The author Parika Gupta is a final year student at the Campus Law Centre, Faculty of Law, Delhi University. This analysis has been done under the guidance of Shri Sher Singh Dagar, ILS, Joint Secretary, Department of Legal Affairs, Ministry of Law and Justice, Govt. of India.
Introduction
Unlike medicine, dentistry, pharmacy and nursing, the allied and healthcare sector did not have a dedicated
regulatory authority in India. Thus, in the absence of a competent central body for healthcare professions, the
Central Government enacted the ‘National Commission for Allied and Healthcare Professions (NCAHP) Act, 2021’ on 28th March, 2021. Published by the Ministry of Law and Justice, it aims to regulate the education and services of the said professionals; assess and rate allied and healthcare institutions, ensure uniform standards and quality assurance; and maintain live National and State Registers for registration of all professionals. Further, the act provides for constitution of a ‘National Commission’,
‘Professional Councils’, ‘State Councils’ and ‘Accreditation Board’ empowered to create and maintain an online, live register with
details of academic qualifications, training, skill and competencies of professionals. While the Act is expected to benefit students, professionals and patients, effective implementation remains vital.
The article is based on examination and review of open source data and will explore the following research
parameters, namely:
• Background: Evolution of and challenges faced by the Medical Council of India
• Corruption and Controversies at MCI
• Setting up of the National Medical Commission
• Expediency for an all-encompassing legislation, i.e. NCAHP Act, 2021
• Differences in functioning of the MCI and NCAHP
• Formation of State Councils
• A brief on the Rules
• Definitions of Professionals
• Impact of the private sector on higher education
• Numerical status of Health Care Centres and Hospitals in Indian States and Union Territories.
The ultimate objective of the act is medical and scientific advancement, and through this article we will discuss the scope of the legislation and its potential to revolutionise the sector.
•Evolution of and Challenges Faced by the Medical Council of India
In order to establish uniform standards of higher education in medicine and recognise it in India and abroad, the Medical Council of India was established in 1934 through the MCI Act, 1933. Its composition was largely limited to nominated members by the central government, based on non-binding recommendations of the state
government (hence, affecting the federal character), doctors of medical university, with a President and Vice President to be elected by the members themselves. All in all, there was disproportionate private representation without any limitation on reappointments. Also, it had set extremely rigid requirements on setting up medical colleges, conditional on availability of physical space, infrastructure and faculty. This had led to costly initial
investment discouraging genuine players. The functioning of the MCI led to a conflict of interest as it not only gave permission to establish medical colleges but also ensured quality of education (rather than establishing an autonomous accreditation body). Further, it was largely limited to licensing of medical colleges with no emphasis on medical ethics. However, one progressive step was undertaken by the MCI during COVID-19, when it had made necessary guidelines for the telemedicine in India which had previously been considered
unethical, enabling patients to consult their doctors in online mode.
• Corruption and Controversies
Over time, the council got riddled with many controversies, allegations of corruption, and involvement of the medical mafia, with some incisive and critical remarks by Dr. Harsh Vardhan1, the Union Health Minister.
There was an increased call for radical reform of its structure, composition and transparency. Mr. Amitabh Kant, then CEO, Niti Aayog, was quoted as saying “Inspection of colleges by MCI was a tool used for control and harassment rather than reform,” recalling that a college in the Himalayan states could face de-recognition for lack of air conditioners in its library whether or not it fulfilled other commitments. Further, to add to its embarrassment, Dr. Ketan Desai, the Head of MCI was unceremoniously removed from his post on allegations of corruption. Moreover, the MCI did not recognise the Indian traditional medicine system of homeopathy, unani, siddha and yoga amongst others since it was only concerned with modern scientific medicine; thus it lacked a holistic character.
•Setting up of the National Medical Commission
As part of the process to reform the MCI, a committee was set up under the auspices of Niti Aayog which prepared a bill, including provisions such as providing admission through a common entrance exam for government and private medical colleges, and the introduction of a qualifying exam for doctors when they enter the job market. Importantly, the committee also suggested replacing the MCI with a ‘National Medical Commission’. Accordingly, the ‘National Medical Commission Act’, 2019 was passed. It was touted as a historical legislation by the Parliamentarians aiding to “rid medical education of vested interests that were subverting qualitative improvements in this sector’ and being more student-friendly. However, the NMC failed to address two major concerns: corruption in medical education and the decline in ethical standards in medical practice due to its rampant commercialisation and profiteering. Also, inadequacy of human resources, poor infrastructure, extreme centralisation (regulating both medical
education and practice) posed to be other lingering challenges necessitating a comprehensive legislation.
• Expediency for an All-Encompassing Legislation, i.e. NCAHP Act, 2021
In the light of this, it became expedient to pass a legislation to regulate the education and services of the
health individuals. Thus, the ‘National Commission for Allied and Health Professions Act, 2021’ was
passed, with overriding powers. Comprising of a chairperson, vice-chairperson and officers of the
bureaucracy, the members are known for their proven administrative capacity, ability and experience. In order to clothe itself with a holistic character, the act provides for setting up ‘Professional Councils’ to give a
representation opportunity to professionals from all medical fields, in case they are aggrieved by the
commission’s decisions.. Further, it somewhat incudes homeopathy under its ambit by holding an annual
meeting with the Central Council constituted under the Homoeopathy Central Council Act, 1973. Moreover, in the spirit of federalism, State Councils are set up, albeit with lesser members , by the state governments. The act is truly an all-encompassing one since it has made provisions for an interim commission within 3 years of it receiving the president’s assent, comprising of the bigwigs of the Indian bureaucracy. To this effect, an interim commission was notified in June, 2022 by the government till the time the permanent commission was set up. Section 45 and 51 of the legislation exclusively deal with the financial component providing for a ‘National Allied and Healthcare Fund’ and its state counterpart, wherein all grants from the government,
bequests, and fees would be credited, with a budget outlay to be appropriated by the parliament. Surprisingly, there is absence of any statistics w.r.t to the amount budgeted, despite the act being in force for 3 years now. For the sake of maintaining financial propriety, the fund shall be audited annually by the Comptroller and Auditor General of India. Also, penalties are imposed if a person impersonates another who is registered under the central/ state register, presents a false degree of qualification or on failing to surrender the registration certificate despite name being removed. Moreover, any grievance or complaint can only be entertained by a Metropolitan magistrate or judicial magistrate of first class if a request has been made especially by the central
government.
• Differences in Functioning of the MCI and NCAHP
While the Medical Council of India’s functions were limited to establishing and maintain standards of medical education, recognising the qualifications in India or foreign, registration of doctors, providing accreditation to the medical colleges, and maintaining the Indian Medical Register, the NCAHP has wide ranging duties, including framing policies for education, regulating standards for professional conduct, laying down the code of ethics and etiquette to be maintained, maintaining an up-to-date online and live Central Register detailing academic qualifications, laying down entry and exit criteria, engaging technical advisors and performing other
functions as may be entrusted by the Central government. Amongst these functions, the maintenance of the Register gains importance, since it helps address the lack of a single source for verification of qualifications and licenses. They will also help regulatory authorities keep track of licensed professionals and take necessary actions against persons practising without requisite qualifications. Overall, the centralized registers under the Act are expected to bring more transparency and
accountability to the sector.
• Formation of State Councils
On the question of whether the states have duly complied with the act and have constituted state councils, an unstarred question was addressed to the Minister of Health and Family Welfare, to this effect. It was made known that only the states of Andhra Pradesh, Arunachal Pradesh, Assam, Kerala, Odisha, Sikkim, Telangana, Tripura and Mizoram have notified the councils. In light of this, and owing to administrative difficltuies and time consuming procedures, the National Commission for Allied and Healthcare Professions 6th (Removal of
Difficulties) Order, 2023 was passed by the government extending the timeline to constitute the State Councils until May 2024 (three years from the date of commencement of the NCAHP Act).
This is a glaring example of states tooting for cooperative federalism, yet refusing to execute it by failing to set up the state councils.
• A Brief on the Rules
Sec 65 of the Act provides for rules to be framed by the central government, comprising of the qualifications,
experience, manner of selection of part time members, allowances and terms of service amongst other
directions. The rules also provides for zonal distribution of the states and UTs, into- Northern ( Haryana, Himachal Pradesh, Punjab, NCT of Delhi, J&K etc.), Central (Chhattisgarh, Uttarakhand, UP, MP), Eastern (Bihar, Jharkhand, Odisha, West Bengal), North Eastern (Assam, Arunachal Pradesh, Manipur, Mizoram etc), Western (Goa, Gujarat, Maharashtra, Daman and Diu and Dadra and Nagar Haweli) and Southern ( Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, Puducherry, etc.). These councils provide an excellent forum where irritants between Centre and States can be resolved through free and frank discussions and consultations.
• Definition of Professionals
The act includes within its ambit physiotherapists who undertake comprehensive examination and appropriate investigation, and providing timely treatment in connection with movement or dysfunction, malfunction, disorder, disability, healing and pain from trauma and disease, using physical modalities. The physiotherapist, should possess a minimum qualification of a baccalaureate degree and can practice independently or as a part
of a multi-disciplinary. Occupational Therapy Professional is a person who delivers client-centred services concerned with promoting
health and well-being through occupation to enable people to participate in the activities of everyday life. The therapist can practice independently or as a part of a multi-disciplinary team and has a minimum qualification of a baccalaureate degree. Inclusion of Occupational Therapy as a separate, independent entity has various implications such as radical revision of the OT curriculum incorporating policies and programs of the Indian health system, and strengthening the existing systems for OT practice. For occupational therapists, the
implications are (1) registering to independently practice OT in India and (2) documenting professional
practice for ethical integrity.
• Impact of Private Sector Participation on Higher Education
The last two decades has witnessed an unprecedented growth in institutes of higher education ordinarily due
to increasing private sector participation. It has contributed significantly in increasing the Gross Enrolment Ratio (GER) from 10% in 2000 to 28.4% in 2022. Despite this, the issues of quality, access, equity and inclusiveness continue to plague this sector. Poor industry-academia linkages, neglect of soft skills, mismatch of curricula and employment needs, have led to a whopping 43% of unemployment levels amongst graduates. There is lack of uniformity in the content, assessment patterns and pedagogy which does not make it a lucrative option for high-ranking students, then opting for the government aided institutes. The profit-maximisation
objective conflicts with the ultimate aim of social equity and inclusiveness. Also, there is the potential of
private players with poor credentials to enter the landscape in the face of demand-supply gap. Though the government has started the reform process by conceptualising and passing various legislations such as the CEI Act, 2006 and the NCAHP Act, 2021, providing incentives such as the IoE status, as well as conducting surveys- NIRF, AISHE, the inadequacy stills looms large and the response has been mixed. It is another glaring example of the failure of the state in fulfilling the aspirations of the youth in the face of impingement by private sector institutions. It is hoped that the impugned legislation will be able to bridge some of these gaps.
• Numerical Status of Health Care Centres and Hospitals in Indian States and Union Territories
Public health & Hospitals being a State subject, the State Governments are primarily responsible for up-
keeping, providing health care to people and maintaining information of hospitals. The following statistics will provide a true picture of the number of hospitals in different states in 2023, post the passing of the
NCAHP Act:
Conclusion
The National Commission for Allied and Healthcare Professions Act 2021 can potentially transform India’s
unorganized allied and healthcare sector. Empowering regulators to prescribe standards, build reliable
registries, enforce ethics, and monitor quality aim to systematize allied health services’ education and practice.
This will not only benefit students by ensuring standardized competency based learning but patients too, stand
to gain from the quality assurance and ethics oversight across allied healthcare professions. However, the Act
can deliver results only if the envisioned governance bodies are constituted quickly and provided adequate
resources. The interim Commission must hit the ground running by setting up IT infrastructure, consultation processes and transition roadmaps. The state governments must also swiftly establish councils and boards. Scope exists to expand the Act by including more emerging healthcare professions within its ambit. Sustained
engagement with diverse stakeholders and a calibrated regulatory approach will be key. Overall, the NCAHP Act should be leveraged proactively to uplift the status of allied health services and education to world-class levels. This will help India effectively tap the potential of allied health professionals in strengthening comprehensive primary healthcare delivery. Robust implementation of this progressive legislation will
catalyse the advancement of India’s healthcare sector.
Bibliography
1. Om Prakash Singh, The National Commission for Allied and Healthcare Professions Act, 2020 and its
implication for mental health, Indian Journal of psychiatry, April 2021
2. Sureshkumar Kamalakannan, Manigandan Chockalingam, The National Commission for Allied and
Health Care Professions Bill 2020: Implications for Occupational Therapists and the AIOTA, National
Library of Medicine, October 23, 2020
3. Neetu Chandra Sharma, Abolition of Medical Council of India historic for medical education, says Kant,
Mint, September 29, 2020
4. Sukriti Mishra, Agatha Shukla, ‘Homeopathic, Ayurvedic Or Unani System Not Within Scope Of MCI
Act: Ministry Of AYUSH In Reply To Plea’, Law Beat, September 9, 2022
5. Dr. Abhay Saraf, Dr. Maajid Mohi Ud Din Malik, Shweta Chougule, Standardization of Education,
Regulation and Registration of Allied and Healthcare Professionals in India through the NCAHP Act
2021, Journal of Propulsion Technology, 2024
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