Padma Prakash: Bitter pill

MOOT POINT

This session of Parliament has seen the tabling of several pieces of legislation directed at reorganising the various bodies regulating medical education in allopathic, homeopathy, and Indian medicine.

Of these, the Medical Council of India (Amendment) Bill, introduced in the Rajya Sabha by the health minister last week, will perhaps cause the sharpest reactions.

The Bill aims to reorganise the composition of the Council and rewrite the rules of constitution of the board of members. In doing so, it shifts control of the functioning of the MCI slightly towards the government.

Expectedly, the Indian Medical Association has promptly opposed the new Bill maintaining that this will "curb the autonomy of the Council". Some of the state branches have demanded that the Bill be withdrawn, contending increasing the proportion of government nominees would enable the central ministry to remove elected members at will.

There may be some justification for the medical profession to fear increased state control, but it may be that it is being forced to swallow bitter medicine because the disease has resisted other remedies. Take a look at what has been happening to the Council and its functioning.

The MCI is a statutory body established under the Indian Medical Council Act, 1956, constituted to regulate and monitor the standard of medical education. The Council is charged with giving permission for starting new colleges and for withdrawing recognition, and to act as a watchdog for maintaining standards.

It currently comprises one member of the medical faculty from each university and one from each state, and seven members are elected from among registered medical practitioners.

One member is nominated from each state by the central government and eight others directly from the Centre. In sum, the MCI has a broadbased representation. Or at least it should have, if the processes of constitution of members are followed efficiently.

However, the parliamentary committee's 133rd Report on Medical Education reported that up to June 2001, of the total MCI membership of 113, only 77 had been filled. Of the vacancies, 35 are from the elected category and 21 of these are for seats reserved for universities.

The reasons given for vacancies are most peculiar, viz. non-constitution of senates/courts of the universities or because the meetings of the senate/court have not been held. Some of these vacancies are more than 15 years old. Another reason for this non-compliance is, the committee discovered, more complicated.

A number of universities now come under the newly created "Health Universities", because of which they have lost their right to be represented on the Council!

Health universities apparently have no Senate, and so they cannot send representatives to the Council. So as many as 21 universities, with a large number of medical colleges, especially in the southern and western states, where the concept of Health university has taken root quite effectively, have no representation in the decision-making apex body on medical education. And here's something even more interesting: it only requires 15 members to constitute a quorum for meetings of the MCI.

There is of course another reading of this situation, which is that the decisions of the MCI have little or no impact or importance really. And this is why it really does not matter whether the process of constituting the council has been completed or not.

Several issues with regard to the MCI have been hanging fire for a long time. For instance, colleges denied recognition by the MCI continue to function, the apex body's decision having been overridden by either the state or the central government or the local university. A case in point is BRD Medical College in Gorakhpur.

The MCI inspected the college in 1995, took three years to communicate to the state its decision to withdraw recognition to the college in 1998, and until 2001 there had been no move to close the college.

The parliamentary committee had pointed to the urgent need for regional councils for monitoring the 183-odd medical colleges, because the state medial councils, autonomous bodies established by state governments, had no authority over or responsibility for the maintenance of standards of medical education in the state.

This would, in fact, not only make for greater efficiency but for a broader base of authority that might make the autonomous institution more sensitive to external agencies, such as the health movement, demanding better regulation.

Medical education, of all the branches of professional education, is most mired in a mess of too many authorities. And because the stakes are so high, none of the authorities is willing to give up control. The unfortunate outcome of this situation is that most decisions having to do with medical education are being decided in courts.

Is the answer lumbering the state with direct quality monitoring of professional education? Is it equipped to undertake this task and be responsive to the rapid changes that are taking place in medical education the world over? Would it not be better to strengthen autonomous structures, but through legislative support and other resources, and ensure that principles of equity are not sacrificed?