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Reviving MCI and med schools: How India can end its crippling healthcare crisis

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Sambit Dash
Sambit DashMay 07, 2016 | 15:40

Reviving MCI and med schools: How India can end its crippling healthcare crisis

One million Indians die every year for the want of healthcare facilities. 700 million have no access to specialist care, with 80 per cent of specialists based in urban areas. An abysmal 1.2 per cent of GDP is spent on public health. There is only one bed per 1050 patients in India while it is 1 for 350 in the US. Indian ratio of 0.7 doctors and 1.5 nurses per 1,000 people is significantly lower than WHO average of 2.5 doctors and nurses per 1,000 people. Certainly, India's healthcare has been ailing and medical education - its integral part - faces several ills.

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On Tuesday, the Supreme Court of India made yet another attempt to fix the regulator of medical education in India, the Medical Council of India (MCI), which has often been charged with inept and corrupt practices.

The SC appointed a three-member oversight committee to oversee all statutory functions and policy decisions of MCI for one year. The committee includes Justice RM Lodha, Vinod Rai and Prof Shiv Sareen, who are tasked to set the course right for an "ossified and opaque" MCI, which manages all of India's 183 government and 215 private medical colleges which produce nearly 52,000 medical undergraduates each year.

Reports of the 31-member Parliamentary Committee Standing Committee on Health and Family Welfare and the Ranjit Roy Chaudhury committee, both of which has scathingly criticised MCI for its management of medical colleges and have called for revolutionary changes in its functioning, formed the bulk of reason for the apex court to appoint overseers for MCI until the Indian Parliament to set MCI in order.

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The doctor-patient ratio remains woefully short in India. 

Demand - supply gap

A planning commission report states that to attain the ideal doctor population ratio of 1:1000, a maximum of 187 new government medical colleges needs to be established by 2022, with Rs 100 crore invested per college. Depending on which report you wish to believe the deficit of doctors in India is in the range of six to 10 lakhs to match the world average. With the demand too high, the supply meagre, that one MBBS seat becomes coveted (also due to social reasons like marriage prospects, etc) and worth killing (think Vyapam!) or paying through the nose for.

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Opening a medical college in India is governed by Establishment of Medical College Regulations, 1999. Among others, possession of adequate land, essentiality certificate, consent of affiliation, operational hospital and submission of financial guarantees are necessary to apply to the MCI for establishing a new college. Many of these requirements need to pass through state government, and others can be played around depending on how strong a legal team one has.

The oversight committee would do good to set this part of the house in order by addressing the rot where grants and permissions needed from state government opens the first door of corruption which eventually grows bigger. Demand supply gap in undergraduate and very importantly in post graduate education needs plugging to establish equilibrium.

Inspection Raj

Ask people from any medical college about the "MCI inspectors" and the reaction one receives ranges from outright horror to disdain. MCI has been using 'serial inspectors' for reasons well understood. Of the 261 inspections held in 2014, inspectors from the state of Gujarat were present in 100 of them. The tainted, once arrested by CBI, former MCI boss and yes, the president-elect of World Medical Association, Ketan Desai happens to be from Gujarat. Did the dots join?

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I teach in a medical school which is ratified by the Malaysian Qualifying Agency (MQA is the MCI equivalent in Malaysia) and our medical school had inspection last year. The stark difference in conduct, process, focus and the behaviour of the team of six inspectors when compared to an MCI inspection was telling.

Justice Lodha and his team should set right this ghost of inspection which focuses on nitty-gritty of infrastructure and human staff (with examples of penalizing for finding a room measuring three square feet less than prescribed) and not on what the priority should be - pedagogy, skills training, competency based curriculum, soft skill training, etc. When what is evaluated eventually becomes important, it is essential that the evaluation parameters of MCI be revisited and tuned to churn out, what the Supreme Court has said is found in wanting, a competent doctor.

Elephant in the room

The sole problem however is not with MCI. The elephant in the room, the politics and economics of medical education in India continues to be unacknowledged. The "profiteering" in medical education that the constitution bench of the Supreme Court has cited in its judgement exists and the beneficiaries of that are often the political class. It is common knowledge that in the five southern states which hold 44 per cent of all medical seats in the country (with Karnataka having the maximum) most private medical colleges are owned by or linked to politicians of all hues.

However the Supreme Court's comment on "business of education" appears erroneously placed on moral high ground. The court commenting on liberal market economies made a point that "Justification for regulatory bodies even in such industries managed by private sector lies in the welfare of people. Regulatory measures are felt necessary to promote basic well-being for individuals in need." While it might find popular acceptance, "profit" or "private" in itself are not unsavoury words and medical education which is capital intensive, more so when high quality is aimed for, cannot be bracketed with terms like "noble", "no profit no loss" and left to grapple in mediocrity.

The oversight committee in assessing policies should embark on pragmatism, come clear on cost of education, for earlier the same apex court have made provision for "reasonable excess" in the fees by private colleges. Of late technology has been successfully used to make a dent in corrupt practices and should be continued. MCI, called as "an exclusive club of medical doctors" by the parliamentary committee needs diversity and perhaps fragmentation to manage so many and newer challenges.

Major overhaul

Medical care cannot be separated from medical education. Rise in medical debt leading to suicides has been reported by P Sainath. India's Out Of Pocket (OOP) spending rate is one of the highest in the world which pushes about 63 million people to poverty each year. Unnecessary diagnostic tests, unwanted surgeries and other unethical healthcare practices are part of this vicious cycle. The burden on healthcare, largely owing to lifestyle disorders, is only set to rise in years to come. Time for course correction is alarmingly running out.

For the sheer amount of money with tens of thousands in black and vested interest involved in medical education, the political will to tame it is excruciatingly low. The judiciary has opened another window for rectification of past ills in regulation of medical education. To lift medical education, and in some way healthcare in India, from its "lowest ebb", let us hope that the new oversight committee makes far reaching and just recommendations and importantly the government of the day to comes together in this overhaul.

Last updated: May 07, 2016 | 22:04
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