Safety has been one of the biggest concerns in the Indian Railways system. While the number of accidents have gone down over the last few years, the number still remains over 100 accidents a year. In light of the recent train accidents in Uttar Pradesh (UP), we present some details around accidents and safety in the Indian Railways.
Causes of rail accidents
The number of rail accidents has declined from 325 in 2003-04 to 106 in 2015-16.[1] The number of rail accidents as per the cause are shown in the graph below. In 2015-16, majority of the accidents were caused due to derailments (60%), followed by accidents at level crossings (33%).1 In the last decade, accidents caused due to both these causes have reduced by about half. According to news reports, the recent railway accidents in UP were caused due to derailment of coaches.
Derailments
Between 2003-04 and 2015-16, derailments were the second highest reason for casualties.2 The Standing Committee on Railways, when examining the safety in railways, had noted that one of the reasons for derailments is defect in the track or coaches. Of the total track length of 1,14,907 kms in the country, 4,500 kms should be renewed annually.2 However, in 2015-16, of the 5,000 km of track length due for renewal, only 2,700 km was targeted to be renewed.2 The Committee had recommended that Indian Railways should switch completely to the Linke Hoffman Busch (LHB) coaches as they do not pile upon each other during derailments and hence cause lesser casualties.2
Un-manned level crossings
Un-manned level crossings (UMLCs) continue to be the biggest cause of casualties in rail accidents. Currently there are 14,440 UMLCs in the railway network. In 2014-15, about 40% of the accidents occurred at UMLCs, and in 2015-16, about 28%.2 Between 2010 and 2013, the Ministry fell short of meeting their annual targets to eliminate UMLCs. Further, the target of eliminating 1,352 UMLCs was reduced by about 50% to 730 in 2014-15, and 820 in 2015-16.2 Implementation of audio-visual warnings at level crossings has been recommended to warn road users about approaching trains.2 These may include Approaching Train Warning Systems, and Train Actuated Warning Systems.2 The Union Budget 2017-18 proposes to eliminate all unmanned level crossings on broad gauge lines by 2020.
Casualties and compensation
In the last few years, Railways has paid an average compensation of Rs 3.03 crore every year for accidents (see figure below).[2]
Note: Compensation paid during a year relates to the cases settled and not to accidents/casualties during that year.
Consequential train accidents
Accidents in railways may or may not have a significant impact on the overall system. Consequential train accidents are those which have serious repercussions in terms of loss of human life or injury, damage to railway property or interruption to rail traffic. These include collisions, derailments, fire in trains, and similar accidents that have serious repercussions in terms of casualties and damage to property. These exclude cases of trespassing at unmanned railway crossings.
As seen in the figure below, the share of failure of railways staff is the biggest cause of consequential rail accidents. The number of rail accidents due to failure of reasons other than the railway staff (sabotage) has increased in the last few years.
Accidents due to failure of railway staff
It has been noted that more than half of the accidents are due to lapses on the part of railway staff.2 Such lapses include carelessness in working, poor maintenance, adoption of short-cuts, and non-observance of laid down safety rules and procedures. To address these issues, conducting a regular refresher course for each category of railway staff has been recommended.2
Accidents due to loco-pilots2,[3]
Accidents also occur due to signalling errors for which loco-pilots (train-operators) are responsible. With rail traffic increasing, loco-pilots encounter a signal every few kilometres and have to constantly be on high alert. Further, currently no technological support is available to the loco-pilots and they have to keep a vigilant watch on the signal and control the train accordingly.2 These Loco-pilots are over-worked as they have to be on duty beyond their stipulated working hours. This work stress and fatigue puts the life of thousands of commuters at risk and affects the safety of train operations.2 It has been recommended that loco-pilots and other related running staff should be provided with sound working conditions, better medical facilities and other amenities to improve their performance.2
Actions taken by Railways with regard to the recent train accident
According to news reports, the recent accident of Utkal Express in UP resulted in 22 casualties and over 150 injuries.[4] It has also been reported that following this incident, the Railways Ministry initiated action against certain officials (including a senior divisional engineer), and three senior officers (including a General Manager and a Railway Board Member).
The Committee on Restructuring of Railways had noted that currently each Railway zone (headed by a General Manager) is responsible for operation, management, and development of the railway system under its jurisdiction.[5] However, the power to make financial decisions does not rest with the zones and hence they do not possess enough autonomy to generate their own revenue, or take independent decisions.5
While the zones prepare their annual budget, the Railway Board provides the annual financial budget outlay for each of them. As a result of such budgetary control, the GM’s powers have been reduced leaving them with little independence in planning their operations.5
The Committee recommended that the General Managers must be fully empowered to take all necessary decisions independent of the Railway Board.5 Zonal Railways should also have full power for expenditure and re-appropriations and sanctions. This will make each Zonal Railway accountable for its transport output, profitability and safety under its jurisdiction.
Under-investment in railways leading to accidents
In 2012, a Committee headed by Mr. Anil Kakodkar had estimated that the total financial cost of implementing safety measures over the five-year period (2012-17) was likely be around Rs one lakh crore. In the Union Budget 2017-18, the creation of a Rashtriya Rail Sanraksha Kosh was proposed for passenger safety. It will have a corpus of Rs one lakh crore, which will be built over a five-year period (Rs 20,000 crore per year).
The Standing Committee on Railways had noted that slow expansion of rail network has put undue burden on the existing infrastructure leading to severe congestion and safety compromises.2 Since independence, while the rail network has increased by 23%, passenger and freight traffic over this network has increased by 1,344% and 1,642% respectively.2 This suggests that railway lines are severely congested. Further, under-investment in the sector has resulted in congested routes, inability to add new trains, reduction of train speeds, and more rail accidents.2 Therefore, avoiding such accidents in the future would also require significant investments towards capital and maintenance of rail infrastructure.2
Tags: railways, safety, accidents, finances, derailment, casualty, passengers, train
[1] Railways Year Book 2015-16, Ministry of Railways, http://www.indianrailways.gov.in/railwayboard/uploads/directorate/stat_econ/IRSP_2015-16/Year_Book_Eng/8.pdf.
[2] “12th Report: Safety and security in Railways”, Standing Committee on Railways, December 14, 2016, http://164.100.47.193/lsscommittee/Railways/16_Railways_12.pdf.
[3] Report of High Level Safety Review Committee, Ministry of Railways, February 17, 2012.
[4] “Utkal Express derailment: Four railway officials suspended as death toll rises to 22”, The Indian Express, August 20, 2017, http://indianexpress.com/article/india/utkal-express-train-derailment-four-railway-officers-suspended-suresh-prabhu-muzaffarnagar-22-dead-4805532/.
[5] Report of the Committee for Mobilization of Resources for Major Railway Projects and Restructuring of Railway Ministry and Railway Board, Ministry of Railways, June 2015, http://www.indianrailways.gov.in/railwayboard/uploads/directorate/HLSRC/FINAL_FILE_Final.pdf.
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.
