The world attention to include the media, newspapers and the ubiquitous social media have been agog for the last two years with focus on health of our planet which is in dire straits due to the corona pandemic having reached almost all the nook and corners with frightening speed. As if this was not enough the Russo-Ukraine war in particular and the flight of Indian medical students from Ukraine to India has been a ‘Déjà vu’ for equal number of medical students from Wuhan ,China in the aftermath of corona pandemic in 2020. Though lots of foreign medical institutions to include from Poland, Hungary and Romania etc have offered to adjust these beleaguered Indian medical students, the question which deserved to be answered in all its truth is ----Why only Indian medical students have to shunt around the world to get a basic medical degree? Why not in home country India?Though reams of paper have been inked in pursuit for getting to the bottom of medical education knot, but it seems more gets added to the already burgeoning knot of medical education turning it into a proverbial ‘Gordian knot’.
The latest to turn the already turbid waters more murky in medical education world is the ‘Rural medical education bill’ introduced in the ‘Loksabha’ by the NCP leader Supriya Sule. With a stated aim to provide the so called ‘Quality medical education’ and ensure adequate distribution of health care personnel to all rural areas in the country ,the bill will have to do lots of answering in the august house of India’s parliament . But sadly the way our elected reps go about their parliamentary business it seems this bill too will get its assent without much ado. In fitness of things it is necessary to have a closer look at the just introduced ‘Rural medical education bill’ in the ‘Loksabha’ with all its connotations for future medical education foot print in the country and judge for ourselves before the elected MPs do so in the parliament .
The new bill proposes to waive off entire medical tuition fees cost, the boarding and lodging expenditure during the period of education for rural medical aspirants, introduce rural quota for aspiring but poor medical candidates in exchange for obligatory rural service with the appropriate government /s for a minimum period of six (6) years. Referring to the doctor patient ratio in the rural areas to as low as 1:25,000, the bill points out that distribution of health care personnel is abjectly skewed in favour of cities /metros where bulk of doctors are found practicing. As a consequence of the above there is a short fall of 78.9% of surgeons, 69.7% of obstetricians and gynecologists, 78.2% of physicians and 78.9% of pediatricians in rural CHC/Community health centers according to a report of 2021 rural health status report of GOI. Well is this a new revelation?
The newly introduced bill lays stress on the government to conduct a survey to assess the shortage of health care professionals in rural areas, calculate the number of medical seats required for rural country side and designate it as ‘Rural quota’ . Apart from the above, the ‘Rural medical education bill’ asks for reservations for the SC/ST and OBCs amongst these budding but poor rural medical aspirants. As if this is not enough the bill mandates setting up of a ‘National board of rural medical education’ by way of notification of an official gazette.
This national board of rural medical education will have a rep each from union ministry of finance, health, and family welfare and rural development, one member each from SC/STs and OBCs plus 3 eminent female members and a member from the transgender race in the medical field. The constitution of the board gives a feeling of playing to the gallery instead of being seriously involved in the issue. The purpose of the board will be to oversee, selection of candidates under rural quota, setting the limits of miscellaneous expenditure on candidates, and taking appropriate action against any defaulting candidates.
Though much is to be debated in the Loksabha by the honourable members when the bill is put on the table of the house finally, I suppose certain preliminaries in the form of following questions ought to be a perfect food for thought to take the subject forward—
· The bill is silent on how and what will be the guiding principles for deciding who is a rural student? Have any parameters been set for it?
· How does the bill segregate a real and needy rural medical aspirant from an artificial one passing off as a rural student?
· Has the bill given any thought from where the proposed rural medical students quota going to come from?
· Will the quota be at the expense of ‘General quota students ‘which has already shrunk to ridiculous levels of percentage?
· With GR (Government regulations) on NEET-UG reservations being 27% for OBCs, 10% for EWS, 15% for SC and 7.5% for STs, totaling a whopping 59.5% does Supriyasule want this country to have a preponderance of quota seats, thereby giving merit a go by?
· Her refrain in the bill says that these rural medical students will go back to their home districts and serve the local rural populace with which they are well versed with after completion of their degree in medicine. Do these rural districts have adequate infrastructure to beckon them to rural medical service?
· Or is the bill proposing to establish rural medical colleges in close proximity the hinterlands of India?
· With more than 60% of Indian population still residing in the rural set up ,having pathetic connectivity in terms of roads, rails, electricity how does the bill propose to manage advance treatment for patients who are beyond the medical management of rural doctors?
· With certain areas of our country like J&K, NE, Chhattisgarh, Uttrakhand and Jharkhand more than 6 days walking distance from the nearest road head how does the rural medical education bill propose to treat that last man /patient in such hazardous terrain even if rural doctors are posted there?
· The PHCs/CHCs (Primary health centers /Community health centers) in such areas are found to be defunct with major life saving drugs either missing or not stocked at all. With majority of doctors missing from their place of posting in such areas has the bill factored in these concerns when the rural doctors get posted under the said bill?
· In areas of J&K ,NE and certain tribal areas of central India the armed forces particularly the air force act as a ‘ first responder’ to any medical emergency developing amongst the people giving many times an airlift to such critical patients to make them reach a nearest medical facility. Has the proposed rural medical education board done any contingency planning to tide over such a condition?
· Will the proposed National Rural medical education board be functioning concurrently alongside the NMC/National testing agency, NTA or will it be a subsidiary of NTA?
· How will the powers of both august agencies sustain themselves even without crossing each other’s path?
· The NTA /National testing agency releases the detailed NEET-UG reservation criteria under the ‘All India quota(AIQ) scheme. Well if the proposed National rural medical education board taking up the onerous responsibility of fixing the rural medical quota, then is this quota divested from the one vested in NTA?
It has to be understood that NEET-UG is directly under reservation guidelines of the GOI which I have already mentioned above in this write up. In every state 85% of seats are reserved under the state quota candidates and NEET-2022 reservation criteria for them is decided by the concerned state government. The DGHS (Dte Gen of health services) on behalf of medical counseling commission (MCC) conduct the counseling for 15% seats available for admission in all government medical /dental colleges.This does not apply to J&K colleges at present. As per NEET-2022 guidelines for reservation there are certain % of seats reserved category wise in government medical colleges in the 15%/AIQ which I have already given the breakdown of. Does the proposed National rural medical board intend upping or adding to this quota to cater for its requirement of recruiting needy rural medical aspirants? Adding to the above confusion is the fact that guidelines for NEET reservations criteria for 2022 for the seats which are under the state quota will be set by the state counseling authority based on the basis of previous reservation policies.
Since all state governments have their own reservation policies, how and where does these rural quota students fit in the scheme of things as proposed in the new national rural medical bill to be debated in the Loksabha? The National rural medical education board will function and formulate its own selection criteria under rural quota of students to include the attainment of marks in NEET –UG entrance exam. It also lays down strict compliance of orders by the rural students. These are some of the grey areas which the Lok sabha has to debate in its full sincerity and cut the so called ‘Gordian knot’ before the country sees more flight of medical students abroad in sheer desperation to chase their career of medicine.
(The writer is a retired army officer and can be approached on his email…firstname.lastname@example.org)