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IASbaba’s Daily Current Affairs – 19th Sep 2017

NATIONAL

TOPIC: General Studies 2:

Statutory, regulatory and various quasi-judicial bodies.

Government policies and interventions for development in various sectors and issues arising out of their design and implementation.

Issues relating to development and management of Social Sector or Services relating to Health, Education, Human Resources.

Poor medical colleges and Shortage of medical doctors: What needs to be done?

Background:

According to the World Directory of Medical Schools, in 2016, India, with 343 medical colleges, had the largest number of operational allopathic medical schools in the world. Brazil, was a distant second, with 193 medical colleges, and China, with a population comparable to India’s, had less than half the number. It is imperative that India ensures that all these medical colleges meet a basic minimum quality standard.

Issues:

The Medical Council of India (MCI) has been repeatedly criticized for providing opaque accreditation to aspiring medical colleges in India.
Many of its members have been accused of taking bribes in order to fast-track accreditation.
Bribes reduce the legitimacy of all accredited colleges and thereby compromise medical college quality overall in the country.

Considering India’s dearth of medical professionals, quality medical colleges are needed to fill the growing healthcare shortages.

NITI Aayog’s recommendation:

Experts at NITI Aayog have proposed replacing the compromised MCI with a new National Medical Commission (NMC), outlined in a draft Bill known as the National Medical Commission Bill of 2016.

The NMC Bill, 2016 – Issues and Way out:

The proposed Bill and recommendations that would raise the integrity and overall quality of accreditation of medical education in India are discussed below:

Mandate of the proposed NMC:
The NMC would split the selection, advising, and actual accreditation process into three separate boards. By dividing power, the hope is to create a system of checks and balances.
Issue:
As per the current Bill, all members of the accreditation board are supposed to be ex-officio members of the advisory board. This defies the logic of good governance.
Instead of creating different boards to watch and observe each other, the NMC would instead create two different heads, but for the most part, a single potentially corrupt body.
Way ahead:
It would be better if all members of the accreditation board are removed from the advisory board.
The accreditation board is not given direct jurisdiction over the accreditation process. Rather, it is given authority over four sub-boards that look into the four core areas of accreditation: undergraduate, postgraduate (PG), registrar of medical professionals, and compliance. The compliance wing is supposed to hire a third party to check that colleges meet standards set by the other sub-boards.
Issue:
The monopolistic nature of this service will produce unnecessary bureaucracy, stifle smooth accreditation and possibly raise the spectre of the old MCI all over again.
Way ahead:
Instead four regional medical councils can be created. Creating these regional options will lead to competition and an increase in the quality of accreditation services overall.
There already exist state medical councils which can be combined for the purpose. There is a great deal of variation in the quality of state medical councils across states. Competition for the accreditation business could ignite life into these bodies.

What more needs to be done?

Sticking to the set standards:
The World Health Organization has put out several drafts on standards for basic medical education, postgraduate medical education (PME), and continuing professional development.
The NMC would greatly benefit from being tied to these best practices. Countries like China and Thailand have already done so to the benefit of their medical education establishment.
Although the standards set by the PME call for schools to balance teaching and research, the Bill needs to incentivize research. A study found that over 57% of medical colleges in India have published no peer-reviewed articles.
Research is fundamental to PG medical education. The PG sub-board should only accredit schools that establish a research-based hierarchy for its faculty and assess students on their research.
The current MCI rules and guidelines prohibit qualified MBBS doctors without a PG degree from performing procedures such as ultrasound and interpreting chest X-rays. The NMC should revisit these rigid regulations to raise the effective availability of qualified doctors in India.
Checking the brain drain:
The other factor contributing to the shortage of medical doctors is the emigration of physicians. India is the largest source of physicians in the US and the UK, and the second and third largest in Australia and Canada.
This brain drain is especially expensive because many of them are trained in colleges subsidized by the government.
It is within the purview of the NMC Bill to recommend a policy to limit emigration of newly graduated doctors.
Case study: Thailand – successfully adopted such a measure in 1972. Their policy mandates three years of government work for all post-graduates. The first year is spent in provincial hospitals, while the second and third years are spent in rural or community hospitals. Statistical evidence indicates that this policy limited brain drain, and reduced medical professional density disparity between rural and urban areas.
Case Study: Kerela- implemented compulsory rural service for all MBBS and PG doctors studying in government medical colleges as a part of Arogyakeralam, its version of the National Rural Health Mission.

Connecting the dots:

India needs to ensure that all these medical colleges meet a basic minimum quality standard. The National Medical Council Bill, 2016 drafted by NITI Aayog can go a long way to serve the purpose. However, there are certain issues that needs to be resolved. Discuss.

NATIONAL

TOPIC

General Studies 1:

Social empowerment, communalism
Salient features of Indian Society, Diversity of India

General Studies 2:

Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and bodies constituted for the protection and betterment of these vulnerable sections

Sub-Categorisation of OBC

In news:

The government recently announced creation of a committee to look into sub-categorisation of Other Backward Classes (OBC). It provides an opening to ensure social justice in an efficient manner. The biggest challenge India faces is that the groups perceived to be disadvantaged consist of a very large segment of Indian society, while public policies are highly limited in scope.

The jobs-claimants mismatch:

The National Sample Survey (NSS) data from 2011-12 show that about 19% of the sample claims to be Dalit, 9% Adivasi, and 44% OBC. This totals a whopping 72%.
Among the population aged 25-49, less than 7% have a college degree. By most estimates, less than 3% of the whole population is employed in government and public-sector jobs.
Since reservations cover only half the college seats and public-sector jobs, the mismatch is obvious.
A vast proportion of the population eligible for reservations must still compete for a tiny number of reserved and non-reserved category jobs. Thus, there is tremendous internal competition within groups.

If we want reservations to make a significant difference in the lives of the marginalised groups, there are only two options.

Either the government must drastically increase availability of government jobs and college seats or it must reduce the size of the population eligible for these benefits.
The only viable option is to reduce the size of the eligible population, possibly along the lines of sub-categorisation proposed by the government.

The practical challenges facing sub-categorisation:

How will we know which castes are the most disadvantaged? At the moment, the only reputable nationwide data on caste comes from the 1931 colonial Census and some of the ad hoc surveys conducted for specific castes.

Lack of credible data:

The Socio-Economic Caste Census (SECC) of 2011 was supposed to provide up-to-date comprehensive data. However, the results remain shrouded in mystery.
When releasing poverty and deprivation data from the SECC in 2015, it was found that about 4.6 million distinct caste names, including names of gotra, surname and phonetic variations were returned, making the results almost impossible to interpret.
For nearly 80 million individuals, caste data were believed to be erroneous.

Way ahead:

Getting credible data:

It would make sense to rethink collection of caste data in Census. Preparations for Census 2021 are ongoing.
There is still time to create an expert group to evaluate the methodology for collecting caste data and include it in the Census forms.
Losing this opportunity would leave us hanging for another 10 years without good data for undertaking sub-categorisation of OBC quota or evaluating claims to OBC status by groups like Jats and Patels.

Addressing caste-based inequalities:

A broader issue, however, focusses on whether we want to radically rethink our approach to affirmative action. We need to think on what would it take to eliminate caste-based disadvantages in next three or four decades.
A two-pronged approach that focusses on eliminating discrimination and expanding the proportion of population among the disadvantaged groups that benefits from affirmative action policies could be a solution.

Checking disadvantages at school level:

The present policies focus on preferential admission to colleges and coveted institutions like IITs and IIMs. But these benefits may come too late in the life of a Kurmi or Gujjar child. Their disadvantage begins in early childhood and grows progressively at higher levels of education.
The India Human Development Survey of 2011-12 found that among families where no adult has completed more than Class X, 59% children from the forward castes are able to read a simple paragraph while the proportion is only 48% for OBCs, 41% for Dalits and 35% for Adivasis.
Improving quality of education for all, including those from marginalised groups, must be a first step in addressing caste-based inequalities.

Ensuring that benefits of reservations are widely spread:

It makes little sense for a young man to obtain admission to a prestigious college, get admitted to a postgraduate course, get a job as an assistant professor, and be promoted to the position of a professor using the same caste certificate. It would make even less sense if his children are also able to obtain preferential treatment using the same caste certificate.
Thus, use of the OBC quota must be limited to once in a person’s lifetime, allowing for a churn in the population benefitting from reservations.
Linking the Aadhaar card to use of benefits makes it possible that individuals use their caste certificates only once, spreading the benefits of reservations over a wider population.

Conclusion:

The present move by the government to rethink OBC quota creates a wedge that could potentially be used to ensure that we have better data on caste-based disadvantages for future discourse. Sub-categorisation of OBCs provides an opening to ensure social justice works better.

Connecting the dots:

The government recently announced creation of a committee to look into sub-categorization of Other Backward Classes (OBC). It provides an opening to ensure social justice in an efficient manner. Critically analyze.