1. Dr.Rajive K.Dikshit
MD,FCCM,MPH
MoH&FW,Uttrakhand

2.  This bill makes it mandatory for each and
every clinical establishment including every
individual clinic, consulting chamber,
laboratory or any other investigative or
treatment place without indoor beds, nursing
homes, hospital etc. by whatever name it may
be called to register and follow minimum
standards of infrastructure i.e. of space /
equipment and qualified para medical staff.

3.  It provides for mandatory
registration of all clinical
establishments, including diagnostic
centers and
 single-doctor clinics across all
recognized systems of medicine both
in the public and private sector
 except those run by the Defense
forces

4.  Initially, provisional registration would
be granted within 10 days of application
on ‘as-is-where-is basis' upon receiving
the application filed with supporting
documents. Once standards have been
notified, permanent registration would
be provided to all those conforming to
the notified standards.

5.  (with its grammatical variations and cognate
expressions) means, with respect to an
emergency medical condition specified in
clause (f), to provide such medical treatment of
the condition as may be necessary to assure,
within reasonable medical probability, that no
material deterioration of the condition is likely
to result from or occur during the transfer of
the individual from one clinical establishment
to other.


6.  The registering authority
can impose fines for non-
compliance and if a
clinical establishment fails
to pay the same, it would
be recovered as an arrear
of land revenue.

7.  There are stringent and huge
monitory penalties for non
registration by any professional,
which are more than many
criminal penalties of IPC.
 For First Offence, 10,00 FOR
SECOND 50,000,subsequent
offenses Rs.5 Lakhs.

8.  Any person serving in non
registered establishment
25,000/-
 Disobeying any direction or
obstruction to inspection Rs. 5
Lakhs.

9.  Rajasthanand Uttar
Pradesh have already
adopted the Act.

10.  The state government is making an all
out effort to crack the whip on
private clinics and hospitals with an Act
which would require them to declare
the amount of fees they charge, the
number of services they offer and get
registration from the
medical authorities to set up a
health facility.

11.  clinics and private hospitals will have to
mention on a display board about the
services they are providing and the fees
they are charging for that.

12.  The proposed Act envisages to
have district level committees,
which would include district
collector, chief medical health
officer and superintendent of
police.

13.  Act would also prescribe minimum
quality standards of services at the
private clinical establishments.
A medical department official said
under the Act, no one can open clinics
and hospitals without applying for
registration. For the first two years, the
department would issue temporary
registration and after two years,
permanent registration would be
provided.

14.  This bill unleashes a license Raj.
Draconian powers have been vested
with authorities at all levels with
little provision for appeal.
 Are doctors doing some illegal
work to be harassed like this??

15.  - Single Doctor establishment and
clinics to be considered for
minimum registration only without
applying strict rules, these
provisions should be prospective in
implementing ( old clinics,
establishments should be excluded).

16.  IMA wants that only those
establishments with indoor
facilities should be included for
registration under this act. Till
date existing establishments
should be exempted from the
provisions of this act.)

17.  That every clinical establishment shall try
to provide every possible care for
emergency cases so as to stabilize the
condition of the patient to best of its
ability and refer it to appropriate clinical
establishment. This is already a part of
ethical conduct.
 Ethics and rules are different and
should not be mixed.

18.  There are many more such objectionable
and highly detrimental provisions Govt.
has included in this Clinical
Establishment Act. IMA has given their
suggestions in writing to everybody
concerned including Union Health
Minister and the Parliamentary Standing
Committee.
 But nobody cared and Parliament had
passed the Clinical Establishment Bill
without discussion.

20. NATIONAL
COMMISSSION FOR
HUMAN RESOURCES IN
HEALTH BILL 2011
(NCHRH)

21.  Decentralization is a slogan of the Union
Government for better organization and
achievements.
 But it is unfortunate to learn that the
benign Government is proposing for
centralization of powers by forming
National Commission and by taking
away the autonomy of all the concerned
Board, Councils and other wings of the
Union Government for health.

22.  The Bill in introduction – States to
supervise and regulate professional
councils in various disciplines of
health sector.
 Page (1) However, subsequently it
dissolves all the existing Councils
and takes away all their duties and
fund.

23.  The Medical Council of India,
constituted by Indian Medical
Council Act 1956, has been an
autonomous body regulating
medical education in the country.
 As the majority of the members were
elected and represented different
states, they were able to give
unbiased opinion regarding medical
institutions and medical courses.

24.  This new Commission is constituted
by Central Government appointed
members.
 They will act like a department of
union Ministry of health and family
welfare and will not be able to give
unbiased opinion.

25.  As per the clause 105(1) & (2), the
Commission, the Board, committee or the
National Council will be bound by the
directions of the central government.
 In other words, the Commission, the
Committee and the Council will execute
the orders given by the central
government.

26.  9) No elected members from Professional
Associations in National Commission
 1) National Commission the proposed supreme
body with vested powers will have no elected
members and State representatives to represent
their needs and demands
 2) Professionals from other discipline of
Management technology and law are given
place in this Commission will pave way for
dilution and nepotism
 3) It is unfortunate in a democratic country
elected representative Council is brought under
appointed non democratic body

27.  There is no provision for the
representation from the professional
organizations, like Indian Medical
Association or Health Universities in
the Commission, Board or Council,
shunning the voice of the health care
providers.

28.  Inthe circumstances, it will
not be possible for the
Commission, Board,
committee or Council to
provide fair assessment of the
medical education or health
care delivery.

29.  Sec. 100 which bars challenging of removal of
name from state register should be deleted. It is
unconstitutional and is against the
fundamental principles of constitution.
 No law can bar the citizen of India from
seeking a judicial recourse for getting relief
against the decision of a regulatory body.
Further a single body can’t be investigating,
prosecuting, judging and then final super
punishing authority whose decision is un-
challengeable in the court of Law.
 It is against natural justice.

30.  Clause 100 & 101 (Page 34) says
the decisions of the Commission
cannot be questioned in the court
of law and the agreed persons
cannot seek legal remedies.

31.  Modern medicine is not defined properly
it is defined only as medicine.
 Health professionals are not properly
defined to discharge their duties.
 Without defining properly the objectives
of the bill will not be accomplished.

32. Similarly the words" medical
practitioner" in section 2(t),
should be replaced with the
words "modern medical
practitioner"

33.  The seventh schedule in continuation of
section 68 in Part I (10) (page 50) says
engage in any business (or) occupation
other than health profession is a
misconduct.
 This prohibits all career opportunities for
health professionals.

34.  The statement of object and
reason for the bill section (2)
page 53 says “……. to reduce
shortage, standardize quality
and bridge the uneven
distribution of existing work
force in the health sector”.

35.  With No roadmap. How is the
Government going to reduce the
shortage of manpower by forming
this Commission?

36.  Use of attractive words will not solve the
problem.
 - There is no need to dissolve the
existing health Councils to achieve this
purpose.
 - Health is a State subject and
resources cannot be redistributed by the
Central Government.

37.  For example - “There is
acute shortage of water &
electricity in various parts of
the country. Will the Central
Government constitute the
Commission to make even
distribution?”
 ·

38. 
 Clause 77 says even the accounts of State
Councils will be audited only by the CAG of
Central Government. State will have no role on
this


39.  The Indian Medical Association
totally rejects the proposed
“National Commission for
Human Resources for Health
Bill 2011 for the following
reasons:-

40. 
 The Government of India has decided to
introduce a Short 3 years course of Modern
Medicine, called BRHC (Bachelor of Rural
Health & Care) exclusively to serve the Rural
population (villages).
 Decision was taken under the pretext that
doctors are not available for rural population.
 It is understood that for this purpose Medical
Schools will be started in District Hospitals.

41.  The recruitment of the students will
be from rural areas and on
completion of the course they will be
obliged to serve in their native rural
area compulsorily for 5 years. Such
graduates will also be given an
option to undergo bridge course so
as to enable them to obtain MBBS
degree.
 IMA opposes substandard, short

42.  Hon’ble Prime Minister of India
said “India needs more Family
physicians and efforts will be taken
to increase the importance of Family
physician.
 Contradicting to this the bill says
4(c) page 53 “….to ensure uniform
augmentation of trained specialist
and super specialist” as its priority.
 ·

43.  National Commission, the
proposed supreme body with
vested powers will not have
elected members and State
representatives to represent their
needs and demands.

44.  Professionals from other discipline
of Management technology and law
are given place in this Commission
which will pave way for dilution
and nepotism.
 It is unfortunate that in a democratic
country elected representative
Council is brought under power of
non democratic body.

45.  Health is a State subject.
 - Independent Councils is the
need of Medical Professions.
 - NCHRH will do more harm to
health education and health care of
India.

46.  In short NCHRH is of the
Government by the Government
and for the Government and not for
health care and medical education.

47.  With No roadmap.
How is the Government
going to reduce the
shortage of manpower
by forming this
Commission?

48.  Salaries of sate govt. doctors
should be at par with central
govt. scales. Stipend of the junior
doctors should be at par with
those of central govt. medical
institutions.

49.  Amend the CPA act.
 Medical profession should be exempted
from the present CPA act, which is
crippling the medical fraternity and
forcing the doctors to do defensive
medical practice resulting in denying of
proper medical aid to needy patients.

50.  Indian Medical Association – positively
responds to the Govt.’s newly proposed
compulsory rural service after internship
for MBBS graduates, provided the
‘provisional doctors’ shall get salary and
other perks as of regular service
personnel along with weight age in PG
entrance exam.

51.  IMA stresses that this mandatory rural service
shall be implied to those students studying in
Govt. colleges only.
 IMA recommends to Govt. of India, that this
‘rural service clause’ shall be optional to those
students studying in private medical colleges.
IMA would also advise the Hon. Health
Minister and BOG of MCI to discuss the matter
with all India Junior doctors association and
other stake holders in medical education,
before finalizing the decision.
 Likewise there are so many issues relating to
health care bothering the medical practitioners

52.  Doctors not going to rural areas is the
problem of governance.
 Adequate allowances and facilities like
rural service allowances,
 proper free accommodation,
 education allowances for children,
 vehicle or vehicle allowances,
 appropriate reservation for education
and employment for their children,
 ·

53.  sabbatical leave for academic
enhancement of Doctors, allowances
for attending academic conferences
for updating their knowledge, f
 acility for interest free personal loans
should be provided to doctors
serving in rural areas.
 This will attract doctors to rural
areas.

54.  Enhance budgetary allotment for
health care from present meager 2%
to at least 12% of GDP.
 Pay good salaries; make sure the
Government PHCs have adequate
supply of medicine.
 All PHCs should be fully equipped
with required para - medical staff
and nursing staff to help the doctors.

55.  Indian Medical Association – positively
responds to the Govt.’s newly proposed
compulsory rural service after internship for
MBBS graduates, provided the ‘provisional
doctors’ shall get salary and other perks as of
regular service personnel along with weight
age in PG entrance exam.
 IMA stresses that this mandatory rural service
shall be implied to those students studying in
Govt. colleges only.

56.  IMA recommends to Govt. of India, that this
‘rural service clause’ shall be optional to those
students studying in private medical colleges.
 IMA would also advise the Hon. Health
Minister and BOG of MCI to discuss the matter
with all India Junior doctors association and
other stake holders in medical education,
before finalizing the decision.
 Likewise there are so many issues relating to
health care bothering the medical practitioners
at local and state level also.