Reforming the regulation of medical education, professionals and practice in India.

Abstract

The regulation of medical education and health professionals is an important aspect of the governance of health systems. This has been an area of concern and institutional weakness in many low and middle-income countries (LMICs) including India.1 2 In 2019, the Indian government addressed the long-standing demand to reform medical education by dismantling the Medical Council of India (MCI), a regulatory body formed during the preindependence era, and established a new institution, the National Medical Commission (NMC).3 The NMC comes at a crucial phase for the Indian health sector, where reforms over the last few decades have taken an unmistakable turn towards privatisation.4 Like several other LMICs with an underfunded public sector and poorly regulated private sector, the expanding role of commercial actors in healthcare and medical education in India has posed major regulatory challenges. Compounding these issues are a growing lack of trust between doctors and patients and diminishing autonomy for doctors in the face of corporate demands.5 6 It is well recognised that the health workforce is key for achieving universal health coverage (UHC), but few analyses have focused on the coherence between education and training policies for the health workforce and UHC.7 Recent experiences in India are illustrative in unpacking these thorny dynamics between financing and service delivery reforms, health workforce production and regulation. What does the establishment of NMC in India during this conflicting trend of increased corporatisation and a professed commitment to UHC imply for overall health systems? In this commentary, we situate the reform being envisaged through NMC in this wider health policy and systems context in India. After providing contextual background, we focus our arguments around three themes—medicalisation, corporatisation and centralisation. We conclude our piece by discussing the implications of these trends on public health and health systems …