Report recommends restoring State autonomy in health and medical education for better outcomes

The Hindu

14 hours ago

A report by Ezhilan Naganathan, MLA, Thousand Lights Constituency, Chennai, and part-time member of State Planning Commission, has highlighted the increasing centralisation of the health and medical education sectors and has called for restoring constitutional and operational State autonomy.
According to the report, submitted to the High-Level Committee on Union-State Relations, set up by the government of Tamil Nadu, there are six key areas where the Union government has encroached upon the State's functioning, overriding State-specific needs and State-specific delivery of healthcare.
The first is medical education, originally in the State List and then brought to the Concurrent List. This arrangement, where the Union government frames policy for healthcare and medical education while the State delivers the healthcare services, creates a policy-implementation gap, it says. The report recommends restoring medical education to the State List and allowing States to be the sole authority for public health and medical education.
The second area is replacing the Medical Council of India (MCI) with the National Medical Commission (NMC), a move that, the report argues, limited the States' role in framing curricula and guidelines. It also flags concerns with NEET and NEXT (exams for admission to medical college and for licensing practice), pointing out that NEET heavily favours the CBSE/NCERT syllabus and that it has led to a massive coaching class industry, not to mention leading to a decrease in government school students being able to secure admission. It recommends abolishing the NMC, bringing back the MCI, and allowing States to decide on admission procedures and examination systems.
One other area the report deals with is organ transplantation programmes: it notes that recent moves by the Union government to centralise organ allocation and data management through the National Organ and Tissue Transplant Organisation (NOTTO) 'have raised serious concerns about efficiency, fairness, and federal balance,' especially as Tamil Nadu has been a pioneer in this field. The report, among other things, recommends a dual-tier system, with State-led allocation for intra-State matches, and NOTTO's role limited to inter-State sharing when no State recipient is available; and ensuring Central rules cannot override State policies that protect socioeconomically disadvantaged patients.
The report also examines the centralisation of drug regulation, focusing on the role of the Central Drug Standard Control Organisation and its impact on States; the operational model of Centre-funded health schemes, which often come with conditions; the imposition of uniform parameters that fail to reflect State-specific health priorities; and what it terms 'cultural centralisation'. According to the report, this refers to the standardisation of health communication, public campaigns, and even medical curricula 'in ways that undermine linguistic plurality, regional identity, and locally evolved practices.'
The report points out that centralisation 'risks flattening diversity into inefficiency' and urges that States be empowered financially and institutionally for better health systems.