Why nursing & midwifery bill may give Centre more say, disempower states

Nurses accuse Centre of not taking states into confidence during drafting bill, fear new law will render state councils irrelevant and put students at mercy of central dictates

Representational image. | PTI Photo

Yet another draft bill is under question for allegedly grabbing the powers of the state governments and giving undue authority to the Centre. This time, it is in the nursing and midwifery sector.

The National Nursing and Midwifery Commission Bill 2020 is currently in public domain for scrutiny and feedback, the submission date for which ends December 6.

Leaders of nursing associations say the bill has been drafted without consulting the major stakeholders involved in it including the state governments.

“Once the bill is enacted, the Indian Nursing Council and state councils will be scrapped. At no stage of drafting, the state governments or state councils have been consulted. This is yet another attempt to weaken federalism,” says P Ushadevi, the president of Kerala Nursing and Midwifery Council.


A closer look at the bill not only validates her argument but also indicates the glaring absence of the representation of south Indian states in the proposed commission.

The objective of the legislation, according to the draft bill, is “to provide for regulation and maintenance of standards of education and services by nursing and midwifery professionals, assessment of institutions, maintenance of a central register and state register and creation of a system to improve access, research and development and adoption of latest scientific advancement”.

The national commission would be empowered with regulating nursing education and service in the country, making state councils irrelevant.

Here are some of the salient features of the bill and the critical questions arising with them:

  1. Formation of a national commission, members of which will be nominated by the Centre:

The bill proposes to set up a national commission having not less than 45 members. Of this, 40 will be nominees of the central government. The bill stipulates that the commission which is given the sole authority to formulate policies with regard to the nursing and midwifery education and practice across the country, will be headquartered in New Delhi and the chairperson will be appointed by the central government.

The commission will have ex-officio members representing the Ministry of Health and Family Welfare, Defence, Indian Clinical Medical Research, National Medical Commission and Directorate of Health Service – all nominated by the Centre.

Five members from the listed institutions in various states on a rotational basis will be included in the commission. There are only three institutions (Madras Medical College (Chennai), NIMHANS (Bangalore) and Sri Chithira Thirunal Institute of Medical Science (Thiruvananthapuram) from south India in this list and that too only on a rotational basis. The bill also proposes five more members, in the rank of deans in various Institutions. The list includes only one institution from the south – ESI Hospital, Bangalore.

  1. Formation of autonomous boards for UG, PG courses and for assessing and rating nursing institutions:

Under the commission, there will be four autonomous bodies as the Nursing and Midwifery UG Education Board, the Nursing and Midwifery PG Education Board, the Nursing and Midwifery Assessment and Rating Board; and the Nursing and Midwifery Ethics and Registration Board. All these boards would have seven members – three full time and four part-time members. The three full time members including the chairperson will be appointed by the Union government. The boards as the name suggest have been given the sole authority to decide matters in the respective areas.

  1. Uniform entrance and final examination with common counselling for admission:

There are experts who welcome this provision in the bill as it may enhance the quality of nursing and midwifery education and practice. However, there are many who fear that this will only help to strengthen the ‘coaching centre industry’.

“Now the admission to nursing schools are being done on the basis of the plus two score. Once the entrance examination is introduced, the poor and the rural students who can’t afford coaching would be left out,” says T Subramanian, the general secretary of Kerala Government Nurses Association.

He also said that the provision that insists on a final examination would make the life of the nurses “hell”. “The nurses and midwives are studying a course and pass out successfully before starting the practice. Insisting on another qualifying examination is unnecessary. This will only create inordinate delay in starting their career,” says Subramanian.

  1. A person aggrieved by the decision of any of the above boards may prefer an appeal to the commission:

This provision is the most dangerous one according to those who go against the bill. “This goes against one’s fundamental right to approach a court of law if there is an infringement of right. The students and professionals have to wait for the mercy of the nominated members of the commission,” says Ushadevi.

She alleges that, regardless of the political affiliation of the party at the Centre, the boards will be filled only with members who are docile to them. “How can one expect an impartial intervention to deliver justice in such a system,” she asks.

The bill also proposes formulation of state nursing and midwifery commissions. These state level commissions are supposed to execute the policies formulated by the national commission. It is apparently clear that the state level commissions will not have the autonomy and powers as enjoyed by the existing state nursing councils. The Indian Nursing Council Act of 1947 will be replaced when the bill is enacted. The Indian Nursing Council and state councils will cease to exist by the new enactment.

All the 29 states have state councils. The Kerala State Nursing Council has nine elected members. All the registered nurses cast their vote in the process of electing the council members. On the other hand, the new structure will not have elected members, which in practice, buries the representation of the working nurses and midwives in India.

According to official statistics, three lakh nurses come out of 1,958 nursing institutions in India every year. According to the Kerala State Nursing Council, 12 lakh working nurses (out of 20 lakh) in India are from Kerala. The nursing schools and hospitals outside Kerala have strong Malayali presence. Kerala alone has 124 nursing schools from which 23,000 nurses (both degree and diploma holders) join service every year.

The nursing and midwifery fraternity in Kerala is alarmed over the new bill as the state is the largest resource for providing quality nursing service to the rest of the world.