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Tuesday, December 07, 2021

In rotten health

The re-emergence of tarnished former medical council chief is symptomatic of the entrenched inadequacy of health governance in India.

Written by Meenakshi Gautham , K.M. Shyamprasad |
Updated: August 14, 2015 12:30:19 am
Admission scam, Madhya Pradesh scam, MP admission scam, MP private medical colleges, medical education, medical college India, Ketan Desai, Medical Council of India, MCI Ketan Desai, Indian Medical Association, World Medical Association, Indian express, express column Ketan Desai a former president of the Medical Council of India (MCI), faces charges of receiving bribes in return for approvals from private medical colleges.

A recent Reuters investigation revisited the fraud and corruption in medical education in India, and the threatening comeback of the man commonly blamed for this decline: Ketan Desai. Desai, a former president of the Medical Council of India (MCI), faces charges of receiving bribes in return for approvals from private medical colleges. But the Indian Medical Association has backed his bid for leadership of the World Medical Association (WMA), which sets ethical standards for physicians all over the world.

The Reuters report might force the WMA to do a rethink, but the fact is that Desai, even after his suspension from the MCI in 2010, continues to wield power and influence in medical education. Over a year ago, the nation watched in distress and disbelief as Keshav Desiraju, a very good health secretary at the Centre, was brazenly transferred apparently for objecting to the health ministry’s approval of Desai’s renomination back to the MCI.

Medical education and the MCI have been steeped in corruption for the last two decades. The present discourse has also exposed the mercenary practice of engaging false patients and false faculty, and the resulting poor quality of medical education. This declining quality of education is seriously impacting the quality of health services. Two recent studies found little difference in the quality of outpatient medical care delivered by professionally trained doctors and informal practitioners without a medical qualification. Both used inappropriate and unnecessary antibiotics. Poor educational standards and weak regulatory frameworks provide an enabling environment for indiscriminate drug use by healthcare providers. India is high on the World Health Organisation’s list of countries with burgeoning antibiotic resistance, a scenario where bacteria change with unmonitored drug use, so that antibiotics no longer work on them.

The real cause of this problem, however, is not Desai, but the entrenched inadequacy of health and clinical governance in India. This will continue to nourish unprofessional practices and Desai wannabees if not dealt with comprehensively and ethically.

Improved governance of the health sector is vital to interrupting this cycle of poor quality education leading to poor quality health services. The WHO defines health governance as “a political process that involves balancing competing interests and demands”. It is a process of stewardship by government decision-makers that involves not just setting health policy but also “detecting and correcting undesirable trends and distortions”, “regulating the behaviour of a wide range of actors — from healthcare providers to health financiers” and “establishing transparent and effective accountability mechanisms”.

What is required is better steering and oversight of medical education and health services across public and private, formal and informal sectors. Medical education is over-centralised, with state governments having a limited role in giving approvals for colleges in their region. As a result, we find a situation where there are 10 medical colleges in the tiny state of Puducherry but only four across the entire northeast.

Another flaw is the disconnect of the universities, which conduct the examinations and give out medical degrees, from the education process, the learning and teaching methodologies and setting a contextually suitable syllabus. We continue to follow a universal syllabus and curriculum which the British left behind. While a vastly reformed General Medical Council (GMC) of Britain rigorously assesses the educational quality of new medical colleges by following through to the first cohort of graduates, the MCI is obsessively occupied with infrastructure and staff. The MCI’s standards have been criticised as easier to flout (by paying bribes) than to follow.

But with many politicians and businessmen benefiting from easy money, the system has fiercely resisted change. Amendments to the Indian Medical Council Act, 1956 or the setting up of a new council for health human resources have not made it through Parliament.

Clinical governance of health services is almost non-existent in India. This inc-ludes risk management to ensure patient safety; clinical audits to assess providers’ performance against standards and identify areas for improvement; use of evidence-based guidelines/ standards of care; training and continuing professional education of healthcare providers; and patient satisfaction and involvement. The MCI has not been able to make continuing medical education or revalidation of doctors compulsory, unlike the GMC, which also maintains an up-to-date register of all living and practising doctors in the country. Patients are encouraged to report the death of a doctor, as well as medical malpractice.

The GMC was pushed to reform itself under external pressure to reform medical regulation, and increase performance surveillance to protect the public from poorly performing doctors. This process has involved curtailing the unchecked autonomy of the medical profession, by reducing the monopoly of medical doctors in the council through increasing council membership of social scientists and the lay public. In India, pressure from the government and an informed public can bring about similar reforms in the MCI. Declining quality standards and increased antibiotic resistance will affect everyone — rich and poor. This is enough reason for the elite as well as politicians to demand speedy reforms in health and clinical governance.

Gautham is a public health professional. Shyamprasad, a former cardiothoracic surgeon, is former vice president of the National Board of Examinations.

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