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.
Medical interventions and health technology are in a phase of rapid metamorphosis globally.
The benefits of rapid scientific developments, technological advancements, and improved and targeted interventions in the health sector have changed the lives of millions.
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.
In this article, the relevance, provisions and the implications of this act for the future of medical education and health practice in the country are examined.
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.
This move will broaden the opportunity for students from all sections of the society to undertake medical education.
This democratisation of medical education is important since it is growing more expensive with every passing year. The rising fees, expensive books and equipment become a barrier for several deserving students.
Social responsibility and empathy for fellow humans are vital traits for any doctor. The presence (or absence) of a paying capacity should not be a determinant for enrolling in an educational programme.
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.
NMC bill have to provide the statutory force to the reforms:
As per the Ministry of Health and Family Welfare (MOHFW), this is an inclusive step with wide ramifications.
The provision of this clause and the percentage can be tweaked in the future to adjust with evolving needs and social realities of the country in the coming decades.
There is no question of NMC bill making medical education a preserve of the rich.
On the contrary, it is common knowledge that before the reforms of NEET and common counselling were introduced by our government, 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.
Reforming Medical Education:
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.
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 professional’s council (AHPC) in the country.
Need to address the overall shortfall in the number of medical doctors:
The thrust on medical education is an essential part of the act. But, other pieces are also necessary to complete the picture.
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.
Active planning for addressing the human resources needs of the future will have to be carried out.
The reactive approach has to be gradually replaced by a proactive approach to plug gaps in numbers and their availability and distribution.
India’s progress towards Development Goals:
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).
Good health is interconnected with development (WHO 2019a). The achievement of the third SDG in India will need well-functioning health systems that work towards assuring universal health coverage.
In this context, the NMC Act is consciously contributing to medical education to channelize the supply-side to meet the future requirements.
The governance reforms at the heart of the act can also be interpreted to be supportive of the country’s intentions in achieving the SDGs.
The future of medical education and practice rests within the frameworks of the NMC Act.
The commission will have to broaden the horizon, engage in proactive dialogue with all stakeholders and take decisions with agility.
The act has been written in the right spirit, addressing the concerns of the present while preparing for the future.
Appropriate structures specified by the act will have to interpret the act, implement its provisions, and monitor the impacts.
The aspirations of an emergent India introduce an urgency to manage medical systems optimally.
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.