Published Date: September 15, 2020
The news of Medical-Aspirants Jothi Sridurga, Aadithya, and Mothilal taking their own lives the day before the annual National Eligibility-cum-Entrance Test for Medical Admissions (NEET) was to be held, has filled me with deep sorrow. The news drove many to bemoan the lack of resilience amongst such students, and to advise that such extreme steps were wholly disproportionate to the stress of facing one exam.
But these three were not first-time applicants who took a drastic decision based on the irrational fear of an unknown ordeal they had not met before. Each had taken the NEET earlier but failed to obtain scores that would enable admission to a Medical College. They had then decided, no doubt with significant input from their parents, to take a whole year (two years in one case) exclusively to prepare for a repeat NEET attempt. So, their fatal decision marked the dead-end of a very narrow and harrowing road. By opting for the Medicine track during the last two years of Schooling, plus the additional year(s) of preparations focused exclusively on NEET, they had effectively opted out of qualifying for other careers of anywhere near equal potential. The fear that, after limiting their options, they would not cross the "cut-off" for Medical Admission this time also, AND that such an outcome would lead to an unbearably bleak future, must have weighed so heavily on their young minds.
The likely mental progression of these students suggests that for many like them, the noble aspiration of becoming a Doctor is shadowed by the grave risk of entering a Corridor of Despair which leads up to NEET, the Guillotine of Aspirations.
Though the enforcers of NEET – an increasingly authoritarian BJP Government in Delhi and a seemingly callous Supreme Court - bear the bulk of the responsibility for this situation, all of society must be of troubled mind. For those in public life, such sorrow is compounded by the frustration that we are unable to free our youth from the utter senselessness of a system that has caused so much pain to so many.
Why are we so dead-against NEET?
Let me start with the basic question: What is the need for a common-to-all-applicants test such as the IIT-JEE or the IIM-CAT (called ‘Standardised’ tests as a category)? The overarching motivation of Standardised tests is to create a uniform assessment scale (Level Playing Field) along which to evaluate students who have applied from a variety of different educational programs (CBSE, ICSE and State Board for example). While the NEET is relatively new, the history of Standardised tests stretches to many Decades in India and globally.
Over this time, Standardised tests have repeatedly proven to be of one notable predictive value: Applicants with high scores who are admitted to an institution tend to have high rates of successful course completion. But they have also been proven to have intrinsic bias on dimensions that institutions did not want/like to use to differentiate applicants – Affluence and Race/Social Status. A recent article covers some of the large and growing evidence for this bias, which recently led to the University of California, one of the largest and most prestigious universities in the world, to totally eliminate the use of such test scores during the admission process.
The outcomes of the IIT-JEE and IIM-CAT in India prove that privilege in Caste and Economic Status have a major impact on results. And the results of international standardised tests like GRE, TOEFL, and GMAT, which are the gateway for Tamilians like Indra Nooyi, and Sundar Pichai to emigrate to the US, is strongly linked to privileges in caste and economic status, as I detailed earlier.
For full disclosure, I should record that my own academic journey included studies at the Regional Engineering College, or REC (now National Institute of Technology) at Trichy. I was admitted in 1983, on merit under the Open Quota. Admissions then were based solely on Class 12 Public Exam results and there was no entrance exam. I have also taken several Standardised Tests (GRE, TOEFL and GMAT) when required for admission, and performed well enough to secure admission to programs of Graduate study at US Universities - the State University of New York (Public)) and the Sloan School of Management at the Massachusetts Institute of Technology (Private).
At no point in my multi-national academic journey were Standardised Test Scores the sole criteria on which admission was determined. In fact, there was a considerable reduction in the weight given to standardised test scores between my applications in 1987 (MS) and 1997 (MBA) – as evidence of the inherent bias in such tests mounted. Since 1997 many Universities globally have either made the reporting of such test scores optional, or eliminated them altogether, even before the current COVID19 pandemic. The pace of rejection has accelerated after the Pandemic, as all crises disrupt the logistics of test-holding and taking, with the most vulnerable (economically, medically) suffering disproportionately.
India stands quite alone in the world with respect to the way standardised tests are used. First, it is one of few countries where such tests are used as the only criteria for admission to the most sought-after Colleges and Universities. Second, it is a rare country where such tests are MANDATED by the Government or ORDERED by the Courts.
Even within the scope of Compulsory Standardised Tests in India, the NEET is far different from the IIT-JEE or the IIM-CAT in three crucial respects. Both IIT-JEE for Engineering and the IIM-CAT for Management Studies have the following properties:
1. They are required ONLY for a few specific institutions (not ALL Engineering Colleges or Management Programs)
2. Such Institutions are funded 100 per cent by the Union Government (not the States)
3. No Private Educational Institution is compelled to use the results of these tests
Consequently, one could fail miserably in the JEE or the CAT, or indeed not take them at all, and still find plenty of opportunities to study Engineering or Management across India. In Tamil Nadu, where a Century of Dravidian values has led to the establishment of hundreds of Colleges, and where college students do not have to take ANY entrance test to enroll (excluding Union Government-funded Institutions such as IITs, NITs and IIMs) this empowers us to achieve a Gross Enrollment Ratio at the Tertiary (College) level of 49 per cent, higher even than the 47 per cent of the United States of America, let alone the 26 per cent average across India’s States. In fact, within India’s States, Tamil Nadu is ranked #1 by a wide margin.
By contrast, the implementation of NEET is unique in its oppressive authoritarianism. The Union Government and Supreme Court insist that it MUST be the SOLE basis for ALL Medical Admissions in ALL Institutions across India, even if the Union Government contributes 0 per cent of its Funding (i.e. for Medical Institutions funded 100 per cent by States and even for Private Medical Institutions).
No other test in India, or indeed anywhere in the world to my knowledge, is as single-point make-or-break as NEET. Even the Civil Service examinations that produce the bulk of India’s Administrators have two components – a written Examination and an in-person interview.
NEET is ubiquitous and omnipotent, and therefore has the SINGULAR power to kill dreams and pre-maturely erase lives. There have been 12 instances of NEET-related Student Suicides in Tamil Nadu alone, since its implementation three years ago.
There are more layers to the oppressive nature of NEET.
As I have detailed here, India is the most-centralised, least-Federal large country on Earth. It was so before 2014, during which time the then Chief Minister of Gujarat (and current Prime Minister of India) Mr. Narendra Modi of the BJP, was the loudest voice advocating Federalism. But after his change of role, Mr. Modi has reversed course by 180-degree, and is now an Authoritarian anti-Federalist like none before in India’s history. New intrusions into Citizens and States’ rights are enacted like clockwork (the recently enacted National Education Policy is a case in point). Many other nations and international institutions have commented publicly on this creeping concentration of power and erosion of Democracy.
Within Education, Medicine is unique in a few ways. No Medical College can exist without a conjoined Hospital. Patients at Government Health Facilities (from Primary Health Centres to Specialty Hospitals) are likely to speak (perhaps only) the local language, and hence Medical Students who are trained at these facilities must also be conversant in the local language. For these and many other reasons, Medicine is ideally suited for governance at a State and Local Body level, and Medical Education is best suited to be administered by each State (which is linguistically distinct by design upon Independence), instead of being remote-controlled by the Government in Delhi.
The per-capita demand for admission to Medical Colleges is uniquely high in Tamil Nadu. Our nation-leading ratio of enrollment in both Higher Secondary and Tertiary education, and the high number of Hospitals and Teaching Institutions (far more than the average number for all Indian States) which are the result of decades of Dravidian Public Health Policies, are two major causes. Further, these factors have resulted in an exceptionally high prevalence of Doctors who are drawn from all communities and regions of the State, because of our unique and long-standing Reservation Policy (started in the 1920’s). These Doctors, who number ~4 per thousand residents, which is almost 6 times better than the Indian average AND better even than the American average of ~2.6, serve as Role-Models and Mentors encouraging many from all regions and communities to aspire to a similar career.
The combined effect is that Tamil Nadu has truly exceptional outcomes on many fronts, as detailed in the table below. Tamil Nadu serves as a Major Destination for Medical Tourism, from both within India, and across the world.
In a functional democracy with a rational policy framework, it should be inconceivable for
1. The Union Government with roughly 50 per cent worse performance on Average across almost every indicator of progress to COERCIVELY DICTATE Policy on Medical Education and Health to the Best Performing State, especially in a field which crucially impacts the delivery of Public Health Services. This is as absurd as an Elementary School student FORCING a study plan on a College student.
2. The Union Government of a Constitutionally Federal Republic (Our Constitution states in Article 1 that "India shall be a Union of States") to FORCE its Tests and Rules onto the Medical Colleges and Hospitals which are 100 per cent funded by the States through appropriations granted by their own Legislators, AGAINST the State Legislature’s will.
Such serious violations of the Constitution and Natural Justice would normally be rectified by the Judicial branch, the last-protector role envisaged in all Democratic nations. But our Supreme Court seems so smitten by the "Versatile Genius of Mr. Modi," to paraphrase a then-sitting Jurist, that such violations do not penetrate the mists of their adulation.
To protect Tamil Nadu’s rights and to ensure that our unique policies for Public Health and Medical Education would not be systematically degraded, our Party Leader Thiru M. K Stalin made many attempts to prevent the implementation of NEET here. NEET was then held at bay till the lifetime of the former Chief Minister. But her party descendants proved unequal to the task after her passing, and it took effect in 2017. After massive public outcry, the AIADMK (a coalition partner of the BJP) Government finally acted, and Tamil Nadu’s Legislative Assembly UNANIMOUSLY passed a bill rejecting the use of NEET in the Medical admission process. However, in a searing insult to Democracy, the President of India has – without citing ANY reason - withheld his assent, which is usually a mere formality required by the Constitution to put every State law into effect. This is yet another example of systemic anti-Federalism. And Tamil Nadu’s Government has stood as a mute spectator whose hands have been tied by political compulsions.
The profound tragedy of NEET is that poor intent has been aggravated by grave procedural flaws in implementation - from systemic failures (untoward personal searches of female candidates appearing for the exam, gross errors in translation of Exam questions to Tamil, etc.) to outright fraud ("substitute" exam takers, fake Nativity Certificates, etc.).
The Dravidian Movement’s series of Legislations and Schemes to leverage Universal Education and Public Health as the crucial paths to Social Justice and Inclusive Growth can be traced back to the first Justice Party Government of the Madras Presidency (under the Diarchy Model of the British Raj). In one instance, the Raja of Panagal, the Chief Minister in the 1920’s and a Sanskrit Scholar himself, removed the Sanskrit-Proficiency requirement for Medical Admission (which effectively excluded most aspirants), thereby opening Medical Admission to many including Dr Muthulakshmi Reddy the first woman Physician and Legislator in Madras Presidency. This broadening of the intake-end of the funnel continued all the way to the abolition of Entrance Exams for Engineering and Medicine, enacted through legislation by our leader Thalaivar Kalaignar in 2006.
A century later, the forces of hierarchy and suppression are back to their old ways, using NEET as the proximate weapon, with deadly consequences for so many. The End-Goal of the progression of events over the last 3 years is noticeably clear – to narrow the intake end of the funnel again, by sending a strong signal of "Don’t even dream of Medical Admission" to all but the richest and the most privileged.
The breath-taking and enraging hypocrisy is that NEET is forced on us against our will in an authoritarian manner, by Union Ministers and Justices of High Courts and the Supreme Court – not one of whom have ever had to pass a standardised test in order to occupy their own positions.
And yet, there is hope. Our Leader Thiru MK Stalin has made a commitment to end NEET in Tamil Nadu when we come to power. A General Election is constitutionally bound to occur by May 2021, 9 months from now, and before NEET 2021. We will strive to ensure that not even one more precious life in Tamil Nadu is lost to the tyranny of NEET.