Reservation debate

Reservation debate

The anti-reservation agitation sparked off by Union human resources development minister Arjun Singh's announcement of an increase in reservations in institutions of higher education, including medical colleges, highlighted several issues. If some of these have to do with the overall availability of seats in medical colleges -- and thus chances -- some have to do with questions of social justice and creating a health system that is responsive to the majority rather than a small elite.

Numbers have been crunched since Singh made his proposals public -- the responsibility for taking the matter forward now lies with a committee headed by Congress leader Veerappa Moily after the Supreme Court's intervention. But crunching numbers can be a perilous exercise. The Health Survey and Planning Committee of 1961, for instance, had recommended that one medical college should be available for five million people. This amounts to 200 colleges, given the country's roughly 1 billion population, with adjustments for the average number of seats in colleges. By this reckoning we have made the grade.

But, as we have said earlier, to meet the health care requirements of the country there has to be a balance between doctors available for the state sector and those either going into private sector or going abroad. This depends partly on the balance between private colleges and government colleges, because getting students from the private sector into the state health sector, especially rural areas is tough. Data from the Medical Council of India (mci) website, as of June 7, 2006, shows that 119 out of 243 colleges are private. Also, the proportion of private seats rose from 6.8 per cent in 1960 to 40.9 per cent in 2003.

The comparative economics of private and public health education makes it clear why students of private colleges don't go to the state sector -- though the caveat that state-educated doctors don't necessarily go there either has to be kept in mind. In private health colleges, a bulk of admissions is based on donations -- or capitation fees as they are called. The Centre, in a reply to parliament in 2002, said the cost of imparting medical education was Rs 3.15 lakh per student annually. Government colleges pay a huge subsidy. Maulana Azad Medical College in Delhi, a government college, for instance, charges around Rs 15,000 as compared to the Rs 36 lakh charged by a private college like Santosh Medical College in Ghaziabad (see box: Malpractice). Rules had been set down by mci in 1997 (for three years) to reduce these wide variations. Private colleges could charge upto Rs 1.10 lakh per student a year, with students getting scholarships paying Rs 13,000 per annum. In 2000, they hiked this by 15 per cent for the next three years.

After this, no revision was made. Not surprisingly. A paper published by the Center for International Development at Harvard University, usa, on higher education reforms in India in 2004 documented the increased involvement of politicians in the lucrative business of health education, because politicians found it easy to get institutes recognised by mci and swing the necessary procedures for getting non-profit status and benefits like tax exemptions and free land.

Even though private medical education was increasing, under pressure from several quarters, the government had to ensure that medical education did not get limited just to those who could pay. The Centre set down some ground rules: 50 per cent of seats of a private institute would have to be filled through a state-level exam and the fee structure for these seats would be the same as that of a government college. But this kind of control has not been possible in most cases.

In 2002, the Kerala government decided to promote the private sector, but within a strict regulatory regime. The government fixed a maximum of Rs 28,750 as annual fees per student and said 50 per cent of students admitted in private colleges should be from a merit list prepared by the government. But after the state government issued the order fixing admission and payment of fees in unaided medical colleges, two colleges appealed in the high court against this order. The court cited a Supreme Court verdict of the same year, in the case of T M A Pai Foundation and others versus the State of Karnataka and others, and ruled that the government order was "arbitrary" and "illegal". It reduced the number of merit seats and increased the fees for them to Rs.1.5 lakh a year on the basis of the government's submission regarding the likely expense that it would incur for a medical student's education.

The question of the government's role in regulating private medical colleges has been embroiled with the reservation issue even before the latest controversies, especially in states that have aggressive reservation policies with a large number of private colleges. Private players argue that reservations can apply only to the seats on the government's merit list.

Litigation has been extensive, with three cases being significant and a lot back and forth movement creating its own share of confusion. On August 12, 2005, the Supreme Court delivered a unanimous judgement in the case of P A Inamdar and others versus the State of Maharashtra and others, saying that the state could not impose its reservation policy on unaided private colleges, including professional colleges. The court held that enforcing the reservation policy of the state on unaided professional institutions constituted a serious encroachment on their rights and autonomy. It also said that merely because the state's resources in providing professional education were limited, it couldn't force private educational institutions to make admissions on the basis of its reservation policy. Private players echoed this view saying the government could fulfil its responsibilities by enforcing quotas on the seats it regulated in private colleges. This argument, of course, begs the question of how wide the government's powers of enforcing a merit list and fixing fees should be.

The Inamdar judgement was an attempt to bring clarity to two previous judgements by the Supreme Court. One of them was the judgement delivered on October 31, 2002, in the Pai case (the Pai foundation runs the Manipal Academy of Higher Education), which set down the precedent on how seats would be divided between the merit and management students. The court suggested that a certain percentage of the seats could be reserved for the management from among students who had passed a common entrance test held by itself or by the relevant state/university, while the rest of the seats could be filled on the basis of counselling by the state.

The other judgement delivered on August 14, 2003, was in the case of the Islamic Academy of Education and another versus the State of Karnataka and others. The Supreme Court interpreted the Pai judgment and said unaided professional institutions were entitled to autonomy but at the same time they would have to take into account the criterion of merit as specified by the government. Secondly, it upheld the earlier ruling on reservation of seats for management filling seats on the basis of counselling by the state agency. The court also suggested that unaided professional colleges should also make provisions for students from poorer and backward sections of society.

But not all state governments were willing to abandon reservations. The Maharashtra government decided to restore reservations for scheduled castes, scheduled tribes and other backward castes in vocational courses run by private educational institutions in the state in May 2006, after a forceful appeal by Union agriculture minister Sharad Pawar. The government will determine admissions for the academic year 2006-2007 in these institutions. A total of 2,210 seats are available in Maharashtra. While 15 per cent of the seats will be filled under non-resident and other quotas, 10 per cent will be filled through an all-India entrance examination. Of the remaining 75 per cent seats, 50 per cent will be reserved for the scheduled tribes, castes and other backward castes.

With the reservation issue hanging fire, a contentious bill pending with the government on distribution of seats between government and management might now have to be re-thought. The fate of the controversial Private Professional Educational Institutions (Regulation of Admission and Fixation of Fee) Bill, 2005, which proposes a division of seats that is largely in favour of private colleges is uncertain, given the reservation debate.

What is certain, however, is that the debate risks getting lost in a morass of detail about percentages, jurisdictions and, with the latest anti-reservation twist, passion and prejudice. What is being lost sight of is the fundamental issue: delivery of quality health care to the people. The Harvard University paper mentioned above makes an important point. On the one hand, the state sector has been on the point of collapse for some time now both in the areas of health education and health care. This has facilitated the growth of the private sector, which the state is trying to regulate, or, indeed, control, with mixed results. The casualty is public health. An examination of issues relating to quality will make this obvious. 12jav.net12jav.net