Prime Minister Modi promised achhe din. Justice Dave delivered them. This past fortnight was memorable for two landmark judgments delivered by a five-judge bench of the Supreme Court. The first, pronounced on April 11, 2016, made all admissions to medical colleges subject to obtaining a rank in the National Eligibility cum Entrance Test (NEET). The second, delivered on May 2, in response to a case on the Vyapam scandal of Madhya Pradesh, appointed a three-person committee to supervise the functioning of the Medical Council of India (MCI) till such time the government of India revamps it with a new architecture. The two judgments have major implications for the future of the health sector.
There are about 35 entrance tests for admission to the 412 medical colleges in the country. The concept of entrance tests started with the All India Institute of Medical Sciences, followed by some government and private colleges. Many states admitted students based on Class XII marks. As per a 1984 Supreme Court judgment, all government colleges were directed to set aside 30 per cent of the seats, later reduced to 15 per cent, for open admission on all-India basis, giving birth to the annually held All India Pre-Medical Test (AIPMT). In 2015, over six lakh students took this exam competing for some 3,700 seats. In 2009, Simran Jain and others filed a petition against the multitude of tests resulting in a Supreme Court direction to consider the possibility of holding a single national test. In December, 2010, the MCI issued a notification to conduct the NEET subjecting all admissions, including in reserved seats, to the ranking obtained in the examination.
The 2010 notification for the NEET got implemented only in May 2013, but was set aside by a three-judge bench of the Supreme Court on July 18, 2013. The NEET, however, continued to be held for the all-India seats and those states and private colleges that opted to use this list for their admissions. The April 11 SC order recalled the earlier judgment of 2013 and, as a special case, permitted the national test to be held in two phases for the current year on May 1 and July 24. While the May 1 AIPMT examination is being counted as the NEET, the remaining students have been permitted to take a similar test 11 weeks later. It is being argued that students studying the non-CBSE curriculum and language medium schools may be at a disadvantage due to the limited preparation time. There is some truth in this apprehension. Yet, this should not deflect from the importance of the NEET and no state under any specious arguments be allowed to seek exemption.
The NEET is necessary for the following reasons: One, multiple examinations are often held on overlapping dates; there is rampant malpractice in admissions where merit is of little consequence; and the abysmally poor standards of knowledge, particularly in science subjects, are largely reflective of the poor standards of the high school education system in the country.
Medical profession deals with human lives and is dependent on the knowledge and basic competencies of the doctor. It is important that standards are not diluted for any reasons. Instead, the focus of governments should be towards improving the standards of science education in high schools. The NEET will compel governments to focus on high school education.
The NEET, however, is not the end of the road. The more effective antidote to the ills of corruption and the production of poorly trained or fake doctors is the exit examination. Based on an MCI recommendation, in 2010, a ministerial decision was taken to conduct a common national exit examination. This was to ensure that a doctor, irrespective of the institution trained in, had the basic skills and competencies as per laid down standards. Further, this test was to be made mandatory for those desirous of getting the MCI license to practice anywhere in the country or go abroad. Those not willing to take the test were, in the interim, to be left to practice only in their states. The time has come to revive the proposal. The wide variation in standards, for instance, between a graduate from the AIIMS or Christian Medical College, Vellore, and an Azamgarh medical college is unacceptable. A common exit exam will compel “bogus” medical colleges to provide quality training or face the prospect of being rejected by prospective students.
The MCI is an anachronism and its reform has been long-drawn and tortuous. The health ministry overlooked the recommendations made by several expert committees to arrest declining standards and the massive corruption that had crept into the system. In 2010, pushed by the PMO, a draft bill revamping the MCI and replacing it with the National Commission for Human Resources for Health (NCHRH) was tabled in the Rajya Sabha. In October, 2012, this was returned to the ministry with three concerns to be examined: One, the autonomy of states and potential violation of federal principles; two, excessive bureaucratisation and centralisation; and three, faulty selection procedure of regulators, providing scope for abuse. The ministry lapsed into inaction and as per a PIL, a fraudulently elected MCI was restored in November 2013. In 2014, at the instance of Dr Harshvardhan, the then minister of health, the Ranjit Roy Chaudhury Committee was constituted. The committee submitted its report in September, 2014, reiterating in large measure the recommendations of the NCHRH Bill. But no action was taken. It is to the credit of the parliamentary standing committee (PSC) that it took suo moto cognisance of the Roy Chaudhury Committee Report and tabled its findings in Parliament on March 8, 2016. The PSC report indicted the MCI providing adequate justification to set it aside. Instead, a three-person committee has been constituted to recommend policy options for revamping the MCI. Many of us were dismayed at the missed opportunity and felt anxious that the “invincible” influence of certain individuals who dominate the MCI does not once again thwart the reform process.
The health sector in India has failed to develop to its full potential on account of the corrupt and incompetent MCI. The MCI has done nothing regarding reforms of curriculum, quality assurance, ethical practice, rational treatment, and humane patient care. By overhauling this institution with appropriate expertise as required to govern this sector, India can expect a great leap forward on health outcomes.
(This article first appeared in the print edition under the headline ‘To better health’)
Sujatha Rao is former union secretary, health, and Sita Naik is former member of the board of governors of the MCI and also member of the Ranjit Roy Chaudhury Committee.