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Several Rajya Sabha seats go to elections this year. The President and the Vice-President are also due to be elected by August. We analyse the impact of the recent State Assembly elections on the composition of the Rajya Sabha and the outcome of the Presidential polls. Rajya Sabha - How will its composition change? Since Rajya Sabha members are elected by the elected members of State Legislative Assemblies, a change in the composition of State Assemblies can affect the composition of Rajya Sabha. A total of 61 Rajya Sabha seats are up for election in April and July. This includes 10 seats from Uttar Pradesh and 1 seat from Uttarakhand. In light of the recent Assembly elections, we work out two scenarios to estimate the composition of Rajya Sabha in 2012. Members of Rajya Sabha are elected through the system of proportional representation by means of the Single Transferable Vote (STV). In an STV election, a candidate is required to achieve a certain minimum number of votes (called the 'quota') to be elected. (For more details on the STV system, click here) For instance, in the case of Uttar Pradesh (UP) 10 Rajya Sabha seats go to election this year. Candidates will be elected to these 10 seats by the 403 elected MLAs of the Uttar Pradesh State Assembly. Each MLA will rank the candidates based on his/ her preference. After successive rounds of elimination, candidates who are able to secure at least 37 {or 403/(10+1) } votes will be declared elected. In the new UP Assembly, Samajwadi Party (SP) has a total strength of 224 members. As a result, SP can elect at least 6 (or 224/37) Rajya Sabha MPs of its choice. BSP's strength of 80 will allow it to elect 2 (or 80/37) MPs to Rajya Sabha. Similarily, the BJP with a strength of 47 MLAs can have one candidate of its choice elected to the Rajya Sabha. This leaves 1 seat. The fate of this seat depends on the alliances that may be formed since no other party in UP has 37 or more seats in the Assembly. If the Congress (28 seats) and RLD (9 seats) join hands, they may be able to elect a candidate of their choice. We build two scenarios which give the likely range of seats for the major coalitions and parties. The actual result will likely fall between these scenarios, depending on alliances for each election. Of the two scenarios, Scenario II is better for the UPA. It is based on the assumption that the UPA is able to put together the necessary support/ alliances to get its candidates elected to seats with indeterminate status. Scenario I is based on the assumption that the UPA is not able to put together the required support. As a result, the seats in question get allocated to candidates from other parties/ coalitions. (See Notes for the composition of the coalitions) Composition of Rajya Sabha
Party/ Coalition | Current composition | Scenario I | Scenario II |
Total seats |
245 |
245 |
245 |
UPA |
93 |
95 |
98 |
NDA |
66 |
67 |
65 |
Left |
19 |
14 |
14 |
BSP |
18 |
15 |
15 |
SP |
5 |
9 |
9 |
BJD |
6 |
8 |
7 |
AIADMK |
5 |
5 |
5 |
Nominated |
7 |
12 |
12 |
Others |
21 |
20 |
20 |
Vacant |
5 |
0 |
0 |
It appears that there would not be a major change in the composition of the Rajya Sabha. Which party's candidate is likely to become the next President? The next Presidential election will be held in June or July. The electoral college for the Presidential election consists of the elected members of Lok Sabha, Rajya Sabha and all Legislative Assemblies. Each MP/ MLA’s vote has a pre-determined value based on the population they represent. For instance, an MP's vote has a value of 708, an MLA from UP has a vote value of 208 and an MLA from Sikkim has a vote value of 7. (Note that all MPs, irrespective of the constituency or State they represent, have equal vote value) As is evident, changes in the composition of Assemblies in larger States such as UP can have a major impact on the outcome of the Presidential election. The elections to the office of the President are held through the system of proportional representation by means of STV (same as in the case of Rajya Sabha). The winning candidate must secure at least 50% of the total value of votes polled. (For details, refer to this Election Commission document). By this calculation, a candidate will need at least 5,48,507 votes to be elected as the President. If the UPA were to vote as a consolidated block, its vote tally would reach 4,50,555 votes under Scenario II (the one that is favourable for the UPA). Therefore, the UPA will have to seek alliances if it wants a candidate of its choice to be elected to the office of the President. Scenarios for Presidential elections (figures represent the value of votes available with each party/ coalition)
Party/ Coalition | Scenario I | Scenario II |
UPA |
4,48,431 |
4,50,555 |
NDA |
3,05,328 |
3,03,912 |
Left |
51,574 |
51,574 |
BSP |
43,723 |
43,723 |
SP |
69,651 |
69,651 |
BJD |
30,923 |
30,215 |
AIADMK |
36,216 |
36,216 |
Others |
1,11,166 |
1,11,166 |
Total |
10,97,012 |
10,97,012 |
Minimum required to be elected |
5,48,507 |
5,48,507 |
What about the Vice-President? Elections to the office of the Vice-President (VP) will be held in July or August. The electoral college will consist of all members of Lok Sabha and Rajya Sabha (i.e. both elected and nominated). Unlike the Presidential elections, all votes will have an equal value of one. Like the President, the VP is also elected through the system of proportional representation by means of STV. The winning candidate must secure at least 50% of the total value of votes polled. Presently, two seats are vacant in the Lok Sabha. If we exclude these from our analysis, we find that a candidate will need at least 395 votes to be elected as the VP. Under our best case scenario, the UPA holds 363 votes in the forthcoming VP elections. As is the case with Presidential elections, the UPA will have to seek alliances to get a candidate of its choice elected to the office of the Vice-President. Scenarios for VP elections (figures represent the value of votes available with each party/ coalition)
Party/ Coalition |
Scenario I |
Scenario II |
UPA |
360 |
363 |
NDA |
216 |
214 |
Left |
38 |
38 |
BSP |
36 |
36 |
SP |
31 |
31 |
BJD |
22 |
21 |
AIADMK |
14 |
14 |
Nominated |
14 |
14 |
Others |
57 |
57 |
Total |
788 |
788 |
Minimum required to be elected |
395 |
395 |
Notes: [1] UPA: Congress, Trinamool, DMK, NCP,Rashtriya Lok Dal, J&K National Conference, Muslim League Kerala State Committee, Kerala Congress (M), All India Majlis-e-Ittehadul Muslimeen, Sikkim Democratic Front, Praja Rajyam Party, Viduthalai Chiruthaigal Katchi [2] NDA: BJP, JD(U), Shiv Sena, Shiromani Akali Dal [3] Left: CPI(M), CPI, Revolutionary Socialist Party,All India Forward Bloc
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.