1

Department of Civics and Politics

M. A. (Hons.) Politics: Part II – Semester III

National Medical Commission Act: A

Subject: Development and Public Policy (with special reference to India)

Guide: Dr. Sanhita Joshi

Submitted by: Sadifa Naaz

Roll no.: 18087

Table of Content

 Introduction …3

 Hypothesis …4

 Objective …4

 Methodology …4

 Research Findings …4

 Suggestions/ Conclusion …9

 Reference …10
 3

Introduction

The National Medical Commission (NMC) Bill, 2019 was passed in the Rajya Sabha on 8 th
August 2019 which has annulled the Indian Medical Council act, 1956 and replaced the
Medical Council of India (MCI). The bill has been introduced in the wake of corruption
allegations against the 63-year-old MCI. It further aims at providing an education system
which would produce high quality individuals to cater the rising needs of the nation in the
health sector.

As the opening sentence of the bill reads:

to provide for a medical education system that improves access to quality and affordable medical
education, ensures availability of adequate and high quality medical professionals in all parts of
the country; that promotes equitable and universal healthcare that encourages community health
perspective and makes services of medical professionals accessible to all the citizens; that
promotes national health goals; that encourages medical professionals to adopt latest medical
research in their work and to contribute to research; that has an objective periodic and
transparent assessment of medical institutions and facilitates maintenance of a medical register
for India and enforces high ethical standards in all aspects of medical services; that is flexible to
adapt to changing needs and has an effective grievance redressal mechanism and for matters
connected therewith or incidental thereto.1

According to the bill the central government would create a 25-member committee which
would consist 1 chairperson, 10 ex-officio and 14 part-time members. The commission would
have four major boards, namely, Under-Graduate Medical Education Board, Post-Graduate
Medical Education Board, Medical Assessment and Rating Board, and Ethics and Medical
Registration Board. It would also be regulating fee structure and all other charges for 50% of
seats in private and deemed universities as well.

Further the bill has combined the third profession MBBS examination and the NEET-PG
exam into one single National Exit Test (NEXT). The same is applicable for foreign students
as well. This exam would provide students their license, MBBS degree and entrance into PG
courses.

It also aims at addressing the issue of shortage of doctors. Section 32 of the NMC bill grants
limited license to mid-level practitioners, who relate to modern scientific medical profession,
to practice medicine as Community health provider, however their number should not exceed
1/3rd of the existing allopathic doctors. They are only allowed to prescribe specific medicines
independently at primary and preventive healthcare centres or otherwise under the
supervision of a medical practitioner registered under sub section (1) of section 32.2

The bill has also made provisions regarding quackery which has become very prevalent in
medical field. It has increased the punishment for personnel found involved in quackery.
According to the bill in section 34, ‘Any person who contravenes any of the provisions of this
section shall be punished with imprisonment for a term which may extend to one year, or
with fine which may extend to five lakh rupees or with both’.3

1
Gazette of India, (August 08, 2019), The National Medical Commission Act, 2019 No.30 of 2019,
http://egazette.nic.in/WriteReadData/2019/210357.pdf
2
Gazette of India, (August 08, 2019), The National Medical Commission Act, 2019 No.30 of 2019,
http://egazette.nic.in/WriteReadData/2019/210357.pdf
3
Gazette of India, (August 08, 2019), The National Medical Commission Act, 2019 No.30 of 2019,
http://egazette.nic.in/WriteReadData/2019/210357.pdf
 4

Hypothesis
The paper is based on following Hypothesis:
To study the implication of the recently developed NMC Act which aims at transforming
Medical Education in India, as well as improvising the doctor-patient ratio.
Objective
 To study the provisions of the bill which are mainly contested by IMA.
 To study Section 32 of the bill which allows mid-level practitioners to practice modern
medicine at PHC centers and its effect in health sector at grassroot level.
Methodology
This study is based on data analysis. The NMC act has been used as the basis for the study.
References have also been taken from the official statements published by the IMA, MCI and
the Union Minister of Health & Family Welfare.
News articles which have covered the issues has also been used as a source of information.
Research Findings
Since the introduction of the bill in the parliament (December 2017), medical associations
across nation have been protesting it, as they feel that many provisions in the bill are unjust
for doctors who are either pursuing modern medicine or practicing it. Many opinions and
articles have flooded-in along with simultaneous protest which is still going on even after the
bill has been passed in the parliament. There have been mixed reviews about the bill. Many
Articles have been written against the bill because the government passed it despite
thousands of doctors still protesting, as well as in favor of the bill given the current scenario
of the medical sector in India.
The bill is regarded as a milestone in medical education. Dr. Harsh Vardhan, Union Minister
of Health & Family Welfare, issued press note regarding various provisions that have been
constantly contested. He quotes:
“The Medical Council of India (MCI) had failed in almost all spheres and had become a
highly corrupt and ineffective body. It recommended that independent regulators
selected through a transparent process should replace thee elected regulators. The
National Medical Commission (NMC) seeks to achieve this, by having eminent medical
personalities who will be appointed for only one term of four years. They will not be
eligible for any further extension. To ensure probity and integrity of the highest order,
they will have to declare their assets at the time of being appointed and again while
demitting office”.4
 Structure of NMC
To begin with, the very structure of NMC is questioned by the IMA. As per the press-note
released by Union Minister of Health & Family Welfare (UMHFW), Dr Harsh Vardhan
quoted, “There are some apprehensions about NMC being dominated by central government
nominees. This is not true. There will be 10 Vice Chancellors of State Health Universities
and 9 elected members of State Medical Councils in the NMC. Thus 19 out of 33 members,

4
Press Information Bureau, Government of India, Ministry of Health and Family Welfare
https://pib.gov.in/newsite/PrintRelease.aspx?relid=192533
 5

which is more than half of the total strength, would be from the States and only a minority of
members will be appointed by the central government thereby ensuring that the NMC is
representative, inclusive and respecting the federal structure of Indian polity”.5 However to
its contrary Dr Santanu Sen pointed out on the floor of the Rajya Sabha on 1 st August “…25
members of National Medical Commission, 21 are doctors. Yes, I do admit 21 are doctors but
all of them are Central Government employees. Can you expect a Central Government
employee to say something against the desire of the Government of India?”. 6 Further the
requirement for selection of its members is not restricted only to medical qualifications,
which is seen is a loophole to let the centre and bureaucrats overpower the board and restricts
the sovereignty of the medical board.
Further, he categorized the bill as anti-federal because firstly, the Bill completely outrages
federalism as explained in the Constitution of India. Among the 14 part-time members, 3
would be on non-rotational basis and 11 on rotational basis. In the rotational category, 6 part-
time members would be from the members of States and Union Territories, who are members
of the Medical Advisory Council, and 5 would be from the nominees of the State and Union
Territories who are nominated from the elected State Council members. And the terms of the
rotational part-time members are for 2 years and of the non-rotational members, 4 years.
Hence, if one State gets represented this year, it will remain unrepresented for the next 12
years in the case of State nominees, and for 14 years in the case of State Council nominees
contrary to the previous system where every year every State used to get three
representations.7
 Regulation of 50% of Seats
Secondly, as the commission would be regulating 50% of the seats in private colleges and
deemed universities, however, it does not clarify the stance of the other 50% seats which can
be used to exploit students. In 2014, the unregulated and prohibitive capitation fee in private
medical colleges was contested in the Supreme Court. In July 2018, the apex court ordered
the formation of a committee that would provide an appropriate fee structure to private
colleges. After this, state governments formed committees and decided upper limits to their
tuition fees. This helped in regulating 80-100% seats in private colleges.
This however cannot be challenged totally as there was no provision to regulate fees in the
Indian Medical Council Act 1956 to begin with which resulted in States signing MOUs with
medical colleges at the time of granting Essentiality Certificate and thereby gain a handle to
regulate fees of state quota seats. Hence, in each state committees were formed, chaired by
retired High Court judges, which decided only the fees and not other charges levied by
private colleges. Deemed to be Universities refused to submit before this committee and
remained virtually unregulated. Hence, under the new act 50% of the seats would be
regulated by the commission and rest 50% would be regulated as per the SC decision by
signing MoU between State government and private universities.
However, the question arises regarding the regulation of the 50% seats by the commission, as
it might turn unfair for students who would be applying under general quota, considering the
5
Press Information Bureau, Government of India, Ministry of Health and Family Welfare
https://pib.gov.in/newsite/PrintRelease.aspx?relid=192533

6
Text of maiden speech of Dr.Santanu Sen (on NMC Bill) in Rajya Sabha on 01-08-2019 http://www.ima-india.org/ima/dr-
santanu-maiden-speech-nmc-rajya-sabha-01082019.php

7
Text of maiden speech of Dr.Santanu Sen (on NMC Bill) in Rajya Sabha on 01-08-2019 http://www.ima-india.org/ima/dr-
santanu-maiden-speech-nmc-rajya-sabha-01082019.php
 6

fact that there is reservation of seats for SC/ST and OBC, hence, only few seats would be left
for the disposal of general quota students to reap its benefits. If not, then it can turn into a
great opportunity for students who get average marks and desire to study in private colleges.
Further, one of the pressing developments that has emerged is the fee hike in various
prominent government institution such as JNU, IITs etc. which puts it in bad light, given the
same government would be determining the fee structure for all medical colleges, if not fro
100% of seats in all cases.
 National Eligibility cum-Entrance Test and EXIT exam
Next, there is provision for National Eligibility cum-Entrance Test and EXIT examination.
There shall be a uniform National Eligibility-cum-Entrance Test for admission to the
undergraduate and postgraduate super-speciality medical education in all medical institutions
which are governed by the provisions of the Act.
There would be common counselling for entrance to UG as well as PG courses. Students will
be able to get admission to seats in all medical colleges and to Institutes of National
importance like AIIMS, PGI Chandigarh and JIPMER through a single counselling process.
All medical colleges would be graded under one scale based on their performance by the
Medical Assessment and Rating Board, hence making it easier for students to choose colleges
without much hassle.
However, the concept of EXIT examination is opposed as it would be burdening the final
year students and is said to be overlooking the importance of merit required for entering PG
program. But the centre claims that students would be able to concentrate on internship
instead of spending all their time preparing for NEET PG and thus the load on students will
be greatly reduced. It is also suggested that this move would end the role of coaching centres
that work as mediator for students to prepare for PG exams.
But the examination format is still under scrutiny as the current NEET-PG paper pattern is
based on MCQ format, hence, it raises question regarding the EXIT exam pattern as well.
Because the act does not specify the paper pattern yet, it is doubted whether the students
would be given their license to practice medicine based on MCQs type questions? The
standing committee recommendation states that the final year exam should be held in a way
that it considers the students’ cognitive domain and assesses their skills. It roots for “case
study type questions” that will help them in the long run. However, it is unlikely that case
study type questions will be converted into MCQs.8. Then, anonymity regarding the syllabus
of the exam is also to be examined whether it would include only final year syllabus, or the
syllabus of all four years. Hence this also remains contested as this provision is made to ease
students’ burden, however if they must prepare for examination combining the syllabus of all
years, it can impact the overall performance as that would be in any way unfair for them.
The Act does not impose any restriction on the number of attempts at NEXT examination.
The same examination will also serve as licentiate exam for foreign graduates as well.
 Section 32 (Community Health Provider)

8
Kaur, B., Kukreti, I., Pandey, K., Jitender, Down To Earth, (August 22, 2019), Debate around NMC Act highlights
problems rankling technical education institutes, retrieved from: http://www.downtoearth.org.in/news/governence/debate-
around-nmc-act-highlights-problems-rankling-technical-education-institutes-66196
 7

Among some of the initial reasons for opposing the bill were regarding the provision made
for a 3-6-month bridge course which would enable AYUSH (Ayurvedic, Yoga and
Naturopathy, Unani, Siddha, Homeopathy) practitioners to get equal status as doctors without
undergoing the rigorous training that they have to go through. However, in the NMC act,
2019, the clause for AYUSH practitioner as well as the bridge course was removed. But
another provision gave mid-level practitioners who are associated with modern medicine the
license to prescribe medicine in PHC centers, which is again contested by doctors for similar
reasons as they feel that this would result in legalising quackery which is already a malice in
medical sector.
Dr Harsh Vardhan stated that: “We are looking at universal health coverage and more
importantly, universal screening of our population for non-communicable diseases in the
years to come. This requires a large number of health professionals. Doctors are a scarce
resource in our country and need to be optimally utilized. They are indispensable for
secondary and tertiary care; the only area where other health professionals can supplement
them is preventive and primary healthcare”.9
As per WHO report the doctor patient ratio in India is 1:1456 against the 1:1000 as
recommended by WHO10. This shows that there is a need of approximately 600,000 doctors
to fill in the gap. To tackle this deficit in shortest time possible, the bill allows personnel
associated to modern medicine to act as facilitators in PHC centers. And as demanded by the
doctors, the AYUSH practitioners were removed from its ambit as it would have also
jeopardized their own acts which regulates them.
It has clarified that eminent doctors in NMC would decide their qualifications through
regulations which shall be finalized after extensive public consultation and debate. Also,
those who will be getting license under this section would only be related to modern
medicine and shall not be dealing with any alternative system of medicine.
“A false impression is being created that the provision for CHPs has been made to legalize
quacks. Nothing can be farther from the truth. On the contrary, the punishment for quackery
has been enhanced to upto one-year imprisonment and upto Rs 5 lakhs fine. Most of the so-
called quacks in the country do not possess any qualifications and would not be able to meet
the conditions that will be set by NMC for becoming a CHP”, Dr Harsh Vardhan explained.
 Condition of Medical sector at grassroot level
Statistics show there is shortage of doctors which needs to be addressed. “There is a huge
skew in the distribution of doctors working in the urban and rural areas. Consequently, most
of our rural and poor population is denied good quality care, leaving them in the clutches of
quacks,” As quoted by Dr Harsh Vardhan.
According to government records, a total of 11,46,044 allopathic doctors were registered with
the State Medical Councils/ Medical Council of India as on December 31, 2018. Further, one
of the WHO report based on the 2001 census shows that barely 20% of those who practiced

9
Press Information Bureau, Government of India, Ministry of Health and Family Welfare
https://pib.gov.in/newsite/PrintRelease.aspx?relid=192533

10
Economic Times, by PTI, (April 14, 2019), India facing shortage of 600,000 doctors, 2 million nurses: Study retrieved
from: https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-facing-shortage-of-600000-
doctors-2-million-nurses-study/articleshow/68875822.cms
 8

medicine in rural India had any medical qualification. It also estimated that 31% of those who
claimed to be allopathic practitioner were educated only up to class 12th.11
It is not new that in rural India people generally don’t have access to doctors, let alone quality
doctors. The news regarding empty PHC centers left under the supervision of the associate
staff, namely nurses, mid-wives or compounders is very common. Under such circumstances
wherein qualified doctors are not willing to work in such areas, the encroachment of this post
by quacks is not something that is evitable. At the time of emergency, these helpless and
ignored masses ultimately restore to anyone who can provide them solution.
A normal PHC center does not just end with a doctor prescribing few medicines to day to day
patients. As the bill is not very clear about the CHP’s overall jurisdiction on the prescription
of medicine as well as usage of license as a doctor, many objections were raised regarding the
same.
“Such a person may prescribe medicine in secondary and tertiary care hospitals under a
person of same qualification. This means that “such" a person who is “connected" to modern
medicine can practice as a General Practitioner anywhere in India both urban and rural. S/He
will be independent. S/He can be employed in emergencies, critical care, neonatal ICUs,
Labor rooms operation theatres, ICUs inpatient wards and OPDs under similarly qualified
persons providing cheap labor for the corporate hospitals,” said R V Asokan, secretary
general, IMA.12
Hence, defining their area of work is very crucial. According to the bill, under section 31 (8)
it says that a separate registry would be maintain for CHP, but how the distinction would be
made visible to normal people is still in question. It is necessary that even after these CHP’s
are entrusted with the responsibility of PHC centers, the distinction between a regular doctor
and CHP should be visible, otherwise it would be unfair for doctors and the CHP’s can
misuse the anonymity created.
As mentioned earlier that along with the clause allowing AYUSH the same status, the clause
for bridge course was also removed in the newly introduce Act. But in order to let the CHP’s
work independently in PHC centers, it is necessary that they undergo some amount of
training before practicing. This clause was added on the foundation that there are
international examples of Health Systems permitting such Community Health workers.
Countries such as Thailand, United Kingdom, China, and even New York have permitted
Community Health Workers/Nurse Practitioners into mainstream health services, with
improved health outcomes. Since we have shortage of doctors and specialists, the task
shifting to Mid- level Provider will relieve the overburdened specialists. This is merely an
enabling provision to grant limited license only in primary and preventive healthcare to
practice medicine at mid-level to such persons, who qualify such criteria as may be specified
by regulations which will have an overwhelming representation of Doctors. Chhattisgarh and
Assam have experimented with the Community Health Workers. As per independent

11
Perappadan, Bindu Shajan, The Hindu, (August 14, 29019) 57.3% allopathic practitioners are not qualified: Health
Ministry, retrieved from: https://www.thehindu.com/sci-tech/health/573-allopathic-practitioners-are-not-qualified-health-
ministry/article29086684.ece
12
Sharma, Neetu Chandra, Livemint (August 01, 2019), Why is the Medical Fraternity opposing the National Medical
Commission Bill?, retrieved from: http://www.google.com/amp/s/www.livemint.com/news/india/why-is-medical-fraternity-
opposing-the-national-medical-commission-bill-2019/amp-1564638843794.html
 9

evaluations (carried out by 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.13
However, it is noteworthy under the Assam Rural Health Regulatory Act, Rural health
providers (RHP’s) were given trained under a three year course namely Diploma in Medicine
and Rural Health Care (D.M.R.H.C.) and only for public health services and primary health
care at village level and complement the efforts of the first health worker - the Auxiliary
Nurse Midwife.
These RHPs were delegated with the following responsibilities: attend OPD and emergency
cases; treatment of minor illnesses/non-communicable diseases; conduct ANC/PNCs and
identify and refer high risk pregnancies; management of LBW newborns; counseling of
mothers on best MCH practices; Routine Immunization and Family Planning.14
Hence, the objective and function of these health providers was clearly demarcated. Plus,
they were been accesses by independent body. Therefore, to make sure that the authority
delegated is not misused and is devolve in good faith is necessary.
Suggestions/ Conclusion
As the bill has already been converted into an act and the selection board has already started
working on the formation of the committee, it is wise that instead of protesting against the
act, the Medical Fraternity should start working on making it a better, more reliable one.
If one would go through the Act that, it is evident that there is a lot of scope for new additions
and improvisation as most of the clauses in the act are not yet specified. It is now
responsibility of the policy makers as well as the medical community to shape the entire act
that can turn into a milestone in times to come.
First of all, regarding the structure of the commission. The point raised by Dr Santanu Sen is
valid as the selection of the 21 members who would hail from medical backdrop will be form
government institution. There should be some mechanism to allow eminent private institution
doctors as well to be the part of the commission as they would work as a levelling field.
Further, regarding the issue of representation, more flexibility should be inculcated as it
would result in marginalization of states and their need for years.
Then, as far as regulation of fee for private institution is concern, a lot of thought must go
into its implementation as there is a very fine line when the entire system can just end up
becoming a profit-making mechanism as already been accused. It is necessary to ensure that
the seats which would be regulated should not sideline general students due to reservation for
SC/ST and OBC. There are many students who score good marks in NEET-UG examination,
however, due to huge amounts demanded by private institution, end up compromising on
their future. If planned rationally this can really help economically backward students to get
quality education. Or, the government should work on converting government institutions
into state of art facilities that would benefit both, students and patients who seek benefit from
these institutions.

13
FAQs on National Medical Commission (NMC) Bill 2019, retrieved from: https://pib.gov.in/newsite/PrintRelease.aspx?
relid=192491
14
Lisam, Suchitra, NHSRC, Rural Health Practitioners in Assam - Mid Level Care Provider, retrieved from:
http://nhsrcindia.org/sites/default/files/Rural%20Health%20Practitioners%20in%20Assam%20-%20Mid%20Level%20Care
%20Provider.pdf
 10

Regarding the National Eligibility cum-Entrance Test and EXIT examination, the exam
pattern must be very precisely curated as future of students will depend on it. There should be
a mix of subjective as well as objective questions as it aims at reviewing their cognitive skill
as well. Combining the exam would lessen the burden for the students to some extent,
however, it totally depends on the syllabus that would be used for assessing EXIT exam.
Keeping the syllabus of the entire degree would be inhuman, but not evaluating them based
on all the subject would have negative impact as students would not give importance to those
subjects which would be left out. Hence, the policy framers need to curate the syllabus
carefully to make it holistic yet subtle.
Moving on to the relation between NMC and rural health, the implementation of Section 32
would require a lot of transparency and accountability on both the sides. The parameters for
selection and license granting should be strict and meticulously planned so that only capable
CHP are able to clear it. It puts a lot on stake as this can resulting in legalizing quackery if
not monitored carefully. From the selection to their practicing, everything would require
regular auditing.
Reference
1. Dr. Harsh Vardhan hails the NMC Act 2019 as historic, path-breaking and a game-
changer, retrieved from:
https://pib.gov.in/newsite/PrintRelease.aspx?relid=192533
2. Economic Times, by ET online, (August 08, 2019), National Medical Commission
bill passes Rajya Sabha test; healthcare on verge of landmark changes, retrieved
from:
http://www.google.com/amp/s/m.economictimes.com/news/economy/policy/national-
medical-commission-bill-passes-rajya-sabha-test-healthcare-on-verge-of-landmark-
changes/amp_artcleshow/70483570.cms
3. Economic Times, by PTI, (April 14, 2019), India facing shortage of 600,000 doctors,
2 million nurses: Study retrieved from:
https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-facing-
shortage-of-600000-doctors-2-million-nurses-study/articleshow/68875822.cms
4. FAQs on National Medical Commission (NMC) Bill 2019, retrieved from:
https://pib.gov.in/newsite/PrintRelease.aspx?relid=192491
5. Gazette of India, (August 08, 2019), The National Medical Commission Act, 2019
No.30 of 2019, retrieved from:
http://egazette.nic.in/WriteReadData/2019/210357.pdf
6. Kaur, B., Kukreti, I., Pandey, K., Jitender, Down To Earth, (August 22, 2019),
Debate around NMC Act highlights problems rankling technical education institutes,
retrieved from:
http://www.downtoearth.org.in/news/governence/debate-around-nmc-act-highlights-
problems-rankling-technical-education-institutes-66196
7. Lisam, Suchitra, NHSRC, Rural Health Practitioners in Assam - Mid Level Care
Provider, retrieved from:
 11

http://nhsrcindia.org/sites/default/files/Rural%20Health%20Practitioners%20in%20Assam
%20-%20Mid%20Level%20Care%20Provider.pdf
8. Mairembam, Dillip Singh, National Health Systems Resource Centre (NHSRC),
Rural Health Practitioners - Augmenting Sub Center Service delivery in Assam,
retrieved from
http://www.cips.org.in/documents/2014/23rd_June/Dr._Dillip_Singh_Mairembam.pdf&ved=
2ahUKEwjI6oftldjIAhUIKo8KHalaCDQFjABegQIARA&usg=AOvVaw3PgZg6qiFn2E9kjY
y9Q2L5
9. Perappadan, Bindu Shajan, The Hindu, (August 14, 29019) 57.3% allopathic
practitioners are not qualified: Health Ministry, retrieved from:
https://www.thehindu.com/sci-tech/health/573-allopathic-practitioners-are-not-qualified-
health-ministry/article29086684.ece
10. Sharma, Neetu Chandra, Livemint (August 01, 2019), Why is the Medical Fraternity
opposing the National Medical Commission Bill?, retrieved from:
http://www.google.com/amp/s/www.livemint.com/news/india/why-is-medical-fraternity-
opposing-the-national-medical-commission-bill-2019/amp-1564638843794.html
11. Text of maiden speech of Dr.Santanu Sen (on NMC Bill) in Rajya Sabha on 01-08-
2019, retrieved from:
http://www.ima-india.org/ima/dr-santanu-maiden-speech-nmc-rajya-sabha-01082019.php