- Advances in Health technology
- National Licentiate Examination
- Accessing Medical Education
- A Balancing Act
- Reforming Medical Education
- Widening Health Care
- Development Goals
- Address the functional challenges
National Medical Commission Act, 2019
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The National Medical Commission (NMC) Act, 2019 enacted by Parliament is a landmark act. The act has generated a lot of debate and strong reactions—both for and against it.
Advances in Health technology:
- Medical interventions and health technology are in a phase of rapid growth globally.
- The benefits of rapid scientific developments, technological advancements, and improved and targeted interventions in the health sector have changed the lives of millions.
- People are living longer and healthier lives.
- The simultaneous improvement in education, income, and other social determinants has also contributed to this phenomenal rise in life expectancy.
- Life expectancy in India improved from below 50 years in the 1950s to 76 years in the recent years (World Bank 2019).
- Medical education needs in the 21st century are vastly different from those in the previous century.
- But the 20th century educational strategies that are unfit to tackle 21st century challenges.
- The changes are needed because of fragmented, out-dated, and static curricula that produce ill-equipped graduates.
- The NMC Act, 2019 is a reformative step in this direction for a transparent and objective governance framework that has the potential to usher in institutional and instructional reforms across the medical education sector.
National Licentiate Examination:
- The ideation of a National Licentiate Examination mooted through this act is a provision that necessitates obtaining a licence to practise after graduation and for admission to postgraduate medical courses.
- This is expected to simplify the admission process for postgraduate programmes and eliminate the stress of multiple examinations.
- At the national level, it could free up a lot of latent human resource potential.
- The internship period of one-year duration, which is a mandatory component of medical education, is sub-optimally utilised in the current times.
- Interns are busy preparing and appearing for multiple entrance examinations with no attention on internship work.
- The freed up time with the single common national examination will enable young medical doctors to diligently spend time with patients and support our health system.
- Further, it shall help young doctors gain knowledge and understanding from real-life practical experiences.
- The act proposes the same standards for MBBS doctors graduating from anywhere in India and outside the country.
Accessing Medical Education:
- Equity in accessing medical education is of vital importance.
- While public institutions substantially subsidise medical education, the NMC will determine fees for a percentage of the seats in private medical colleges and deemed universities.
- The NMC’s authority to determine a percentage of fees in private medical colleges and deemed universities can open doors for those who want to pursue a career in medicine, but do not have the financial means to do so.
- This means that almost 75% of total seats in the country would be available at reasonable fees.
- The state governments would still have the liberty to decide fees for remaining seats in private medical colleges.
- The reforms have eliminated the role of black money in medical education and the NMC bill will provide statutory force to the reforms which have been carried out.
A Balancing Act:
- The NMC Act has outlined the composition of the NMC with ex officio members, nominees of states and union territories, and from amongst persons of ability.
- The Act also recognises the relationship between the states and the central government, and balances the need of the state initiatives with the wider need of a holistic central outlook towards health.
- From the wider perspective of health professional education, the act seeks to enhance the interface between homoeopathy, Indian systems of medicine and modern systems of medicine.
- It proposes a joint sitting of the commission, the Central Council of Homoeopathy and the Central Council of Indian Medicine at least once a year.
- Inter-professional education has the potential to bring various disciplines closer and lower the barriers to ensure efficient service delivery.
Reforming Medical Education:
- The NMC Act is directed towards reforming and regulating the medical education and practice.
- Continued engagement and reforms, possibly at varying levels of intensity, might be necessary to align all the councils that are charged with managing the education and practice of different medical professions.
- The emphasis on limited licence to practise at the mid-level as community health provider has been extensively debated.
- The interpretation is that this move is not intended to create “medical doctors” through crosspathy, but help support the creation of 1,50,000 mid-level providers within the next few years to provide comprehensive primary and preventive care at Health and Wellness Centres.
Widening Health Care:
- The HWCs are a part of the countrywide efforts to upgrade sub-centres within the public system to provide a wider basket of services.
- We have a skewed distribution of health professionals in the urban and rural areas of the country.
- Mid-level community health providers are expected to be the human resource thrust that will help supplement the health system in delivering quality care, particularly to rural populations.
- A limited and successful experience of the states of Chhattisgarh and Assam demonstrate such cadres’ positive impact on primary healthcare indicators.
- Currently, we do not have an allied health professionals council (AHPC) in the country.
- Since community health providers have been included in the National Medical Commission Act instead of an AHPC, it could have resulted in the misconceptions surrounding this particular clause.
- It will be helpful if there is a greater clarity on whether these community health providers will function only at the level of HWCs in the public sector, or whether they will be permitted to function even within the private sector.
- The ideas of equity and strengthening of the primary healthcare through mid-level community health providers are also important in the context of India’s progression towards the Sustainable Development Goals (SDGs).
- The achievement of the third SDG in India will need well-functioning health systems that work towards assuring universal health coverage.
- The NMC Act is consciously contributing to medical education to channelize the supply-side to meet the future requirements.
- The thrust on medical education is an essential part of the act.
- The availability of adequately trained medical professionals can provide quality care in a dignified manner and in sync with the national health goals.
- The undergraduate medical education board and the postgraduate medical education board will have to take cognisance of the overall shortfall in the number of medical doctors, particularly post-graduates across the country.
- Their shortfall, particularly at the district and the sub-district levels will need remedial action.
Address the functional challenges:
- The NMC has inherited the responsibility to address the structural and functional challenges within the health system.
- Governance reforms have the potential to create an enabling environment, standardise processes, and introduce transparency in functioning.
- The impetus will have to be on a greater attention to both quality and quantity.
- The NMC will have to deftly handle such challenges on the medical education front.
- In this case, medical colleges and medical teachers will also have to rise to the occasion.
- The Medical Assessment and Rating Board constituted under this act will rate all the medical colleges and present this information in the public domain.
- This can be expected to bring greater transparency in the performance of the medical colleges.
- This can usher in greater levels of competition among medical colleges and improve their quality.
The aspirations of an emergent India introduce an urgency to manage medical systems optimally. The commission will have to broaden the horizon, engage in proactive dialogue with all stakeholders and take informed decisions. Medical education has to keep pace with these rapid developments. The NMC Act is not a matter of choice, but an imperative in the national interest.