The report identified the shift of medical education to the Concurrent List as a major dilution of state authority, arguing that this move transferred control away from the states.
Published Aug 18, 2025 | 11:32 AM ⚊ Updated Aug 18, 2025 | 11:32 AM
Representative image of a medical student
Synopsis: The report identified the shift of medical education to the Concurrent List as a major dilution of state authority, arguing that this move transferred control away from the States. It also described replacing the Medical Council of India with the National Medical Commission (NMC) as another setback, noting that the new body functions with limited state representation and greater central dominance.
DMK MLA Dr. Ezhilan Naganathan has presented a detailed report on State Autonomy in Health and Medical Education to the High-Level Committee on Union–State Relations. The committee, set up by the Tamil Nadu government, held its consultation on 14 August.
The report noted that the Indian Constitution places public health and sanitation under the State List, but over the last two decades, powers relating to health, medical education, drug regulation, and organ transplantation have been steadily centralised.
This has reduced the state’s ability to innovate and address local needs, even as Tamil Nadu has consistently achieved outcomes above the national average in maternal health, infant mortality reduction, immunisation, and organ donation.
The report identified the shift of medical education to the Concurrent List as a major dilution of state authority, arguing that this move transferred control away from the states. It also described replacing the Medical Council of India with the National Medical Commission (NMC) as another setback, noting that the new body functions with limited state representation and greater central dominance.
The report further highlighted the over-centralisation of the National Health Mission, saying this has reduced the flexibility of states to tailor the scheme to local needs. It also noted the tightening of drug regulation by the Central Drugs Standard Control Organisation (CDSCO), which, according to the report, has constrained the scope for State-level regulatory action.
Additionally, the report pointed to the Union’s control of organ transplantation through the National Organ and Tissue Transplant Organisation (NOTTO), observing that this shift has weakened the role of State institutions.
Finally, it referred to ideological impositions in health education and policy, which it said have undermined the ability of States to shape health systems in line with their contexts.
“The unitary approach adopted by the Union government has systematically eroded the Constitutional space for states in health and medical education. This undermines efficiency, social justice, and context-specific delivery of care,” Ezhilan stated.
Among the strongest recommendations is a demand to reverse the 42nd Constitutional Amendment of 1976, which moved medical education from the State List to the Concurrent List, creating what Ezhilan called “a disconnect” between public health and medical education.
The report also criticised the NMC, calling it an extension of the Union Health Ministry with minimal State representation, “antithetical to cooperative federalism.” It further states that centralised exams like NEET and NEXT disadvantage rural and vernacular-medium students.
Other proposals include reinstating a medical council with state participation, mandating state consultation in national health programme design, and allowing states to reallocate up to half of central health grants to their priorities without Union approval.
(Edited by Majnu Babu).
