Is this the tipping point?

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Trading in medical education has to stop. The arrest of the Medical Council of India president on charges of bribery could just be the tipping point to precipitate long overdue change. Merging the best from two existing Bills may be a starting point to bring about this change

The murky deals involving the president of the Medical Council of India might look like piffle compared to the IPL imbroglio. But despite being an insignificant side show, the MCI scam is far more worrisome because the MCI is responsible for administering and enforcing standards of medical education for the entire country. So if the president of such an organisation is embroiled in a bribery and extortion racket involving a medical college, it questions the degree to which standards are at all being met by other colleges. The quality of the products of such a wayward system will ultimately impact upon individual health and safety. The absence of a trustworthy oversight body is a matter for grave concern.

On paper the MCI is a truly representative body with the bulk of its members elected from the medical faculty of every State and every university. Added to this long list of nearly 100 elected council members, there are another 40 representatives nominated either by the State Governments or by the Union Government. If one cannot trust such a democratically established body set up by an Act of Parliament, who then can we trust?

First a little history. For decades after it was set up, the MCI performed a limited role — to register medical practitioners and to lay down standards for a handful of medical colleges, mostly in the Government sector. Up to 1992 the requirements for setting up of medical college were simple. The MCI was an elite body that invariably advocated against setting up more medical colleges. Some Chief Ministers, notably Janardhan Reddy of Andhra Pradesh cocked-a-snook at such prescriptions and permitted new medical colleges to start in his State. This incensed then Prime Minister PV Narasimha Rao so much that he had an Ordinance issued; overnight the Union Government assumed authority to permit new medical colleges to be established, to open a new courses of study or to increase the intake of students. But — and this is extremely important — only by acting on the recommendation of the Medical Council of India.

The Ordinance became law but nothing was done to alter the structure of the council to fulfill its new responsibilities. In 1999 new regulations were notified which set out all the requirements that a medical college needed to fulfill to come into being, to diversify its courses and increase intake. These requirements call for the injection of an extraordinary amount of resources (Rs 500 crore) while constantly running the risk of rejection at inception or midstream. Only the rich and powerful dare try.

There are now 300 colleges in the country with an annual intake (all levels) of more than 50,000 students. More than half are in the private sector. The latest annual report on the council’s website, shows that in two years about 180 letters of intent were issued but an equal number failed to secure MCI’s recommendation. The council recommended 30 new colleges but more than half that number was turned down. While the continuance of recognition was recommended in four cases, five times that number was recommended for rejection. Detractors say that unrealistic conditions have been prescribed, leaving the ground clear for quid pro quos and barter.

Supporters of the MCI say that the council runs through independent committees whose deliberations are transparent and available for scrutiny; and the president does not direct the show. Critics say that MCI’s committees are run by cartels carved from grateful elected representatives who do as they are told. MCI’s inspectors are briefed in advance where to say “yes”, “no” and “if”. Handpicked committees just stamp their reports.

And in this entire where does the fount of all authority, the Union Government feature? For the most part it does not. In the fullness of time when MCI’s recommendations reach the Ministry of Health and Family Welfare, the cases can be returned with comments or questions; clarifications can be sought; but the Government cannot overrule the council or convert a case of acceptance into rejection and vice versa.

Should such a situation just be allowed to continue in the name of self-rule conferred by a 1956 Act? Medical education is on the concurrent list of the Constitution. It is serious business — even of wrong medication if not life and death. In 2005 a Bill was prepared called the Indian Medical Council (Amendment) Bill, 2005 which sought to modify the composition of the MCI by drastically reducing the elected element. The 2009 National Council for Human Resources in Health draft Bill went a step further by proposing the replacement of all health councils with a largely professional bureaucracy to perform those functions.

There can be no ideal answer but a business as usual approach cannot go on; trading in medical education has to stop. Merging the best from the two Bills may be a starting point and the arrest of the president of the MCI could just be the tipping point to precipitate a change — long overdue. But only if the voice of reason, not the powerful that run private medical colleges is heeded.

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