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5 May 2016 Editorial


5 MAY, 2016

Bitter medicine for the Centre

The Supreme Court has given the Centre a deserved rebuke by using its extraordinary powers and setting up a three-member committee headed by former Chief Justice of India R.M. Lodha to perform the statutory functions of the Medical Council of India. The government now has a year to restructure the MCI, the regulatory body for medical education and professional practice. The Centre's approach to reforming the corruption-afflicted MCI has been wholly untenable; the Dr. Ranjit Roy Chaudhury expert committee that it set up and the Parliamentary Standing Committee on Health and Family Welfare in the Rajya Sabha had both recommended structural change through amendments to the Indian Medical Council Act. Now that the Lodha panel will steer the MCI, there is hope that key questions swept under the carpet at the council will be addressed quickly. Among the most important is the need to reduce the cost of medical education and increase access in different parts of the country. This must be done to improve the doctor-to-population ratio, which is one for every 1,674 persons, as per the parliamentary panel report, against the WHO-recommended one to 1,000. In fact, it may be even less functionally because not all registered professionals practice medicine. In reality, only people in bigger cities and towns have reasonable access to doctors and hospitals. Removing bottlenecks to starting colleges, such as conditions stipulating the possession of a vast extent of land and needlessly extensive infrastructure, will considerably rectify the imbalance, especially in under-served States. The primary criterion to set up a college should only be the availability of suitable facilities to impart quality medical education.

The development of health facilities has long been affected by a sharp asymmetry between undergraduate and postgraduate seats in medicine. There are only about 25,000 PG seats, against a capacity of 55,000 graduate seats. The Lodha committee is in a position to review this gap, and it can help the Centre expand the system, especially through not-for-profit initiatives. There is also the contentious issue of choosing a common entrance examination. Although the Supreme Court has allowed the National Eligibility-cum-Entrance Test, some States are raising genuine concerns about equity and access. A reform agenda for the MCI must include an admission procedure that eliminates multiplicity of entrance examinations and addresses issues such as the urban-rural divide and language barriers. The Centre's lack of preparedness in this matter, even after it was deliberated by the parliamentary panel, is all too glaring. The single most important issue that the Lodha committee would have to address is corruption in medical education, in which the MCI is mired. Appointing prominent persons from various fields to a restructured council would shine the light of transparency, and save it from reverting to its image as an "exclusive club" of socially disconnected doctors.

NOTA on my ballot

Voters in this round of Assembly elections have made or will make, depending on where their constituencies fall in the staggered poll schedule, acquaintance too with a new symbol on the ballot. The last option on the electronic voting machine now carries a symbol of a big, fat cross mark to denote “none of the above”, or NOTA. It was designed by Ahmedabad’s National Institute of Design — and its introduction may focus attention on the ways in which this tool is being used by voters to drive home a message. Just recently, women activists in Kerala launched an awareness programme, asking voters to hit the NOTA button if they do not see women candidates in the fray. Of course, should the number of NOTA votes in a constituency of women-less candidates top even those of the highest-polling contestant, he will still get elected. In its landmark judgment in September 2013 ordering the inclusion of the NOTA option, the Supreme Court had clarified that a high NOTA count would not invalidate an election and the highest-polling candidate would be declared elected. The voter essentially got a method to register discontent, a protest that became unavailable to her with the shift to EVMs. Earlier, voters could deface the ballot paper or leave it unmarked to cast an invalid vote. With EVMs, a vote is deemed to have been taken place only when a button is pressed. Voters can still fill a form under Rule 49-O of the Conduct of Election Rules to invalidate votes, but the process is not anonymous.

Unlike invalid paper ballot votes, there is nothing ambiguous about choosing the NOTA button. There was no way to determine if a paper ballot had been rendered invalid unwittingly or by design. Voting NOTA is a statement of intent. And less than three years into its existence, perhaps we are still to distil the messages in its tally. For starters, the fact that on average NOTA votes tend to be just over 1 per cent of total votes cast, suggesting that cynical lump-all-politicians attitudes are not exactly prevalent. Voter turnouts in Indian elections continue to be staggeringly high, and the voter clearly does not go through the trouble of getting to a polling booth just to reject everybody. But there are cases where spikes in the NOTA tally may tell a story. In the 2013 Assembly elections in Chhattisgarh, for example, it was more than 3 per cent of total votes cast — indicating possibly coercion (whereby a voter forced to cast her ballot beats the effort by invalidating it) or relatively higher alienation. Or consider an analysis in this newspaper that found NOTA votes are disproportionately higher in reserved constituencies, at the Lok Sabha and Assembly levels, revealing an undercurrent of social prejudice. For most candidates, however, it will remain an exercise in getting every potential NOTA vote — so that like Kannur’s runner-up in the 2014 Lok Sabha election, they are not hit by a margin of defeat that is less than the NOTA count.


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