The Saat Nischay 3 initiative has triggered a major controversy in Bihar after the state government approved a proposal to impose a blanket ban on private practice by government doctors and medical teachers under the allopathic system. The move has drawn sharp opposition from the medical community, with doctors urging authorities to adopt a more flexible, incentive-based approach instead.
State Government Approves Blanket Ban on Private Practice
In a resolution issued on April 11, 2026, the Bihar Health Department granted approval to prohibit private practice by doctors serving under the Bihar Health Service Cadre, Bihar Medical Education Service Cadre, and Indira Gandhi Institute of Cardiology Medical Service Cadre.
The decision has been taken under Clause 5(c) of the Saat Nischay-3 programme, which aims to strengthen public healthcare delivery by ensuring the availability and accountability of doctors in government institutions.
The government also stated that detailed guidelines regarding implementation, including provisions for Non-Practising Allowance (NPA) or other incentives, will be issued separately after approval from the competent authority.
Medical Fraternity Opposes Move, Calls It “Arbitrary”
The Indian Medical Association (IMA) Bihar has strongly opposed the blanket ban, calling it potentially arbitrary and legally questionable. In a formal representation to the Principal Secretary of the Health Department, the association urged the government to adopt a consultative and legally sustainable policy.
According to IMA, a uniform prohibition without addressing systemic issues could lead to unintended consequences such as loss of experienced doctors, weakening of medical education, and increased chances of legal challenges under constitutional provisions like Articles 14 and 21.
Doctors Suggest Optional NPA-Based Model
As an alternative, IMA has proposed an Optional Non-Practising Allowance (NPA) model. Under this system, government doctors would be given the choice to either opt out of private practice and receive NPA equivalent to central government norms, or continue private practice without availing the allowance.
The association also suggested that key administrative roles such as Civil Surgeon, Superintendent, Principal, and Heads of Departments should be designated as mandatory non-practicing posts, with applicable NPA benefits.
Additionally, doctors opting for NPA would be required to give a formal undertaking not to engage in private practice, with strict penalties in case of violations.
Concerns Over Impact on Healthcare and Medical Education
IMA Bihar warned that a blanket ban could push experienced faculty toward private medical institutions, affecting teaching quality, research output, and postgraduate training. It also highlighted the risk of non-compliance with regulatory norms due to faculty shortages.
The association emphasized that the Medical Education Cadre requires flexibility, including academic incentives, research support, and optional NPA, to maintain standards.
Structural Issues Behind Doctor Absenteeism Highlighted
Addressing the root causes of absenteeism, IMA pointed out several systemic challenges such as lack of residential facilities, inadequate security, staff shortages, and excessive administrative workload.
It stressed that punitive measures alone would be ineffective unless these underlying issues are addressed. The association recommended improving infrastructure, providing rural allowances, and ensuring proper accommodation for healthcare staff in remote areas.
Call for Balanced and Consultative Policy Approach
IMA Bihar has urged the state government to adopt a balanced, incentive-driven, and legally robust framework rather than enforcing a blanket prohibition. The association has expressed willingness to cooperate with authorities in strengthening the public healthcare system.
Speaking on the matter, Dr Sunil Kumar stated that a memorandum has already been submitted to the government. He added that while the association remains hopeful for a positive resolution, further action may be taken if their concerns are not addressed.
The issue now puts the spotlight on how Bihar balances accountability in public healthcare with the practical realities faced by its medical workforce.
