Rarely has one seen so much public dismay on a public policy as over the National Eligibility Entrance Test (NEET). Inconvenient policies, for example, the Clinical Establishment Act, are quietly sabotaged. Or policies for revamping the MCI, on which despite a determined Supreme Court and the scathing report of the Parliamentary Standing Commmittee, government is dragging its feet.
But the street protests and the unprecedented and most unfortunate act of India’s premier institution, CMC Vellore, suspending admissions for this year, must make the authorities sit up and take note. Time has come for the Ministry of Health to get actively engaged with the issue and the Supreme Court to take a more reasoned stand. The need for a consensus cannot be greater. Government faced three compelling reasons to institute the NEET: Extortionist policies of private medical colleges that admitted students on their ability to pay rather than commitment to the profession; weakening standards of high school education with students not having even rudimentary knowledge of basic sciences like biology or chemistry; and over 30 entrance tests for students to gain admission, making it highly iniquitous and stressful. Keeping in view the affirmative policies that provided quotas for various social categories, admissions were to be made by selecting the highest performer within that category.
The process that started with a MCI resolution in 2009 went through a tortuous drill of consultations with states and two Supreme Court directives before being operationalised in 2017. After much deliberation, the NEET was envisaged as the most reasonable way out as in one stroke all three ills seemed to have been addressed: Discretionary admissions reduced with confining admission to those getting a rank; a basic knowledge standard ensured; and just one test. And all this without in any way interfering with states’ affirmative policies. It looked like a win-win. Finally, due to the substantial variance in high school standards, the nationwide CBSE was adopted as the basic standard to go by.
To be fair, states like Tamil Nadu were not in favour of the NEET right from the start. Nor were private medical colleges like CMC Vellore. What skewed the thinking was that states that had the largest number of private medical colleges protested the loudest which then seemed to confirm that the protests were motivated by financial considerations. Even in the Supreme Court case, it was CMC Vellore and 92 other private colleges that fought against the policy. Convinced that commercial gains were behind the objections to the NEET, government allowed the court to adjudicate. The NEET was introduced in 2016, stayed by an ordinance for a year to “give time for students to prepare” and finally implemented in 2017.
The maximum protests have come from Tamil Nadu. There are two reasons making the issue more complex than what is believed. First is the issue of wide variance in standards between the competitive CBSE and the SSC followed in most states. While CBSE syllabus focuses on science and math and encourages thinking, the state boards tend to focus on the rote method of learning and liberal arts, worsened by the non-availability of science, english and math teachers in rural areas. Over the years, this variance has seen the steady exodus of the well-to-do middle classes from state boards to CBSE schools. The gap has widened further with most competitive exams based on CBSE, thereby implicitly denying students from rural areas and poor families access to professional education.
In the above backdrop, the NEET was a harsh blow with the exam based on a CBSE plus standard, compelling even the bright CBSE students to take recourse to expensive tutorials for cracking the exam. In other words, the NEET failed to harmonise the qualifying exam, making it fair while rewarding the brightest. Not without reason, the NEET is seen as elitist, favouring the rich, urban families.
The second factor has to do with the state of Tamil Nadu itself. Tamil Nadu is the best performing state in so far as health outcomes and equitable access are concerned. They have more government colleges and in recruiting students from rural backgrounds have also been able to ensure availability of doctors at peripheral facilities that has in no small measure been a contributory factor for the outcomes. In pursuing “high standards”, it is apprehended that the IIT phenomenon may be getting repeated. Under the highly competitive IIT system, the majority are in the US or multinational companies and a handful in rural areas or government. Such a development in the health sector can have disastrous consequences. Likewise, denying growth opportunities to more than three-quarters of our students is simply unsustainable.
Finally, the issue of colleges like CMC Vellore. Like in the UK, over the years, they have “perfected” the admission policy to look beyond marks and assess students’ commitment and value systems through a process-based interview — a system that government should adopt as well, including for recruiting IAS officers. The NEET is clearly a regressive policy in so far as such colleges are concerned.
There are four action points: One, enforce an acceptable standard of school education, making entrance examinations unnecessary. The NEET is, after all, a symptom of a failed education system. Two, till that happens, the NEET must harmonise the test keeping in mind the syllabus of what is taught in state high schools and the CBSE in order to provide a level playing field to all aspirants. Three, revive the old system of pre medical course where the medical students can be taught for one or two years basic sciences and brought on par with the knowledge levels required for medical education. And, four, given our commitment to cooperative federalism, allow states to have their own admission policies but make an All India Licence Examination for registration with the MCI mandatory for those wanting to study or practise in other states or go abroad (on the logic that states have an obligation to fulfill the minimum criteria that is acceptable to all if their doctors seek to treat patients of other states), alongside instituting the National Exit Examination.
Standards are not neutral. Political systems cannot be insensitive to concerns of inequality, exclusion and those that widen disparities. It is essential that government steps in and seeks to build a consensus.
The writer is former Union Secretary, Ministry of Health, Government of India