Education needs great churning to be useful for the country to grow and prosper

 

12 March 2022

A few days back, there was TV news about our medical students in the war-torn Ukraine wanting to return home. About 18,000 students are studying medicine there. Obviously these students did not do well in the NEET examination to qualify for the seats in the Government-aided medical colleges in India.

There is a great shortage of medical seats in India as compared to the number of aspirants. The Medical Council of India (now National Medical Commission) had even brought down a few years ago the cut-off marks required to get more admitted in the medical colleges, so that those who do not get into the Government-aided colleges find admission into the private ones. However, here is a catch. It is only those who can pay the hefty fees running into millions can get admission in the private medical colleges. It is said that tuition fees in such colleges are as high as INR 15-20 million over the whole course. This turns out to be more than 5-10 fold costlier as compared to the tuition fees charged in some European and Asian countries. And hence, students flock to these countries for studying medicine. As per the Ministry of External Affairs, many students study medicine abroad for e.g. China 23,000, Ukraine 18,000, Russia 16,500, Philippines 15,000, Kyrgyzthan 10,000, Georgia 7,500, Kazakhsthan 5,200, Poland 4,000, Armenia 3,000 and others. Thus, the private medical education in India caters to the needs of academically less competitive but a wealthy class.

In the context of evacuation of our students, there was an unfortunate comment that these so-called academically poor students will be eventually poor doctors once they come home. Mockingly, these students are shown in poor light in the media (Photo 1). Sometime, these comments are also reserved for those who get admission on the basis of payment seats as well as for those who belong to reservation classes in the country. It must also be realised that poor standing at the entrance test for medicine or any other discipline does not necessarily mean that student is academically poor lifelong. And this is surmountable with hard work, integrity and good leadership qualities.

 

The fact of matter is that the opportunities are denied to those who need higher education by creating shortage of seats and increasing the cost of education in the Government or Government-aided colleges.

India has less number of doctors, about 134 doctors for a population of 1,00,000. Some estimates are even lower than this. India ranks 67^th in the terms of doctor: population ratio in the world. We have about 1 million qualified doctors. It is reported in 2017 that India needs about 2 million more doctors by 2030. Many of our doctors practice in towns and cities. Often, the villages are hardly served by the qualified doctors. The Stats of India released digital map of densities of rural medical facilities that will corroborate that public health is in shamble, leave alone presence of medical personnel (Photo 2).

                    

 

However, the short supply of doctors against demand is arguably justified in the name of quality education that is possible only in the present circumstances with the infrastructure available.

The Government ensures that the overseas medical graduates meet our standards of education. And, it conducts the Foreign Medical Graduate Examination (FMGE) annually and found that only 14.20% of the overseas medical graduates between 2015 and 2018 passed the FMGE to be eligible to practice (Photo 3).  Unfortunately, those who studied medicine in the country like China and Russia performed far poorly than those from Bangladesh and Pakistan in the FMGE. I am sure that the standard of medical education in China and Russia is either at par or better than India, while those in Pakistan and Bangladesh cannot be better than ours. And hence, this test cannot be a true measure of the quality of medical education in those countries or standard of their MBBS students. The FMGE also generated controversy being non-transparent and unfair in the past.

This reminds me of exodus of our medicos to the foreign land in the last century. I happened to meet two doctors in the UK working there. It was said that the UK’s National Health Service may collapse if the foreign medicos are to leave the service. I am not sure if this trend is still on. I met an Egyptian medico in New York intending to study abroad. Surely from his talk, it seems that it is a long road ahead to succeed. One of my relatives who finished his MBBS here just two years back surely tried to go to USA for the higher studies. He seems to have settled here. Reviewing the opinions of others who settled abroad, our own medical education is not up to the standard that the developed countries have.

                        

 

I asked my doctor friends in India as to how our own native MBBS graduates would perform if they have to take FMGE. There is no definitive answer. But more than 50% will clear it as most MBBS undergrads start preparing for their PG exam from 2^nd year onward, says Dr. Pranav Jawade who is doing the PG in Pune. But, surely at the time when I was competing for the All India Agril Res Service examination in mid-1970s, many of those in-service staff members were not sure of clearing it, as they reasoned being old or are not in competitive mode to clear it off. I am sure those who clear Indian Civil Service examinations in India are not in majority from the specialised courses like medicine or engineering. Competitive examinations are not every body’s and every time’s cup of tea. It is all-together different ball game. And this is also a case of overseas medicos appearing in the FMGE.

Fortunately to have a level playing field, the National Medical Commission will soon start the National Exit Test (NExT) for all MBBS students (or only overseas MBBS medicos?) replacing FMGE which will also be used for admission to the PG courses besides being providing eligibility to practice medicine after one year of internship. Hope these are not restricted to two years from award of MBBS degrees as the overseas medicos are in different situations even geographically.

In general, the quality of medical education and of services is not keeping a pace with demands of better infrastructure and human resources in the country, as it keeps upgrading rapidly in the developed countries.

This also reminds me of what we are going through in agricultural sector and its education policy. Recent emphasis on natural farming, zero budget natural farming, organic farming has ignited most to think if this is more to cater to the needs of influential section of the society when majority of population still faces food insecurity. These farming methods disregard the use of fertilizers and agrochemicals which are essential for high productivity.  Their use is reported to be responsible for all ills that the present day agriculture represents. Addressing problems require holistic contemporary approach rather than return to the old-time measures.

India had faced food scarcity in 1960s as food production was not enough for the population we had. We had to live literally ship-to-mouth existence, as the Government depended upon the food imports. Realising the importance of food self-reliance, the Government had taken steps to create exclusive agricultural universities and institutions both at state and national level. And we succeeded to the great extent fulfilling our needs of quality farm education and technology generation. And this helped us achieve self-reliance in agriculture. We produce about 310 million tons of foodgrains and more than 330 million tons of fruits and vegetables annually. We are exporting agri-products earning about US$ 17 billions annually.

Over those years, agricultural education was mostly restricted to the Government sector. However, since 1980s, I learnt the mushrooming of agricultural colleges in the private sector in the South India. And this was because that many who did not get admission in medicine or engineering preferred agriculture for graduation, as there were many opportunities of employment. Later, many states started promoting private agricultural colleges, which led the private sector  to see business opportunities and charged the prospective students hefty fees too.

My colleague who happens to be the Head of Department in the Agricultural University in Maharashtra State talked about the poor conditions of these colleges. Many do not have requisite infrastructure and human resources. These are poorly monitored by the Government accreditation system. Some colleges have however done exceptionally well.

Some of our premier agricultural institutions have contributed unwittingly to the shortage of seats for admission into their M.Sc. and Ph.D., and even for B.Sc. (Agriculture) programmes. My own institution, Indian Agricultural Research Institute used to admit 2-3 students in M.Sc. and 4-8 students in Ph.D. in each discipline annually, despite the fact that there were more faculty members and equally good research setup discipline-wise. At any given time, there are not more than 15-20 Ph.D. students and 5-8 M.Sc. students in a Division of about 25-30 faculty members. This has led to the underutilization of human resources and other facilities and depriving students who have missed the very high cut-off.

India invests about 5% of its budget for agriculture annually. It is about US$40 billion of investment in agriculture. In return, the farm sector contributes 20% to Indian GDP and supports more than 50% of population through employment. Yet rural agro-services (markets, warehouses, cold storages, mills, milk centres etc.) are not as wide spread as expected to provide impetus for its growth (Photo 4).

                    

 

As far as farm research and development investment is concerned, it is poor merely 0.3% of the Agricultural GDP which is less than that of many middle and low income countries like China 0.6%, Brazil 1.8% and South Africa 3.06%. And this has constrained the capacity of the agricultural institutions under the National Agricultural Research System which employs about 27,500 scientists and 1,00,000 supporting staff to function efficiently. Further, most farm universities have not prioritised education and research base, and are content with spread of the existing technologies developed many years ago. The result is that most technologies of present times have not come out of the farm research per se, but from the allied and interdisciplinary sectors such as biotechnology, nanotechnology, ecological engineering, space and information technologies. And these technologies will take years to be implemented for the benefit of farmers. Thus, farmers will have no choice in their utilization, but to wait.

While we may lament now about our students educating abroad and some settling there, and others returning home to find fewer opportunities, much more is needed to churn out the quality education, be it agriculture, medicine, engineering or any other and to broaden the base for the natives at home. And this will not happen with promotion of pseudoscience, when we are at the forefront of fighting hunger and malnutrition, and providing health cover to all. An eminent farm scientist Dr. C.D. Mayee rightly remarked in his post published in Lokmat, Nagpur edition of 2 March 2022 that there is no scope for pseudoscience. India ranks very high amongst the nations where more than 800 million are food insecure in the world. Besides, malnutrition continues to take a heavy toll of many more. As we become the most populated nation in the world by 2027 as per the UN report in 2019, both food and health needs will be the priorities that we must tackle with science and technology for which quality education for most aspirants in all strata of the society is a must.