Skip to main content

RESERVATION.......

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 propriety of actions and dedication to public service should also be seen as markers of merit, which cannot be assessed in a competitive examination,” observed the bench comprising Justice D.Y. Chandrachud and Justice A.S. Bopanna. 

In the light of these crucial observations, it is high time that we demystify the narrow definitions of merit. “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. In this regard, the practices followed by Tamil Nadu, where the notion of merit has taken into account the role of historical privileges instead of an illusory inborn ability, can be replicated to facilitate social advancement throughout India.

A tectonic shift

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. Today, the public health sector in Tamil Nadu has 900 super-specialists in different disciplines, a number comparable only to a few European countries.

The unique scheme had a dual 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.

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.

If one attempts an objective analysis of the contribution of two prestigious institutions — MMC and IIT-Madras — where ‘bright’ and ‘meritorious’ students land, in societal advancement and regional development, MMC would shine largely due to its adoption of reformatory policies that are consistent with the societal needs of Tamil Nadu.

A myopic view

However, with the introduction of NEET and Regulation 9 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.

Shockingly, the Union government went to the extent of filing affidavits opposing in-service reservation before the Madras High Court and Supreme Court when the new rule was challenged by the Tamil Nadu Medical Officers Association. 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 nebulous regulations of MCI, a regulatory watchdog without any legal teeth to formulate policy. 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.

It is unfortunate that the affidavits filed by the Centre on both the OBC reservation and the government in-service doctors reservation cases in the court are based on a narrow reading of what constitutes merit rather than an inclusive prism called public health. Instead of trying to widen the scope of a time-tested practice, which would ensure robust supply of specialist and super-specialist doctors to strengthen public health care, the Union government is hell bent on unleashing misery. Its lament about the unwillingness of doctors to work in rural areas and its attempt to push them to take up compulsory rural service after MBBS or to introduce a bridge course for AYUSH doctors to incarnate them as rural physicians is purely rhetorical.

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. Disposing of a case filed in the Madras High Court by members of the Service Doctors and Postgraduates Association for the reintroduction of 50% service doctors’ reservation in super-speciality courses, the court has directed the Centre to provide reservation for service doctors in super-specialty courses. Will the Union government 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?

Sakthirajan Ramanathan is Assistant Professor of Nephrology, MMC; Sundaresan Chellamuthu is Associate Professor of Radiation Oncology, Tamil Nadu Government Multi Super Specialty Hospital and State president, Government All Doctors Association

Comments

Post a Comment

Popular posts from this blog

Fossil Fuel Steam Generator

Hello, I welcome you all in this course on Power Plant Engineering. Today, we will discuss Fossil Fuel Steam Generators. Now, fossil fuel is the fuel which is made in billions of years when the vegetation is buried under the ground and in millions of years may be 100 or 200 million years; this vegetation is converted into the mineral oil or the coal or the natural gases. And this source of energy is non-renewable source of energy. And the major drawback of this source of energy is that; when the heat is liberated at the same time when we burn this fuel heat is liberated at the same time carbon dioxide is also liberated and which causes the global warming. However, in India more than 60 percent power generation is through the burning of fossil fuels. Now, topics to be covered today are; first of all, we will do the classification of steam generations and then we will discuss the working of a few of the classical steam boilers namely Lancashire Boiler, Cornish Boiler, Cochran Boiler and ...
Post a Comment
Read more

Coal Handling

 Hello, I welcome you all in this course on Power Plant Engineering. Last lecture, we discussed about the Properties of the Coal and in this lecture, we will discuss about the Coal Handling. Now, topics to be covered in today's lecture are Outside plant handling of the coal, storage of coal inside the plant, inside plant handling of the coal, coal transfer from one place to other from the coal mines to the power plant side and Pulverized coal handling. So, these topics we will be covering in today's lecture. In a thermal power plant, bulk of the coal has to be used. I will give you an idea. For example 2000 megawatt plant, it is a I mean quite large size of the plant approximately 5 million ton coal has to be consumed per year. 5 million tons means approximately 2000 tons per day on the basis of 250 days, right. So, quite large amount of coal has to be handled. So, this coal has to be brought from coal mines to the plant site, right and from plant site and it has to be stored b...
Post a Comment
Read more

History of AI from 40s - 90s

  Alright, so, welcome to the AI course, from today we are going to talk about the technical aspects of AI. And before I start I want to mention that while I am going to be presenting the course, I have I am really standing on the shoulders of giants in other words, there are a lot of lot of people who have taught AI taught AI really, really well taught AI probably much better than me, taught AI I have learned AI lot from them and so on so forth. And I have learned from many such people and the slides that I will be using will be stolen from different places of course with you know, some, some permission, some permission, I would say. And so, because of that, you know, we will be sort of taking interesting bits from wherever I found and combining them in the course, I should also point out that I am going to credit all the people that have taken slides from in the first slide, not on individual slides, but you know, I really, really thank them for developing this course for me and ...
Post a Comment
Read more

Mountings and Accessories-I

 I welcome you all in this course on Power Plant Engineering. We have amply discussed in the previous lecture about the steam generators. And now we will discuss about Mounting and Accessories of steam generators. Mountings are important in a steam generator; I will give you an example for example in a car, proper control of a car or monitoring of a car steering is required, brakes are required without them you cannot run the car right. For carrying the luggage, the carrier is required. So, these are all mountings of the car. Similarly, in case of the boilers, mountings are required for the proper operation and safety of the boiler because safety of the boiler is very important. And in India we have an act IBR and in it was introduced in 1925 and all the boilers operating beyond a particular range. For example, the volume of the shell is more than 25 liters, it is covered under IBR; if the pressure any pressurized storage of steam is covered under IBR. Any pipe which has diameter m...
Post a Comment
Read more

Machine Learning

 welcome to machine learning for engineering and science applications I am Balaji Srinivasan I am in the mechanical engineering department hi I'm gonna put the Krishna mood I am in the department of engineering design and both of us are from iit madras so if we look at various applications that all of us are using already in real life for example this is Amazon's recommender system some of you might have seen Amazon echo which is a speech recognition system of course everybody has used Gmail spam classifier and this is Google Lexus this is a latest self-driving car all of these use machine learning algorithms in one way or the other our purpose in this course is to try and utilize the same algorithms for more general problems for example medical image diagnosis or for speeding up CFD computations we look at the course aims basically we will try to understand some of the basic machine normal learning models thoroughly with specific emphasis on deep learning which is the current ...
Post a Comment
Read more

Longitudinal Dynamics

  so we will continue with what we were doing in the last class we were looking at a broad picture or perspective of vehicle dynamics so we were looking at how we are going to approach the subject of vehicle dynamics we said that for us though there is a vehicle it has its components and so on when we are studying vehicle dynamics we said the center of this whole thing is the mathematical model so mathematical model comes from our good old euler-newton equations and this has an input and an output remember that when we looked at the dynamics okay which is defined by using these mathematical equations they are classified into what we called as longitudinal dynamics lateral dynamics and vertical dynamics okay we said that we classify the dynamics what we are going to study using this mathematical model into a longitudinal lateral and vertical dynamics we also said that for these of understanding its effect we may most of the times delineate or decouple them and study them in isolatio...
Post a Comment
Read more

Boiler Performance

Hello, I welcome you all in this course on Power Plant Engineering. We have amply discussed about the boilers normal boilers high pressure boilers their mountings and necessaries. Now today we will discuss about the performance of the boiler. Because performance of the boiler is a very important parameter to assess the efficiency of the power plant right and for example, if we if we take a car. So, before we purchase a car, we assess the performance of the car and the performance of the car is assess how much mileage it is giving per liter how much kilometers it is covering . In similar way, the boiler performance is also assessed and there are different parameters to assess the performance of the boiler. Now, the first parameter is evaporation rate. How much water is getting converted into this? So, there are certain units for evaporation rates for example, this is kg per hour. Now, kg per hour per meter square, kg per hour per meter square; because there are different boilers having ...
Post a Comment
Read more

Mountings & Accessories-II

 I welcome you all in this course of Power Plant Engineering. Today, we will continue to discuss the Mounting and Accessories of steam generators. Topics to be covered today are the boiler mountings, remaining boiler mountings. Some of the boiler mountings we have already discussed in the previous lecture, and some of the boiler mountings will be discussing in the current lecture, and some of the boiler accessories we will be discussing here. So, let us start with a boiler mountings. There is a fusible plug which is required in almost all fire tube boilers. If fire tube boiler is a boiler, where in the shell the water is filled and there is a tube that maybe 1 tube or maybe 2 tubes or 3 tubes which are carrying the hot fuel gases which are burned in the combustion chamber of the boiler and these hot gases are surrounding by the water. Water is not filled up to the top, it is filled up to the certain level, right, in certain level is maintained. And, when these gases they when they ...
Post a Comment
Read more

Material Property Landscape

So far, we have looked at the materials that changed the history. So, we looked at wood, ceramics, fiber and cloth, and so on. So now, let us look at the concept of what do we mean by material science and what do we mean by materials engineering. Or, in other words, let us see what is -- how these two fields of study have been classified. So, the material science per se actually deals with the structure-property correlations. So, basically, what is the structure and what is the property that is obtained in the material through that structure? So, material science deals with the structure-property correlations, while materials engineering deals with designing or engineering of the structure of a material for specific application. So, basically it relies on structure-property correlations, and it takes from there, and then tries to design structures or components for a material -- of a material, for a specific application in mind. So, what do we mean by structure? A structure is nothing ...
Post a Comment
Read more

Coal Properties

Hello, I welcome you all in this course on Power Plant Engineering. Now we have discussed boilers and the performance of the boilers in the previous lectures. Now the coal is used in the thermal power plant. Coal is the main fuel which is used in the thermal power plants. And today we will discuss about the properties of coal. And we will discuss topics to be covered today are first of all discuss about the coal, analysis of coal, classification of coal, we will talk about the Indian coal and coal beneficiation. Now, regarding the coal is the oldest fuel which is used in the power plant. Actually oldest fuel is the wood; I mean which is used for heat generation or in power plant also earlier the wood was used, but coal is the main I mean for the commercial power generation the coal is the oldest fuel. And the earth has sufficient reserve for the coal for the another let us say 20, 30 years. So, still we can go for the coal based power plants. Shifting earlier many of the power plants w...
Post a Comment
Read more