase I approved by Cabinet on 2 June 2011 |
| Disposal of remaining claims under the Scheduled Tribes and Other Traditional Forest Dwellers Act | |
| Introduction of amendment to the Wakf Act | Passed by Lok Sabha; pending in Rajya Sabha |
| Enactment of Communal Violence (Prevention, Control and Rehabilitation of Victims) Bill, 2005 | Pending in Rajya Sabha since 2005 |
| Enactment of Women’s Reservation Bill | Passed by Rajya Sabha; pending in Lok Sabha |
| Constitutional amendments for 50 percent reservation for women in panchayats and urban local bodies | Two Bills introduced in Lok Sabha in November 2009; both pending in Parliament |
| Establishment of National Council for Higher Education and Research | Higher Education and Research Bill, 2011 introduced in Rajya Sabha on 28 December 2011 |
| Legislation for facilitating participation of foreign academic institutions in the education sector | Foreign Educational Institutions Bill, 2010 introduced in Lok Sabha on 3 May 2010 |
| Voting rights for Indian citizens living abroad | Bill passed. NRIs can vote at the place of residence that is mentioned in their passport |
Table 3: Some Items from the President’s speech to Parliament on 21st February 2011
| Agenda Items outlined in the President’s Speech | Current Status |
| Enactment of Food Security Law | Introduced in Lok Sabha on 22 December 2011 |
| Whistleblower Bill | Bill passed by Lok Sabha; pending in Rajya Sabha |
| Enactment of Judicial Standards and Accountability Bill | Introduced in Lok Sabha on 1 December 2010 |
| Enactment of new Mines and Minerals Bill | Introduced in Lok Sabha on 12 December 2011 |
| Rural teledensity of 40 percent by 2014 | Rural teledensity of 33% as of February 2011 |
| Construction of 1.2 crore rural houses during 2009-14 | |
| Enactment of Women’s Reservation Bill | Passed by Rajya Sabha; pending in Lok Sabha |
| Introduction of Bill regarding protection of children from sexual offences | Introduced in Rajya Sabha on 23 March 2011 |
| Introduction of Biotechnology Regulatory Authority of India Bill | Not introduced till date |
Today, the National Medical Commission Bill, 2019 was passed by Lok Sabha. It seeks to regulate medical education and practice in India. In 2017, a similar Bill had been introduced in Lok Sabha. It was examined by the Standing Committee on Health and Family Welfare, which recommended several changes to the Bill. However, the 2017 Bill lapsed with the dissolution of the 16th Lok Sabha. In this post, we analyse the 2019 Bill.
How is medical education and practice regulated currently?
The Medical Council of India (MCI) is responsible for regulating medical education and practice. Over the years, there have been several issues with the functioning of the MCI with respect to its regulatory role, composition, allegations of corruption, and lack of accountability. For example, MCI is an elected body where its members are elected by medical practitioners themselves, i.e., the regulator is elected by the regulated. Experts have recommended nomination based constitution of the MCI instead of election, and separating the regulation of medical education and medical practice. They suggested that legislative changes should be brought in to overhaul the functioning of the MCI.
To meet this objective, the Bill repeals the Indian Medical Council Act, 1956 and dissolves the current MCI.
The 2019 Bill sets up the National Medical Commission (NMC) as an umbrella regulatory body with certain other bodies under it. The NMC will subsume the MCI and will regulate medical education and practice in India. Under the Bill, states will establish their respective State Medical Councils within three years. These Councils will have a role similar to the NMC, at the state level.
Functions of the NMC include: (i) laying down policies for regulating medical institutions and medical professionals, (ii) assessing the requirements of human resources and infrastructure in healthcare, (iii) ensuring compliance by the State Medical Councils with the regulations made under the Bill, and (iv) framing guidelines for determination of fee for up to 50% of the seats in the private medical institutions.
Who will be a part of the NMC?
The Bill replaces the MCI with the NMC, whose members will be nominated. The NMC will consist of 25 members, including: (i) Director Generals of the Directorate General of Health Services and the Indian Council of Medical Research, (ii) Director of any of the AIIMS, (iii) five members (part-time) to be elected by the registered medical practitioners, and (iv) six members appointed on rotational basis from amongst the nominees of the states in the Medical Advisory Council.
Of these 25 members, at least 15 (60%) are medical practitioners. The MCI has been noted to be non-diverse and consists mostly of doctors who look out for their own self-interest over public interest. In order to reduce the monopoly of doctors, it has been recommended by experts that the MCI should include diverse stakeholders such as public health experts, social scientists, and health economists. For example, in the United Kingdom, the General Medical Council which is responsible for regulating medical education and practice consists of 12 medical practitioners and 12 lay members (such as community health members, administrators from local government).
What are the regulatory bodies being set up under the NMC?
The Bill sets up four autonomous boards under the supervision of the NMC. Each board will consist of a President and four members (of which two members will be part-time), appointed by the central government (on the recommendation of a search committee). These bodies are:
How is the Bill changing the eligibility guidelines for doctors to practice medicine?
There will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-speciality medical education in all medical institutions regulated under the Bill. Further, the Bill introduces a common final year undergraduate examination called the National Exit Test for students graduating from medical institutions to obtain the license for practice. This test will also serve as the basis for admission into post-graduate courses at medical institutions under this Bill. Foreign medical practitioners may be permitted temporary registration to practice in India.
However, the Bill does not specify the validity period of this license to practice. In other countries such as the United Kingdom and Australia, a license to practice needs to be periodically renewed. For example, in the UK the license has to be renewed every five years, and in Australia it has to renewed annually.
How will the issues of medical misconduct be addressed?
The State Medical Council will receive complaints relating to professional or ethical misconduct against a registered medical practitioner. If the medical practitioner is aggrieved of a decision of the State Medical Council, he may appeal to the Ethics and Medical Registration Board. If the medical practitioner is aggrieved of the decision of the Board, he can approach the NMC to appeal against the decision. It is unclear why the NMC is an appellate authority with regard to matters related to professional or ethical misconduct of medical practitioners.
It may be argued that disputes related to ethics and misconduct in medical practice may require judicial expertise. For example, in the UK, the regulator for medical education and practice – the General Medical Council (GMC) receives complaints with regard to ethical misconduct and is required to do an initial documentary investigation in the matter and then forwards the complaint to a Tribunal. This Tribunal is a judicial body independent of the GMC. The adjudication decision and final disciplinary action is decided by the Tribunal.
How does the Bill regulate community health providers?
As of January 2018, the doctor to population ratio in India was 1:1655 compared to the World Health Organisation standard of 1:1000. To fill in the gaps of availability of medical professionals, the Bill provides for the NMC to grant limited license to certain mid-level practitioners called community health providers, connected with the modern medical profession to practice medicine. These mid-level medical practitioners may prescribe specified medicines in primary and preventive healthcare. However, in any other cases, these practitioners may only prescribe medicine under the supervision of a registered medical practitioner.
This is similar to other countries where medical professionals other than doctors are allowed to prescribe allopathic medicine. For example, Nurse Practitioners in the USA provide a full range of primary, acute, and specialty health care services, including ordering and performing diagnostic tests, and prescribing medications. For this purpose, Nurse Practitioners must complete a master's or doctoral degree program, advanced clinical training, and obtain a national certification.
