With Health Ministry finalising guidelines, Uniform bond policy on the cards for doctors
New Delhi: In a major overhaul amid massive protests on stringent Bond service terms in Haryana and demands for uniformity across the country, the Union Health Ministry has decided to do away with the bond policy for doctors and is currently finalising guidelines based on the recommendations by the National Medical Commission (NMC).
The information to this effect was shared by the official sources familiar with the matter to the Press Trust of India.
According to the bond policy, doctors are required to serve for a specific period in state hospitals after the completion of their MBBS and postgraduate degrees, failing which they have to pay a penalty (amount specified beforehand by every state and union territory) to the state or medical college.
In July last year, stressing upon the need to have a "stringent and uniform" bond policy for doctors to boost the mainstream healthcare facilities in the country, Minister Nitin Gadkari had written to the Union Health Minister, Shri Mansukh Mandaviya.
He pointed out that a large number of medical students pursue their medical education in government institutes with financial support from the public exchequer and patients from the public at large. Minister Gadkari also reminded in his letter about the draft of uniform bond policy prepared by MCI (Now National Medical Commission) which is pending with the Central Health Ministry since July 2020.
In August 2019, the Supreme Court upheld the bond policy of states and observed that certain governments impose rigid conditions. It suggested that the Centre and the then Medical Council of India (MCI) should frame a uniform policy regarding the compulsory service to be rendered by doctors trained in government institutions which will be applicable across states, an official source told PTI.
In pursuance of the Supreme Court's directions, the health ministry constituted a committee under the chairmanship of Dr B D Athani, Principal Consultant, Directorate General of Health Services, in 2019 to examine the matter. The committee submitted its report in May 2020 and it was forwarded to the National Medical Commission (NMC) for comments.
The NMC furnished its comments in February 2021. It said the report does not clearly address the origin of the policies on compulsory imposition of bond conditions by the various state governments for students.
The NMC, in its comments, stated that since the promulgation of the bond policy by the various states, much has changed in medical education in the country and therefore, it may be worth reviewing the merits/effectiveness of this policy by the various states.
"The NMC submitted its detailed observations. In view of its observations and notwithstanding the observations of the SC upholding the legalities related to the bond policies of the state governments, the commission was of the considered view that medical students should not be burdened with any bond conditions and doing so may run contrary to the principles of natural justice," the source said.
Further, the matter was thoroughly examined by the ministry and it was proposed that there is a need to re-examine the entire bond policy de-novo along with the views of all states, union territories and other stakeholders.
Since then, meetings have been held to deliberate on operationalisation of the uniform bond policy, including finalisation of quantum of bond, manner of enforcement and timely availability of posts in states after completion of internship etc., the source said.
There is no provision of a bond under the NMC Act, 2019 or the erstwhile Indian Medical Council Act, 1956 and regulations made thereunder. The condition of bond is imposed by the state to increase access to improved healthcare services, especially in rural areas by filling the vacant position in community health centres (CHCs) and primary health centres (PHCs).
The amount of bond is decided by the state in lieu of subsidised education being provided in the government medical colleges.
The amount of bond varies from state to state and ranges widely between Rs 5 lakh (Goa, Rajasthan, Tamil Nadu) and Rs 1 crore (Uttarakhand) for MBBS and up to Rs 2-2.5 crore (Kerala, Uttarakhand, Maharashtra) for PG and super-speciality.
The duration of compulsory service also varies between 1 year and 5 years.
"In a meeting, it was observed that there is a consensus that there should be mandatory rural service to enhance availability of doctors in rural and remote areas with flexibility. Also, the bond could be non-financial and implemented through an administrative mechanism," the source said.
"The health ministry is working to finalise guidelines for doing away with the bond policy based on the recommendations by NMC," the source added.
Protests over Bond policy
With no jobs since 5 months, an unplanned bond policy and their certificates being withheld, the resident doctors in Rajasthan were protesting last month condemning the State Government for the unplanned implementation of bond service policy in the State.
Currently, medical services were hit in the state of Haryana as the protest by medical students against the Haryana government's bond policy continued for the seventh consecutive day on Sunday.
The agitated medicos have alleged that the government's bond policy is a perfect example of bonded labour as it forced the doctors to sign bonds and pay a hefty bond fee if they don't want to continue with government services.
The Haryana government had earlier announced that the MBBS students need not pay a bond amount of Rs 10 lakh during admission to government medical colleges.
Instead, the medicos will now only have to enter into a bond-cum-loan agreement of the amount with the college and the concerned bank. The state government will finance the bond amount if MBBS and MD pass-out students wish to join government service as a doctor and serve for a specified period of seven years. But candidates who do not want to join government services in Haryana will have to pay the amount themselves.
Medical Dialogues had previously reported that as per a circular by the State Government of Haryana, Rs 10 lakh annual bond policy was supposed to remain effective for this academic year as well and the MBBS students were required to pay the amount at the start of every academic year till the completion of the MBBS degree of four and a half years.
Upset with the State Government notice regarding Rs 10 lakh annual bond for students pursuing MBBS courses in the Government medical colleges in Haryana, the medicos belonging to Kalpana Chawla Government Medical College (KCGMC) launched a signature campaign
The students also went on protest against the annual bond policy of the Government which was supposed to be effective from the current academic year and will continue till the completion of the MBBS degree. The medicos of Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS) also protested against the government's decision.
Taking cognizance of the ongoing protests chief minister Manohar Lal Khattar held a review meeting regarding the implementation of the state government's policy on Wednesday and declared that medicos will no more require to deposit Rs 10 lakh annual fee at the time of MBBS admission.
Meanwhile, the Director of PGIMER held a meeting with the Directorate of Medical Education & Research Haryana (DMER) and stated that as of now " No Bond Money is to be paid during admission." The clauses will be changed in Bond Papers. Moreover, for batch 2020 and 2021, there is no need to pay bond even if the medico join PG i.e. MD / DNB immediately after MBBS or join Govt. Service but they will have to pay in case they join 2 Year Diploma courses as DGO after MBBS.
For now students only have to give an undertaking and they will need to pay the bond only if they neither join PG (except DGO as mentioned above) nor Govt. Services.
However, the doctors have still highlighted some unresolved issues. The State chairman IMA JDN Haryana, Dr. Karan Junega pointed out that the students who get in to Government medical colleges in Haryana are expected to compulsorily work in the Government sector for 7 years (after MBBS). If doctor wishes to pursue other career options, they will still have to pay Rs 40 lakh. He mentioned that this rule does not apply to AYUSH students or to private medical colleges. It doesn't apply to IIT's Engg or Law colleges. Students are agitating against this new rule in Haryana.
He further stated, " This applies to 2021 MBBS batches onwards. Their fees thus goes up from Rs 53,000 a year to over Rs 10 lakh a year, equalling that of private medical colleges. This is seen as exploitation, taking away the "Right to Education". It makes it difficult for students from non-wealthy backgrounds to come forward to become doctors. It will turn bright people away from applying for MBBS merit seats. The public will eventually suffer."
"There is also no guarantee that there will be enough Government jobs for those who pass MBBS in the future, and what the Bond terms will be if no job is available. The policy doesn't make it mandatory for the state government to provide employment to MBBS graduates. With this uncertainty, students' future has been put at risk", he had stated.
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