The Dravidian model of public health

• The recent Supreme Court judgement upholding the constitutionality of reservation for Other Backward Classes (OBC) in National Eligibility cum Entrance Test (NEET)‘s All-India Quota (AIQ) seats for undergraduate and postgraduate medical and dental courses is a landmark in the history of social justice in the country.
• The practices followed by Tamil Nadu can be replicated to facilitate social advancement throughout India.

Tamil Nadu model of health

• Successive Dravidian governments in Tamil Nadu have had a broad and an inclusive understanding of ‘merit’ and its social implications.
• Hence, affirmative action to provide reservation for in-service doctors has stood the test of time for well over four decades.
• The introduction of the scheme reserving 50% of the postgraduate and super-specialty medical seats for government doctors ushered in a tectonic shift in providing tertiary health care in government hospitals.
• It resulted in the expansion of public health infrastructure in the State.
• This progressive reform paved the way for ensuring the availability of specialists in multiple disciplines such as gynaecology, anaesthesia, general medicine, paediatrics, general surgery and orthopedics, which were scarce in almost every district headquarters hospital across the State 40 years ago.
• This was complemented by super-specialty departments like Urology, Nephrology, Cardiology and Neurology in the Madras Medical College (MMC) in the 1960s and 1970s.
• The provision of reservation for government doctors in super-specialty courses contributed to a steady rise in the availability of multi-specialty experts not only in metropolitan cities like Chennai, Coimbatore and Madurai, but also Tier-2 cities as early as the 1990s.
• The unique scheme had a positive effect.
• It encouraged young MBBS graduates to serve in rural areas, as serving for three years in Primary Health Centres (PHCs) in rural areas is an eligibility criterion for graduates to avail themselves of the reservation policy.
• As a consequence, State PHCs and government hospitals never witnessed a shortage of doctors and people got better healthcare facilities at their doorsteps.

Retaining merit in government service

• The healthcare managers in the Tamil Nadu government were not short-sighted while formulating the policy.
• They unveiled a unique superannuation bond for these government doctors to ensure that those who secure postgraduate or super-specialty seats by availing themselves of in-service reservation will serve the government till their retirement.
• This legal binding has ensured that a vast majority of the specialists continues their service in the government sector throughout their career.
• The main aim of this superannuation bond was to prevent the brain drain either to the private sector or to places abroad.
• It has proved to be a win-win situation for doctors and the government.
• This unique scheme is present nowhere in the country.

Introduction of Undesirable reforms

• With the introduction of MCI and Regulation by the Medical Council of India (MCI), the admission policy has undergone a sea change.
• The weightage for government doctors who serve in rural areas has reduced.
• The MCI has framed a policy of giving only 50% of postgraduate diploma seats to service doctors, exempting postgraduate degrees.
• Besides lack of consultation with stakeholders, the policymakers in Delhi are yet to put forth their rationale for this myopic view in the public domain.
• While the State government rightly says that dismantling incentives to serving doctors would jeopardise healthcare delivery system in the State, the Union government is opposing the very idea by hiding behind the regulations of MCI.
• With this move, the Union government has put the rural healthcare delivery system in peril and pushed young doctors, who find it difficult to compete with their urban counterparts who have access to niche coaching institutes, out of the system to prepare for competitive exams instead of serving the poor in rural areas.
• In continuation of the maladies of NEET, from 2017, it became compulsory for individual States to surrender all the seats of super-specialty courses to the central pool for common counselling, forgoing the domiciliary needs (15% of MBBS seats, 50% of postgraduate seats but 100% of super-specialty seats are surrendered to Centre, which is known as AIQ) and also abolishing government doctors’ reservation.

Conclusion

• Union government should act in accordance with the recent judgement of the Supreme Court, which has advocated a broader definition of the concept of merit by facilitating a smooth reintroduction of in-service doctors and domiciliary reservation for respective States in super-specialty courses from the current academic admission year.