The debate about the National Eligibility-cum-Entrance Test, the deciding factor in admissions to all undergraduate medical and dentistry colleges around the country, has flared up again with the death of S Anitha. The 17-year-old student from Tamil Nadu, who had challenged the applicability of the exam in the Supreme Court, committed suicide on Friday, allegedly after failing to secure a medical seat.

Anitha had got 1,176 out of 1,200 in her Class 12 examinations under the Tamil Nadu state board – a score that would have easily got her into a government medical college in any other year. But this year, Tamil Nadu joined all the other states in admitting students into undergraduate medical programmes through the national-level entrance test, which was made mandatory by the Supreme Court in 2016. Anitha appeared for the National Eligibility-cum-Entrance Test and scored just 86 out of 720.

Students from state boards have fiercely resisted the national exam conducted by the Central Board of Secondary Education, alleging that it is based on the central board’s syllabus, which is vastly different from the ones they follow. The matter is of particular concern for students like Anitha, from economically disadvantaged and rural backgrounds with no access to coaching or any additional support. Nationwide protests delayed the implementation of the exam, initially set for 2012, by several years. But it became a reality in 2016.

The Tamil Nadu government’s attempts to wriggle out of the exam – through Bills, ordinances and negotiations with the Centre – failed. On August 22, the Supreme Court dismissed Anitha’s petition too.

In the wake of her death, supporters and opponents of the National Eligibility-cum-Entrance Test are once again locked in battle. Supporters insist that the exam is a check on corruption and the commercialisation of medical education, and the only means of ensuring the meritorious get admission and quality of education is maintained.

Detractors have once again raised questions about equality of access and marginalisation. Pointing to the disparity in Anitha’s performance in the board exam and the entrance test, they have also questioned the viability of a test based on one board’s syllabus being imposed on all students and the role that private coaching plays in a candidate’s success.

Commercialised education

Gulshan Garg, chairman of the Delhi-based Sankalp Charitable Trust, has been a part of various Supreme Court cases as a supporter of the National Eligibility-cum-Entrance Test since December 2012. He said he “never wanted for anyone to die” but insisted that the exam was not responsible for Anitha’s death.

The test ensures “the best people” enter the medical field and keeps a check on corruption, according to the former army doctor. It was introduced to “control the private colleges”, he added. He explained: “More than half the medical colleges are private. By 2010-2011, many were admitting without any form of screening of candidates. Seats were booked two-three years in advance. Colleges, schools, administrators and politicians were all in it together. Not only was the quality of doctors emerging poor, they ended up caring more about recovering the massive amounts they had spent than patients.”

In December 2010, the Medical Council of India, the country’s medical education regulator, had amended existing regulations to make way for a national-level entrance exam for admission into undergraduate medical (MBBS) and dentistry (BDS) colleges. This was apparently done to streamline and centrally monitor the admission process. The national exam would replace all existing admission mechanisms in the states, including the state-level “common entrance tests”.

For Garg, as well as a large section of the medical fraternity and later even the Supreme Court, a common, uniform test means meritorious students enter the system and commercialisation of the sector is checked.

But not everyone is convinced. According to Chennai-based education activist Prince Gajendra Babu, the National Eligibility-cum-Entrance Test has had a very different impact. “Fees have increased to an extent that without Rs 80 lakh-Rs 1 crore, you cannot complete the five years in a private college,” he said. “Some candidates with scores that are not high enough for government colleges but still good for private ones are finding it impossible to pay and are opting out of medicine altogether. Those seats are being filled by students with very low scores but more money. This was happening before, so what difference has NEET made?”

Nationwide protests against the National Eligibility-cum-Entrance Test delayed its implementation for several years. But in 2016, it was made mandatory for admissions to all medical and dentistry programmes by the Supreme Court. (Credit: HT)

Merit and quality

The debate also rages over the quality of medical education, and the impact of the National Eligibility-cum-Entrance Test on it.

Garg insisted “an entrance examination common throughout the nation” is the only way to achieve and maintain a high standard of medical education. Such uniformity of standards cannot be guaranteed if states hold their own entrance exams based on the syllabi of their school education boards. “If they will not accept a common standard, then let them practice only in their states,” he said.

But Mariappan Veerapandi of the Students’ Federation of India, a Left-wing organisation that had campaigned against the national exam, bristled at the suggestion that doctors graduating from Tamil Nadu colleges may be sub-par. “You should come to Chennai, we have good doctors and we even have medical tourism because of them,” he said. He added that the state board syllabus is different from that of the central board, not inferior to it. In Anitha’s case, what she lacked more than anything else was “exposure”, he said.

Babu was more blunt. “Merit is a myth”, he said, adding that the National Eligibility-cum-Entrance Test has little to do with gauging it. “If the standard of NEET is higher, why have students who have scored high in NEET not done equally well or better in their board examinations?” he asked.

According to the activist, such gaps reveal “the hand of coaching institutes”. He said, “Those who have done well, irrespective of the board, have been coached. A large number of students who appeared for counselling this year had spent one-two years preparing at home after school.”

Veerapandi pointed out that coaching can cost as much as Rs 4 lakhs – well beyond the means of students such as Anitha, the daughter of a daily-wager.

The Tamil Nadu government had used this very argument in 2005 to abolish state-level common entrance tests for technical and professional programmes, saying these exams were a “traumatic experience” for students, encouraged coaching and placed rural children at a disadvantage. Years later, it used the same arguments to oppose the National Eligibility-cum-Entrance Test.

CBSE and state board

While the argument that a test based on the central education board’s syllabus is detrimental to students from state boards has been a big part of the resistance to the National Eligibility-cum-Entrance Test, there is another area of concern – the language in which the test is taken.

This year, the National Eligibility-cum-Entrance Test was conducted in 10 languages, including Tamil. And it led to candidates in several states filing petitions in courts alleging different questions and difficulty levels in papers in English and in regional languages.

To Garg, such concerns do not mean the national exam should be dropped, only that it should be supported and improved. “Throughout India, medical courses are taught in English,” he said. “Even if candidates write the test in another language, how will they cope once they are in college?”

He pointed out that just 15% of seats in state-run institutions come under an all-India quota – that is, students from across the country are eligible for these seats – and students from within the state “compete among themselves” for the remaining 85%. “NEET is only the test,” he said. “We are not disturbing the quotas or reservations.”

However, Veerapandi pointed out that even among the 85%, students from Central Board of Secondary Education schools have an edge over those from state boards.

Tamil Nadu had made an attempt to reserve this 85% of seats for state-board students but this was defeated in the Supreme Court in August.

Babu’s take on this problem is different. He believes the problems with the National Eligibility-cum-Entrance Test will persist no matter who conducts it and even after state syllabi are revised. “It will simply lead to classroom teaching being replaced with coaching,” he said. “It will impact not just those who secure seats in medical colleges but the lakhs who appear for the exam after neglecting their regular course-work and consequently leave school without picking up essential skills.”