NMC under the scanner Serving whose interest?

Following its election held in August 2009, there has been a lot of speculation on the functioning of the Nepal Medical Council (NMC). An article in a vernacular monthly “Nepal’s Health and its Biological Variations” raised many questions. Having completed 27 years of representation on the governing body of the Council, I feel that I should jot down on paper some of my thoughts and experiences about the NMC.

The NMC came into being after the enactment of the Medical Council Act of 2020 BS to register all allopathic practitioners and to regulate the practice of medicine in Nepal. It started functioning only after Dr. L.N. Prasad was nominated as President by an official notification in the Nepal Gazette of 19th Poush 2039. As the primary function of the Council is to protect the public, we on the executive felt it was incongruous when the Nepal Medical Association (NMA), which looked after the interest of the doctors, had a majority of 5 to 4, in the governing body. Thus, we proposed the first amendment.

This first amendment rectified some anomalies but created new ones also. The representation of the NMA was reduced from five to two and the Dean of the Institute of Medicine (IoM), a producer of health manpower, was included as an ex-officio member. One shortcoming of the Act was that, whilst previously

the President could have been elected by the members from amongst themselves, the new enactment stated that s/he would be nominated by the government. As the government, following Jana Andolan I, queried if there were any anti-people provisions which needed to be changed, we pointed this out and suggested that this should be scrapped. Nothing came out of it.

In those days, those of us on the executive of the Council tried to model the workings of the NMC on the General Medical Council (GMC), which having been established in England as far back as 1858 AD, may be referred to as the “Mother of all Medical Councils”.

For the subsequent second amendment of 2047 BS the proposal had been made that all Universities having medical colleges should be represented in an enlarged e.g. 19-25 member body with representation of the public and some of the special fields of medicine. Thus Dr. Badri Prasad Shrestha, a noted economist, was appointed as the first lay person. He has been followed by other illustrious personages but that nomination has been vacant for the last two years. Our suggestion regarding representation of the universities conducting medical courses was not put into effect. The government decreed instead that a single representation was adequate and thus IoM was replaced turn wise in the following years by BPKIHS (Dharan), KU and now NAMS.

It was only in 2049 BS that the partial election to the executive of the NMC took place and the Vice-President and eight members were elected for the first time. Later in 1993, Dr. MR Baral, who was President of NMC, was summarily removed. He brought a court case against the government, won and was reinstalled. As a number of medical colleges had come into being, a request was also made to create a special post of Inspector who would be concerned with the periodic inspections and also to oversee the examinations being conducted by the affiliating universities. This request has never been addressed by the government. However a Special Ordinance to ‘Am-end some Health Acts’ enacted in 2058 BS now states that any government nominated members can be confronted with a ‘show cause notice’ and then removed.

The third amendment made to the NMC Act in 2056 BS made provision of having 19 members, of which eight were nominated by the government,

nine elected by the NMC registered doctors or dentists and two ex-officio members who would be the Presidents of the medical and dental associations respectively. Minimum criteria for filing nominations were also stipulated.

The last fifteen years has seen an ever increasing interest, not only in the nominations to the governing body but also in the elections of the NMC. There is great political interest by those holding the reins of power. We in our Naya Nepal are on the threshold of creating a federal structure. Perhaps the composition of the NMC needs to be revamped to ensure that it has regional, educational and gender wise representation from both basic sciences and clinical areas. Inspection of both facilities and examinations should be the concern of a specially constituted body that does it regularly, consistently at a certain standard and is subject to various safeguards. Last but not the least, a much larger representation of the lay public, whose

welfare and health should be the primary concern

has to be catered for. The production of fully and properly trained doctors, both within and out of the country is of prime importance. Adequate steps, such as the licensing examination need to be taken in this regard so that the health of the Nepali citizen is safeguarded. The tendency to assault medical personnel providing medical care has to be prevented.