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Medicine for the rich

Jaswant Kaur Jaswant Kaur
04 Oct 2021

Over the last few years, I have been visiting many rural schools, be it government or private. It was my engagement with Deepalaya, the excitement of interacting with children and the need to understand their aspiration levels that made me visit these schools.
One thing that struck me was their ambition. A majority of them wanted to be a doctor, an engineer or a teacher. Perhaps, they never heard of anything beyond these three professions. Many of them show interest as they want to outperform their peers in the village. Many want to serve in the neighbourhood areas to bridge the huge gap between the haves and the have-nots. Many express their interests because their parents want them to be in the medical or engineering line.
The craze for becoming a doctor has not been a new one. But getting admission to a medical college has always been an uphill task. I have grown up hearing different stories. I remember how my friends used to prepare for various entrance exams immediately after they appeared for Class XI. The board exams hardly mattered to them despite the fact that marks scored in Board exams were given weightage at the time of admission to a medical college.
Our school allowed them to go home early. Our classes used to get over by 12 noon, as many of them had enrolled for coaching classes. The school principal gave us enough flexibility. The students believed that if they performed well in these entrance exams, they would automatically score well in the board exams.
Twenty-four years on, if I look back, only two could get admission to a medical college, that too for Bachelors in Dental Surgery (BDS). None of them got into MBBS despite the fact that we had several options. State-level entrance exams were different from the national level. Rest of them had to change their career paths as they could not get the rank despite several attempts.
The story is no different today. However, the students do not have the option to appear for several exams. They have to work hard for the National Eligibility Entrance Test (NEET), a common test introduced way back in 2016. Their score in the board exams is not given any weightage. Worse, there is no reservation for the economically and socially backward communities.
In fact, the story of the introduction of NEET itself is questionable. It was introduced in 2010 when the Medical Council of India issued a notification making it mandatory for getting admission to the MBBS course. In 2012, a similar notification was issued by the Dental Council of India (DCI). However, these notifications were challenged in the Supreme Court.
The three-judge bench held that the MCI and the DCI had no power to regulate the admission procedure in these colleges. It also ruled that “the regulations are ultra vires the Constitution, since they have the effect of denuding the States, State-run universities” and contrary to the decisions in the T.M.A. Pai Foundation case, which gave freedom to minority institutions for taking decisions regarding enrolments. However, one out of three judges did not agree with the other two.
A review petition was filed against the judgement in 2016. By that time, the two judges, who heard the initial petitions, retired. The petition was brought in the court of Anil R. Dave, the dissenting judge, who led the five-member bench. A decision was taken to recall the earlier judgement by writing on record, “We do not propose to give reasons in detail at this stage so as to see that it may not affect the hearing of the matters.” This is shocking, to say the least. Not only this, pursuant to a Public Interest Litigation (PIL), the court allowed it to conduct NEET from 2017 onwards.
Understandably, the tactics used to make NEET mandatory, appear to be shady. Well, the entrance exam has come under severe criticism since 2017 for various reasons. There have been a number cases, where the students committed suicide because they could not get the desired rank. Nor did they have hefty money for getting a paid seat.
In 2019, the Madras High Court had made strong observations against NEET, calling it discriminatory in nature, as only students who could get expensive coaching could clear the exam. At that time, the court observed that out of 3081 students who appeared for the exam from Tamil Nadu only 48 could succeed without any kind of coaching.
In other words, close to 98 per cent of students could clear it as they had enrolled for a special coaching. The court had also highlighted that the students pay about Rs. 5 lakh to the coaching centres. As such this kind of coaching is unimaginable for the poor. Taking a dig at the central government, the court said that, “the present government has been reversing all schemes implemented by the UPA government. Why can’t it reverse NEET as well?”
Well, things remained the same. The students kept on committing suicide but to no avail. Of late, the Tamil Nadu Government constituted a panel for studying the data relating to the medical admissions in the state and for giving recommendations for safeguarding the interests of students from backward sections.
Last week, the panel headed by retired high court judge A K Rajan submitted a study based on data on students who passed NEET. The 165-page report shows that the number of students clearing NEET from English medium has increased from 55.64 per cent in 2010-11 to 69.53 per cent in 2020-21 while those appearing from Tamil medium dropped from 16.26 per cent to 1.7 per cent during the same period. These students got admission in government colleges. 

A similar trend has been observed for students who took admission in self-financing colleges. A majority of the seats were grabbed by those studying in English medium rather than Tamil. Overall, only 2 per cent students from Tamil medium got admission in MBBS last year.
Not only this, NEET has widened the urban-rural divide with less than 50 per cent students getting admission from rural areas. It also says that students start preparing for coaching as early as Class VIII and continue it a few years after Class XII as well. One can imagine the kind of money these coaching institutes are making without any guarantee of getting a seat in any medical college.
It also says that some of the private medical institutions charge tuition fees as high as Rs. 30 lakh per annum. A majority of the students getting admission in these colleges are those who score average NEET score. Some of them get as low as 20 per cent marks! Yet they get admission because they can afford to pay the hefty fee.  
The report also shows that the number of students getting admission to medical colleges from State Board schools fell from 98.23 per cent to 59.41 per cent over the last ten years. More and more children from CBSE schools are clearing NEET as it is based on CBSE curriculum. The nine-member panel also reported that a  majority of the students who got admission had an annual family income of more than Rs. 2.5 lakh. Earlier, 47.42 per cent students from the lower strata of society used to get admissions. This has come down to 41 per cent.
Now the question is what was the purpose of introducing NEET? It was clearly defined in the report of the 92nd parliamentary committee that “if a unitary Common Entrance Exam is introduced, the capitation fee will be tackled in a huge way; there will be transparency in the system; students will not be burdened with multiple tests; and quality will get a big push”.
Has NEET brought in the much-needed transparency and reduced the burden on students? At least the report submitted by the panel does not show this. In fact, just two days after the report, the Central Bureau of Investigation (CBI) unearthed a huge racket in NEET exams. A Nagpur-based educational institute charged a sum of Rs. 50 lakh from students for helping them in clearing NEET in collusion with the high-ups.  
The parents of these children were asked to give post-dated cheques and original mark sheets of the candidates as security, to be returned once they get admission and their money is released. Proxy candidates were asked to appear for exams. In fact, the institute used to give assurance to the candidates of providing answer keys and manipulating OMR sheets.”
Now will such students who get admission to medical colleges be able to provide good quality health services? This is certainly a question that needs larger discussion. As far as NEET is concerned, the report has proved that it is counter-productive and has failed to achieve its objective. 

In a nation of 1.3 billion people, where 52 per cent of the doctors are practising in just five states, we need a better system of producing doctors, especially in the rural regions. NEET is certainly a roadblock. The earlier it is removed the better.

(The writer, a company secretary, can be reached at jassi.rai@gmail.com)

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