A Bombay high court judgement upholding a state government order mandating new MBBS graduates to execute an indemnity bond of Rs.5 lakh to serve in public hospitals for a year after graduation, has come as a shock for medical (MBBS) students in Maharashtra state. The judgement delivered on April 5 by a division bench comprising Chief Justice Mohit Shah and Justice D.G. Karnik also ruled that they will undertake not to emigrate for five years after acquiring their MBBS degrees. The ruling came in response to five petitions filed by about 150 medical students from the 2004-05 and 2005-06 batches challen-ging the state government order issued in 2007.
Currently Maharashtra (pop. 112 million) hosts 14 government, four municipal corporation and 15 private medical colleges which offer the five-year bachelor of medicine and surgery (MBBS) degree programme. Of the total capacity of 4,400 seats in these colleges, 2,000 are in the government colleges (including municipal) and the remaining 2,400 in private institutions. As per the records of the Directorate of Medical Education and Research, the state government subsidises the education of each MBBS student in government medical colleges to the tune of Rs.4 lakh per year (Rs.23 lakh for the complete education of an MBBS student). That’s because students themselves pay a mere Rs.18,000 against the actual cost of Rs.4 lakh per year for provision of medical education. Neither subsidies nor the high court ruling are applicable to students graduating from the state’s 15 private medical colleges which levy tuition-cum-residential fees of Rs.1.68-4.5 lakh per year.
“If the government is spending such huge amounts on subsidising the education of students in government colleges, it’s not unreasonable that it expects them to contribute one year’s service to public hospitals,” says Dr. P. H. Shingare, deputy director of the Directorate of Medical Education and Research, Maharashtra. “In rural Maharashtra, there are thousands of dispensaries in which doctors’ posts are vacant because qualified medical practitioners are unwilling to work in rural areas.”
Graduates of government medical colleges who have paid rock-bottom tuition fees for expensive medical education are not averse to this logic. “We are willing to serve in rural areas but where is the infrastructure in primary health centres (PHCs)? Before asking an MBBS graduate to serve in rural Maharashtra, they should first build some facilities,” says Dr. Anil Dudhabhate, a resident doctor at Mumbai’s KEM Hospital.
Currently despite its huge population — almost double of the UK (pop.61 million) — Maharashtra graduates only 4,400 allopathic medicine practitioners per year and has established a mere 1,816 PHCs statewide, of which 320 are sited in remote tribal hamlets without any infrastructure. Of them 625 PHCs are unserved even by nurses, let alone visiting doctors.
While MBBS graduates undoubtedly have a point when they bemoan the abysmal healthcare infrastructure of village India which not only makes it impossible for urban-educated doctors to set up base there but also nullifies their utility, this chicken-and-egg issue has been hanging fire for decades. The plain truth is that the overwhelming majority of students who top the state government’s tough CET (common entrance test) exam by availing the services of high fees-levying coaching schools are middle class citizens availing highly subsidised medical education. Therefore there’s an emerging cons-ensus that if they’re unwilling to serve in rural areas, they should pay-back the actual cost of their medical education to be absolved of this obligation.
With the issue of MBBS graduates contributing a year of national service having been discussed threadbare for decades, prescient academics recomm-end abolition of the subsidised higher education regime and addressing supply-side issues.
“The primary need is to bridge the demand-supply gap by freely allowing the promotion of medical colleges and replacing tuition subsidies with long-term loans. Unless these hard decisions are taken soon, neither policy tinkering nor court judgements will solve the problem of Maharashtra and India’s abysmal healthcare infras-tructure and services,” warns Dr. Arun Jamkar, vice chancellor of the Maharashtra University of Health Sciences, Nashik.
But this hardly is the first time this warning has been given.
Manas Srivastava (Mumbai)
Fudged insurance scheme
On the statute books of the Central and state governments across the country, there is a plethora of populist laws and public welfare legislation which budget deficit-plagued governments prefer to ignore. One such welfare measure is the Maharashtra government’s Rajiv Gandhi Student Accident Insurance Scheme launched with much fanfare in 2004, which the state government prefers to forget about. Under the scheme covering the state’s 24 million students in classes I-XII, the government pays a premium of 59 paise per student per annum to insure them against accidental death (Rs.3,000), permanent physical disability (Rs.50,000); accident medical treatment (Rs.2,000-10,000), loss of books (Rs.350); missed examination fees reimbursement, loss of bicycle (Rs.1,500) and loss of spectacles (Rs.750).
But curiously during the past three years, the volume of student insurance claims has dwindled drastically, transparency and accountability has decreased and the percentage of pending claims has increased consid-erably. For instance, 1,405 claims were received from primary schools last year, of which only 124 were approved, six were disqualified and the remaining 905 are pending investigation. Pune-based Gauri Kulkarni who lost her seven-year-old son Atul in a road accident in 2009, is yet to receive any insurance payout despite making the rounds of several government offices and completing a mountain of paperwork.
According to Maharashtra’s school education minister Rajendra Darda, only 21,488 insurance claims aggregating Rs.11.85 crore have been paid since 2003. The minister admits the settlement ratio is low considering that the state government has paid over Rs.17.96 crore by way of premium to several insurance companies. Darda says Rs.5.55 crore was paid as premium to Oriental Insurance in 2003-2005; another Rs.4.46 crore was paid to Oriental Insurance and National Insurance over the next three years (2005-2008), and Rs.1.69 crore to United India Assurance for 2009-10.
Curiously, the volume of claim applications has consistently decreased during the past three years. In 2003-04, the number of claims was a mere 598. In 2006-07 they rose to 15,237. However, there has been a steady decline since then with the number of claim applications falling to 3,513. Last year (2010), only 2,085 claim applications were received from primary, secondary and higher secondary schools across the state. “There are very few claims because awareness about the scheme is low and those who register claims are forced to run from pillar to post to procure a mountain of documents only to be denied the benefit on specious grounds,” says RTI (Right to Information) activist Vihar Durve.
Responding to these allegations, a senior official of National Insurance, blames the state government. “The scheme has not been properly stream-lined. We get claim applications from all nooks and corners of the state making it very difficult to keep track of claimants, eliminate ineligible claims, and ensure that all the requisite documents are properly attached. Answering correspondence and telephone calls takes a lot of time. It has become very difficult to pay attention to other office work. We will soon issue an official statement in this matter,” he says.
Against this backdrop, the Pune Municipal Corporation (PMC) is all set to mount a drive to publicise the Rajiv Gandhi Student Accident Insurance Scheme. It intends to issue circulars detailing benefits of the scheme to 372 private, aided/non-aided and PMC-run schools in the city with an aggregate enrolment of 700,000 students. That a publicity drive trumpeting the scheme is overdue is indicated by the reaction of Madhura Kulkarni, principal of Pune’s NMV Girls High School. “We have tied up with an insurance company and are insuring our students on our own because we weren’t aware of this scheme. Now we intend to gather information about the scheme and create awareness among teachers and parents,” she says.
Hope springs eternal.
Huned Contractor (Pune)