BIOGRAPHICAL NOTE

Md. Aatif Iqbal is a second-year BBA LLB student of Chanakya National Law University. He received
outstanding in the Legal Research Methodology. He is currently related with free legal aid for the time
being as a student. He is interested in Criminal law, Environmental laws and social justice for backward
and poor people residing in the society as one. He is concerned about the convict who commit brutal
crime not to save them from punishment but save them only to that extent as per there rights available
to them.

Dooms Day with over Centralization

Despite nine years of confabulating, the National Medical Commission Bill 2017 has the danger
of having similar outcomes as the old Indian Medical Council (MCI) Act. The Indian Medical
Association (IMA) and doctors at large have expressed outrage at some of the provisions in the
Act. The idea of reforming and revamping the MCI took root in the Independence Day speech of
former Prime Minister Manmohan Singh in 2009. The vision was to replace the MCI with an
overarching National Commission for Human Resources for Health with four verticals looking
after the four different aspects of regulation – undergraduate, postgraduate education,
accreditation and licensing and ethical practice. It was to provide platforms for cross consultation
and coordination between the disciplines and medical and non-medical personnel. In 2013, the
Parliamentary Standing Committee (PSC) returned the ambitious Bill with three terse
observations:

1. The states’ autonomy and potential violation of federal principles;

2. excessive bureaucratisation and centralisation; and
3. faulty selection procedure of regulators, providing scope for abuse.

Ironically, all these observations pertain to the current NMC Bill as well.

In 2014, the current government constituted an expert committee under Dr Ranjit Roy
Chaudhury to come up with a draft taking into cognisance the concerns of the PSC. Since
nothing happened, the PSC took up a suo moto cognisance of the rotten state of affairs in the
MCI and in 2016, submitted a scathing report recommending that the Roy Chaudhury report be
implemented. Instead, the government constituted yet another committee chaired by the then
deputy chair of NITI Aayog, the CEO of NITI Aayog and the additional secretary to the PM,
later adding the health secretary too. They were tasked to provide options for reform. Instead,
they came up with a draft Bill that was based on widespread consultations with state
governments and a cross section of people and organisations. The draft Bill was also put on the
website. An estimated 22,000 responses were reportedly received. The comments were examined
and some changes made. Subsequently, the group of ministers chaired by the finance minister
examined the draft. The new NMC was approved by the cabinet and placed for discussion in the
Lok Sabha on January 2, 2018. In terms of consultative processes, one could not have expected a
more exhaustive one and the hard work put in by NITI Aayog officials needs to be commended.
Yet, when the Bill came to light, it generated an unprecedented response – a one-day strike by
nearly three lakh doctors and protests from all sections – doctors, health activists, former policy
makers, academicians and so on, forcing the government to refer it to the Standing Committee
for further deliberation.

While the Act has far too many issues that cannot be detailed given the space limitations, there
are four complex issues that have caused this widespread anger and concern.

The MCI constitutes one member from each state nominated by the central government in
consultation with the concerned state government; one elected member representing the union
territories; one member from each university elected by the senate, court, or equivalent body of
that university; one member with medical qualifications elected from each state from among the
registered medical practitioners of that state; and eight members nominated by the central
government. In addition, there are eight MCI officers appointed by the Government of India. As
on 1 April 2017, the MCI had 112 regular and 65 contractual employees. The president and the
vice president of the MCI are elected by the members from among themselves. The executive
committee may also be considered an elected body, as of its 11 members, only three are
nominated while eight are elected.

In contrast, the proposed NMC will be a nominated body. The central government shall appoint
the NMC and shall, through notification, establish autonomous accreditation boards under the
general supervision of this commission. General superintendence, direction, and administration
of the commission shall be vested in the chairperson. The central government shall appoint the
chairperson, presidents of the boards, part-time members, and the member secretary through
selection by a search and selection committee. Again, the central government shall constitute the
search and selection committee, which will consist of the cabinet secretary; CEO, NITI Aayog;
two persons nominated by the Ministry of Health and Family Welfare (MoHFW), and the
secretary of the MoHFW, as the convener. In short, a 25-member commission selected by a
search committee and headed by a union cabinet secretary will replace the elected MCI. This
bureaucratic structure could possibly dent the autonomy of the proposed commission. By
splitting the selection, advisory, and accreditation process into three separate boards, the bill
aims to create a system of checks and balances. However, all the members of the accreditation
board are considered to be ex-officio members of the advisory board. This means that instead of
having different boards that can monitor and regulate each other, the NMC would have a singular
body with two different heads, the possible corruption potential of which contravenes any
arguments about good governance. Moreover, a shift from the elected MCI to the nominated
NMC—a shift perhaps from a democratic system towards an autocracy—does not bode well,
either.