Amid apprehensions that clause 32 in the National Medical Commission (NMC) Bill will encourage quackery, the health ministry on 6th August said it was a provision to grant a limited licence to those who qualified the criteria as might be specified by regulations "only in primary and preventive healthcare to practise medicine at the mid-level".


Along with other provisions, the medical fraternity is opposing sections 32(1), (2) and (3) of the bill, saying it will encourage quackery by providing licence to practise modern medicine as community health providers to those who do no possess the MBBS degree. The ministry cited examples of health systems in countries such as Thailand, the United Kingdom and China, which have involved community health workers and nurses in mainstream health services with improved health outcomes.

"Since we have a shortage of doctors and specialists, the task of shifting to mid-level providers will relieve the overburdened specialists," the ministry said in "FAQs" on its website. "This is merely an enabling provision to grant limited licence only in primary and preventive healthcare to practise medicine at the mid-level to such persons, who qualify such criteria as may be specified by regulations which will have an overwhelming representation of doctors," the ministry said. It further said Chhattisgarh and Assam had experimented with community health workers.

"As per independent evaluations (carried out by the Harvard School of Public Health), they have performed very well and there is no ground of concern if the quality of personnel is regulated tightly," it said. Seeking to address the unclarity over the introduction of NEXT, which will be a common final-year MBBS exam held across all private and government medical colleges, the ministry said the enabling provision was made to ensure common standards.

Regulations for operationalising NEXT would be made in due course, keeping in mind the importance of both the theoretical as well as clinical skill sets required at the undergraduate level, it clarified, adding that there was a three-year window before NEXT became operational, leaving ample scope for detailed negotiations on the contours of the exam. "Composition of NMC includes 75 per cent doctors representing central and state institutions or councils and health universities. Such a composition of NMC will ensure that due weightage to theoretical as well as clinical skill sets is adhered to," the FAQs stated.

The ministry also dismissed the allegations in reference to clause 10(1)(i) of the bill, which deals with regulation of fees, that medical education will become expensive, saying before the reforms of NEET and common counselling were introduced, rich students who could afford to pay huge and unrecorded capitation fees were able to secure admission to private medical colleges.

"Our 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," the ministry said. "Nearly 50 per cent of the total MBBS seats in the country are in government colleges, which have nominal fees. Of the remaining seats, 50 per cent would be regulated by NMC. This means that almost 75 per cent of the total seats in the country would be available at reasonable fees," it explained.

In the spirit of federalism, the state governments would still have the liberty to decide on the fees for the remaining seats in private medical colleges on the basis of individual MoUs signed with the colleges. "We need to balance the interests of the poor but meritorious students and the promoters of private medical colleges in order to expand the number of seats on offer. It is not correct to assume that colleges would be free to arbitrarily raise the fees for unregulated seats.

"The transparency provided by NEXT results would lead to regulation of fees through market forces. Colleges would have to provide quality of education commensurate to the fees charged by them, otherwise there would be no takers for their management quota seats," it said. The rating for medical institutions would be provided by MARB on the basis of the standard of education. This will serve to regulate the fee through market forces.

The IMC Act, 1956 has no provision for regulation of fees. As a result, some states regulate the fees of some seats in private colleges through MoUs signed with the college managements. In addition, the Supreme Court has set up committees chaired by retired high court judges to fix fees in private colleges as an interim measure.

Deemed universities claim that they are not covered by these committees. India has a doctor-population ratio of 1:1456 as compared to the WHO standards of 1:1000. "It will take seven-eight years to ramp up the supply of doctors, therefore, in the interim, we have no option but to rely upon a cadre of specially trained mid-level providers, who can lead the health and wellness centres," the ministry said. The Indian Medical Association (IMA) has given a strike call on August 8 to protest against certain provisions of the NMC Bill.

It said medical students would continue with their strike across the country under the IMA Medical Students Network.