Bitter pill: Members of the West Bengal chapter of the Indian Medical Association protest against the NCHRH Bill

The chorus against the National Commission for Human Resources for Health Bill (NCHRH), 2011, seems to be growing louder. In addition to the medical organisations that had been agitating against the bill ever since it was introduced in Parliament last year, some non-Congress political parties too are questioning what the proposed legislation actually intends to achieve.

Medical professionals, on the other hand, are divided on provisions of the bill pertaining to strictures on practising in the country after completing higher medical studies abroad.

Essentially, the NCHRH Bill proposes creating an overarching regulatory national commission to oversee medical education in the country. It seeks to repeal the Indian Nursing Council Act, 1947, the Pharmacy Act, 1948, the Dentists Act, 1948, and the Indian Medical Council Act, 1956. In other words, existing councils such as the Dental Council of India, the Nursing Council of India and the Medical Council of India (MCI) will be subsumed under the commission.

The MCI was dissolved in 2010 after its then president Ketan Desai was arrested on corruption charges. It is believed that the Health Resource Bill was conceived in the wake of the public uproar over the irregularities in the MCI.

However, bodies like the Indian Medical Association (IMA) and some political parties feel that subsuming independent entities like the MCI can only lead to a greater degree of “centralisation” while the ostensible reason for putting forth the NCHRH Bill is “decentralisation”. In fact, Trinamul MPs voiced this concern during the ongoing Lok Sabha session. Earlier this year, Tamil Nadu chief minister J. Jayalalithaa too had expressed reservations about the bill.

The IMA fears that since the members of the national commission will be hand-picked by the Centre, the body can end up being an “autocratic” organisation. “The states will have little say in medical education matters, if we go by the bill,” says Dr R.D. Dubey, president of the West Bengal chapter of the IMA.

But the controversy over the bill doesn’t end there. A couple of its critical provisions are being hotly debated in the medical fraternity. For example, according to Section 59 of the bill, any person who has pursued undergraduate, postgraduate, doctoral or postdoctoral degrees at Central or state government medical colleges or universities in India and then leaves the country for higher education abroad should try to serve in India for a period of three years after the completion of the course.

If this is not complied with, his or her name “shall be removed from the National Register or the State Register, as the case may be” (the bill envisages setting up a national council and state councils that are required to maintain registers of medical practitioners).

“Asking doctors who study abroad to return and serve in India for three years is a way of ensuring a back-door entry for foreign degrees that are not recognised in India,” says Dr Fuad Halim, member of the IMA.

In 1978, India de-recognised UK degrees like FRCS (Fellow of Royal College of Surgeons) and MRCP (Member of Royal College of Physicians), the equivalent of Indian postgraduate degrees, after England de-recognised Indian medical degrees. This meant that these foreign degrees wouldn’t be recognised by the Indian government and professional medical councils in India and doctors holding these degrees wouldn’t be eligible for posts in government medical colleges. Although in 2007-2008, the then health minister Anbumani Ramadoss announced that FRCS and MRCP would be recognised in India, the status quo remains, says IMA’s Dr Dubey.

“By allowing such indirect recognition, the bill misses the point. If some foreign countries don’t recognise our degrees, why should we acknowledge their degrees,” wonders Dr Halim.

But others contend that there are merits in Section 59 of the bill. “The suggestion that every student graduating from a government medical school must serve his or her country for three years if he or she wants to go abroad for higher study is a positive one. That’s because India needs more qualified doctors,” says Dr Kunal Saha, who heads a voluntary organisation in India called People for Better Treatment, which has submitted a memorandum to the parliamentary standing committee on health and family welfare on certain provisions in the NCHRH Bill.

Adds Dr Bhaskar Narayan Chaudhuri, a city-based microbiologist who has taught in a private medical college in Calcutta, “The government trains undergraduate students for five-and-a-half years, charging them negligible fees. This calls for some reciprocal gesture from the doctors to serve their country for a period of at least three years.”

He further says that most medical graduates leave for the West after obtaining MBBS degrees or after having failed to qualify for PG courses in India. “The PG admission tests are pretty tough and competitive in our country compared to the UK or the US,” he says. “Those who return do so after a period of 5-10 years, get high-salaried posts in corporate hospitals, and start a dashing practice, charging exorbitant fees only because of their foreign suffixes.”

Others point out that the bill is not clear whether doctors returning to India from abroad would be asked to serve in government hospitals or rural areas where there’s an acute shortage of medical personnel. “If this is not specified and doctors return to private hospitals only, how will the three-year clause help the nation,” asks Dr Halim.

Another provision of the NCHRH Bill is also drawing criticism. It says that an Indian who wants to study medicine in a foreign country has to obtain an eligibility certificate from the National Board for Health Education or NBHE (the bill seeks to set up the NBHE), stating that he or she meets the minimum criteria of getting admission to an Indian MBBS course. In other words, the candidate cannot appear for the screening test to get admission to a foreign university without the NBHE certificate.

“This is absolutely ludicrous for obvious reasons. Why should it be the headache of the Indian government to control the minimal requirement for admission to medicine if it is in a foreign country,” asks Dr Saha. “When an Indian student goes abroad to study medicine, it is none of India’s business to judge the standard of entrance requirements for medical schools in the foreign country.”

While experts debate the efficacy of the bill, the government doesn’t seem to be in a tearing hurry to implement it. Apparently, the proposed legislation is still with the Department-Related Parliamentary Standing Committee on Health and Family Welfare. “We want the bill to be scrapped altogether and we are approaching chief ministers of states that are not ruled by the Congress in this regard,” says Dr Dubey of IMA.

With so many critics training their guns on the NCHRH Bill, clearly, it’s unlikely to be plain sailing for the beleaguered bill.