Social Sector Reform: Eight Key Steps That Modi Government Took In 2017

1. National Medical Commission (NMC) Bill, 2017

Earlier this month, the union cabinet cleared the NMC Bill, 2017 that seeks to replace the much-tainted Medical Council of India (MCI) with a 25-member body comprising medical professionals and experts from associated fields. As per the Bill, a committee under the Cabinet Secretary will be responsible for the selection of the members.

The Bill embodies a fundamental shift in regulatory philosophy from inputs such as teacher salaries to learning outcomes. It proposes common entrance and exit examinations for medical colleges at the national level. While the former will allow students to compete on the basis of merit instead of their ability to pay capitation fee, the latter will ensure that all doctors in the country possess a minimum set of competencies.

Another important feature of the Bill is the proposal to establish dedicated boards for regulating graduate education, postgraduate education, accreditation and assessment of institutions as well as ethics and registration. If implemented, the provisions of the Bill will ensure greater flexibility for medical institutions, including doing away with the need for colleges that have received graduate recognition to seek separate permission for starting a postgraduate course.

This is the first time in several years that such a comprehensive overhaul of the MCI has been attempted and, with several vested interests at play, it will be a challenge to ensure that the Bill is passed by both houses of Parliament, without diluting its core philosophy. However, what could perhaps make it easier for the Bill to navigate the parliamentary process successfully is that it was drafted following extensive consultations with a range of stakeholders. It was also examined by a Group of Ministers to ensure that any concerns raised by states and other experts were addressed. Moreover, the multiple failings of the MCI have been acknowledged by numerous stakeholders and a systematic reform of medical education in the country has been long overdue.

2. National Nutrition Mission

The National Nutrition Mission approved by the union cabinet in December 2017 has paved the way for information and communication technology-enabled, real-time monitoring of children from the stage the pregnant mother registers at an Anganwadi centre till the first 1,000 days of their life. Other noteworthy features of the Mission include a very robust convergence mechanism among ministries, incentivising Anganwadi workers for using information technology-based tools, introducing height measurement of children at Anganwadi centres, establishing Nutrition Resource Centres and involving masses through Jan Andolan for their participation on nutrition. The approach proposed under the Mission signals a significant departure from business as usual and has the potential to make an important dent in the country’s persistent malnutrition problem.

Ensuring convergence among various schemes that impact nutrition indicators has been a persistent challenge. Setting up the NNM is an important signal to all concerned stakeholders that nutrition is a priority for the government at the highest levels. This, coupled with the intensive monitoring proposed under the Mission (through a technical unit at NITI Aayog), will help to ensure that this time around the desired convergence actually happens.

Additionally, the Mission proposes to provide incentives to states and union territories which, in turn, can provide incentives to districts and gram panchayats. This will create a sense of competition and spur action towards achieving the targets set out by the Mission. Similar incentives are also proposed for grassroots workers to encourage adoption of technology tools and greater transparency in reporting.

3. Indian Institutes of Management Bill, 2017

In a significant reform effort to provide greater autonomy to Indian Institutes of Management (IIMs) and strengthen their position as institutions of excellence, both houses of Parliament passed the IIM Bill, 2017 on 19 December 2017. As per the provisions of the Bill, IIMs will be instituted as body corporates and governed by a Board also comprising alumni. The Board will have the authority to take decisions with respect to administration, curriculum design and granting of degrees. With the passage of the Bill, IIMs will also be able to award MBA degrees instead of diplomas.

The IIMs will need to ensure that they make the most of the complete autonomy provided to them by investing appropriately in the infrastructure and human capital necessary for imparting world-class education in their institutions.

4. National Testing Agency

In November, the union cabinet approved the creation of an autonomous and self-sustaining National Testing Agency to conduct entrance examinations for higher education institutions. Not only will this move relieve agencies like the Central Board of Secondary Education (CBSE) of their responsibility of conducting entrance examinations, it will also ensure greater standardisation and reliability in the methodology for assessing students. The examinations will be conducted online at least twice a year and training will be provided to students in rural centres at district and sub-district levels.

While the Agency will initially conduct examinations overseen by CBSE, it will subsequently need to expand to other examinations such as those conducted by the All India Council of Technical Education. It will therefore be important to harmonise and standardise the process, including with the Indian Institutes of Technology and other top engineering and medical schools, in due course, as the Agency takes on additional examinations.

5. Higher superannuation age of doctors

It is well-known that India faces an acute shortage of doctors. As of 31 March 2017, an estimated 10.23 lakh allopathic doctors were registered with the MCI or State Medical Councils. Assuming 80 per cent availability, only 8.18 lakh doctors may actually be available for active service. This yields a doctor-population ratio of 1:1613, much below the World Health Organization norm of 1:1000.

In this context, the enhancement of the superannuation age of doctors, barring those who belong to the Central Health Service, to 65 years by the union cabinet is an important development. This will enable retention of experienced doctors for a longer period of time, thereby improving the doctor-population ratio as well as increasing patient satisfaction levels.

Of course, addressing the low doctor-population ratio in the country and ensuring that government doctors remain motivated requires several additional measures as well. Some of these have also been introduced by the government including time-bound promotions for doctors and provision of a longer period of study leave for pursuing higher studies or research work.

6. Medical Devices Rules

Medical devices have tremendous potential to transform healthcare in India. Historically, however, only 15 categories of devices have been regulated in the country and that too as drugs. This was an unsatisfactory situation especially given the increasing variety and complexity of devices.

Earlier this year, the Ministry of Health & Family Welfare notified the Medical Devices Rules, 2017. The Rules, which have been framed on the basis of international best practices, will classify devices according to their risk profile. Regulatory requirements that need to be met by manufacturers will also vary depending on the risk classification of their devices. The Rules prescribe third-party assessment and certification of devices in order to ensure that they comply with the highest quality standards. Further, they specify that there will be no requirement for the periodic renewal of manufacturing and import licenses till such time that they are cancelled or surrendered. The process of applying for a licence will also be streamlined through an online electronic platform.

Currently, it is estimated that approximately 75 per cent of the current demand for devices in India is met through imports. The implementation of these Rules will catalyse innovation and indigenous manufacturing of medical devices by easing some of the regulatory uncertainty and bottlenecks.

One of the key challenges in the implementation of these Rules will be ensuring that adequate capacity is built among regulators as well as those responsible for inspecting manufacturing sites in a relatively short time span.

7. Restructured National Rural Drinking Water Programme (NRDWP) and Swacchta Action Plan

NRDWP is a centrally sponsored scheme launched in 2009 with the objective of delivering adequate quantities of water to the rural population in a sustainable manner. In 2017, the union cabinet approved the restructuring of this programme to make it more outcome-based, ensure greater focus on functionality of services as well as provide greater flexibility to states in utilising funds allocated under the scheme.

As part of the restructured programme, 2 per cent of the funds have been earmarked for Japanese Encephalitis in affected areas. The National Water Quality Sub-Mission initiated by the Ministry of Drinking Water and Sanitation in February 2017 has been included as a sub-programme under NRDWP to provide clean drinking water in 28,000 habitations affected by arsenic and fluoride. Release of a certain proportion of funds from the centre to states will be contingent on the functionality of the piped water supply infrastructure as verified by a third party.

The approach of assessing functionality instead of simply putting infrastructure in place could pose teething challenges because it is a departure from the manner in which infrastructure-related schemes have historically been monitored. However, eventually it will lead to better outcomes by ensuring that the focus is not just on laying down water pipelines but ensuring their continued functionality.

To give a further impetus to the Prime Minister’s vision of a clean India, the Swachhta Action Plan was launched on 1 April 2017. Under the plan, various ministries and departments have committed Rs 12,468 crore during the 2017-18 financial year. This is an important step towards ensuring that swachhta or cleanliness truly becomes everyone’s business. In order to be impactful, the reform will need to be accompanied by a strong monitoring mechanism to ensure that the funds allocated by ministries and departments are spent effectively.

8. Backward Districts

A New India by 2022 can only be realised if the country’s most backward areas progress. In line with this vision, a new initiative has been launched for converging efforts of the central, state and local governments in 115 backward districts and putting in place a real-time monitoring mechanism for assessing progress.

A baseline would be established for the districts based on key indicators in the areas of health, education, nutrition, basic infrastructure, and financial inclusion. Improvements from the baseline will be tracked on a regular basis. This approach will help to instill a sense of positive competition among districts. Prabhari Officers in the rank of Joint Secretary or Additional Secretary will coordinate the efforts of the centre and states in catalysing the transformation of these districts.

One of the key challenges of this approach will be sustaining the motivation levels of district officials. This could be enabled through the provision of appropriate incentives as well as widespread dissemination of the progress being made by districts at regular intervals. The Prabhari Officers will also need to play an active role in ensuring that the momentum is not lost.

Disclaimer: The views expressed are personal.