Tamil Nadu model of public health

HEALTH/ FEDERALISM/ GOVERNANCE

• GS-2: Federal Challenges
• GS-2: Government policies and interventions for development in various sectors and issues arising out of their design and implementation. 

Tamil Nadu model of public health

Context: The recent Supreme Court judgement upholding the constitutionality of reservation for OBCs in NEET’s All-India Quota (AIQ) seats for undergraduate and postgraduate medical and dental courses is considered as landmark in the history of social justice in the country.

• “Merit should be socially contextualised and reconceptualised as an instrument that advances social goods like equality that we as a society value,” the apex court said. 

Tamil Nadu’s Public Health Model

• Govt. in-Service doctor Reservation: The state provides reservation of 50% of the postgraduate and super-specialty medical seats for in-service government doctors
• Criteria of Rural Service: Serving for three years in Primary Health Centres (PHCs) in rural areas is an eligibility criterion for graduates to avail themselves of this reservation policy. 
• Bond of government service till retirement: The reservation Policy has 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. 

What are the merits of such Public Health Policy model?

• Increased Skilled manpower: The introduction of the reservation scheme ushered in a tectonic shift in providing tertiary health care in government hospitals by ensuring the availability of specialists in government hospitals.

• Regional development: It led 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. 
• Strengthened Primary Health Centres: It encouraged young MBBS graduates to serve in rural areas as it was part of criteria to avail the reservation benefits. As a consequence, State PHCs and government hospitals never witnessed a shortage of doctors and people got better healthcare facilities at their doorsteps. 
• Prevents Brain Drain: The superannuation bond has ensured that a vast majority of the specialists continues their service in the government sector throughout their career. This has prevented the brain drain either to the private sector or to places abroad.

What are the changes brought in with the introduction of NEET?

• The Medical Council of India (MCI) has framed a policy of giving only 50% of postgraduate diploma seats to service doctors, exempting postgraduate degrees.
• Also, 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 
  • It also became compulsory for abolishing government doctors’ reservation.

Criticism of new NEET Policy

• The Union government went to the extent of filing affidavits opposing in-service reservation before the Courts when the new rule was challenged by the Tamil Nadu. This is considered as against the Federal spirit, especially when it was done without adequate consultation with State.
• Tamil Nadu State government says that dismantling incentives to serving doctors would jeopardise healthcare delivery system in the State. It has also criticised that MCI which is a mere regulatory watchdog doesn’t any legal teeth to formulate such a policy.

Connecting the dots:

• Tamil Nadu’s Case against NEET
•  Medical Education: Over-centralisation is harsh (Criticism of NEET)
• National Medical Commission