INDIA: Medical education may be cut from foreign bill

India's Health Ministry and the Medical Council of India have together opposed the government's proposed Foreign Educational Institutions Bill to allow and regulate foreign universities in India, refusing to support the landmark legislation that is being closely watched around the world.

Their move could further delay the bill's timetable for consideration by parliament, and could prompt the possible exclusion of medical education from the bill.

The country's apex medical education regulator and health ministry officials informed the parliamentary standing committee examining the bill in March that opening up medical education to foreign players could hurt India's medical sector, drain faculty resources and raise quality concerns.

Medical education could be made an exception, instead covered by another bill being drafted by the health ministry.

The Medical Council of India (MCI), the statutory authority for health education, said it was not against the entry of foreign players in medical education, but it must be supported by strong legislation.

Any institution offering medical degrees in India has to submit to rigorous MCI scrutiny. The council said the current bill does not make provision for this prior to a foreign provider setting up a medical education facility.

The health ministry's opposition to Ministry of Education involvement in medical education is not new.

It also opposed medical education coming under the ambit of the new regulatory body for higher education known as the National Council of Higher Education and Research, currently being set up. The health ministry's stance led Prime Minister Manmohan Singh to announce the formation of a separate regulatory body for health under the National Commission for Human Resources for Health Bill, 2011.

"Why should the education ministry decide on what is best for medical education?" asked Ranjit Roy Choudhury, a member of the MCI's governing body.

"We have a separate bill for human resources and medical education. We will provide for the entry of foreign universities because we believe they will ensure competition and improve the standard of medical education in the country. Before that happens, we need to settle issues of quality, equivalence and faculty shortage.

"Most important is the quality issues. If foreign medical colleges come, doctors from abroad will come as part of the faculty. If they have foreign qualifications they will need a licence to practice in India. The MCI has not come to a decision on how to handle this issue," said Roy Choudhury.

The problem of equivalence also exists. For instance, Indian doctors and teachers have to take various exams in different countries where their Indian degree is not considered equivalent. There are many universities whose basic medical degree is not acceptable in India. The same applies to Indian doctors who have studied in India but have not kept up their registrations. They also have to take qualifying tests.

A number of prestigious collaborations with foreign institutions are already in the pipeline, with providers watching the passage of the bill closely.

Foreign providers such as Duke University in the US have signed major agreements to create institutions in India. The Medanta Duke Research Institute (MDRI) joint venture with an Indian medical organisation was announced in February as "a world-class early phase clinical research facility".

"This is not a degree-granting programme which is under a different regulatory environment - there are no restrictions on research," Director of Duke Medicine Global, Krishna Udayakumar, told University World News. However he said MDRI, which includes a 1,500-bed hospital in Gurgaon near Delhi, was part of Duke's aim to "establish an academic presence in India.

"In India we will have some kind of medical education programme. We will expand the education side after the relevant bill [is passed]," Udayakumar said. "Now is the time to be in India and build these partnerships, so we are not dependent on legislation although that would broaden our perspective. Medanta is less about degree-granting programmes and more about long-term relations with India."

But the MCI is concerned that better pay packages and incentives offered by foreign counterparts could wean away faculty members and doctors from Indian medical facilities.

According to the MCI, there is already a faculty shortage across medical colleges in India, estimated at 3,000 to 4,000 vacancies. Opening up medical education to foreign players would mean that more faculty could move to foreign institutes, deepening the crisis.

India believes it is short of 800,000 doctors, and that medical education needs to be expanded to bridge the gap.

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