The radiating impact of the war on Ukraine goes far beyond bullets and bombs. The collateral damage can even be felt closer home as 20,000 odd Indian students find themselves in the midst of an unfortunate controversy.
First, the difficulties they faced during evacuation from various cities of Ukraine. Second, the uncertain future. And third, becoming unwitting pawns in the game of politics.
Just as the students were arriving back home with reports of having to fend for themselves, Union Parliamentary Affairs Minister Pralhad Joshi was quoted as saying that 90 per cent of students who go abroad fail the National Eligibility cum Entrance Test (NEET), the qualifying exam for studying medicine in India.
Predictably, Joshi’s statement not only wound up the medical fraternity but also led to retaliatory fire from the Opposition that called it an insult for Indian students.
While it is true that the remarks were insensitive and badly timed, it did bring up the issue of so many Indian students studying in Eastern Europe and of the huge shortage of doctors in the country.
Over 80 per cent of students who go to Ukraine pursue medical, dental and nursing courses. The biggest incentive — much lower fees and cost of living. Also, easier admission norms and access to good jobs. The cumulative MBBS fee in countries such as Ukraine, Uzbekistan, Kazakhstan and Kyrgyzstan is around Rs 35 lakh, including the cost of education and living expenses.
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In contrast, the cost of an MBBS degree in a private college in India is in the range of Rs 75 lakh to a crore. And there aren’t enough seats to go around.
The National Medical Commission, the apex medical education regulator, said Joshi’s remark needed deeper debate on the continuing unaffordability of Indian medical education and the wide gaps between demand and supply.
In 2021, more than 1.5 million students wrote the NEET, which is the qualifier for undergraduate medical courses. But there are only 88,120 seats up for grabs. And out of this around 50,000 seats are at the 313 government-owned medical colleges. Many students who cannot find a seat in the government medical colleges take the next flight out.
Professor Vitull K Gupta, Chairman of the Association of Physicians of India (API) in Malwa, said, “About 15 lakh students appear for NEET, about 8 lakh students qualify for about 90,000 seats where a portion of the seats are reserved restricting the opportunity for students seeking admissions on economical government seats. What choice do they have?”
Note the irony here: Not only is there a severe scarcity of seats, but also a frightening paucity of qualified medical personnel. India has an estimated shortage of 600,000 doctors and 2 million nurses.
In India, there is one government doctor for every 10,189 people, while the WHO recommends a ratio of 1:1,000, or a deficit of 600,000 doctors, and the nurse-patient ratio is 1:483.
The burgeoning Indian healthcare sector is expected to generate demand for 15 million to 20 million new jobs for doctors, nurses and allied health professionals by 2025.
According to a report by consulting firm RedSeer, the number of Indian students opting for higher education abroad grew from 440,000 in 2016 to 770,000 in 2019 and is set to grow further to roughly 1.8 million by 2024.
Compared to this, the number of students domestically increased from 37 million to roughly 40 million between 2016 and 2019.
Even as the number of Indian students opting for higher education overseas grows annually, their abroad spending is set to grow from current annual $28 billion to $80 billion by 2024, according to RedSeer.
What are the factors driving Indian students abroad? Indian students head out due to better quality of education, as well as superior job scope. Indian families doing much better financially lend wings to this move.
As per UNESCO, despite a major pandemic and restricted travel across the world, 91 per cent of Indian students showed interest in pursuing their studies abroad. At least 71 per cent of these students reported better healthcare as one of their reasons to choose to study abroad.
As per the Ministry of External Affairs, in 2020 alone 261,406 Indian students went abroad. Though the number was half of what was experienced in 2019 (588,931), the MEA reported it to be a large count with consideration of the ongoing pandemic. Currently, 71,769 students have been reported by MEA to have moved abroad until 28 February 2021 for study purposes.
Countries like Canada, UK and Germany are on top of the priority list. Next in line are New Zealand and Ireland for the easy facilities they offer.
As per the WES Survey of Prospective Students, US universities witnessed a downward trend in terms of international students’ enrolments. More than 29 per cent of international students were less interested in studying in the US.
Instead of the US, 67 per cent of international students opted to study in Canada, with its friendly visa and immigration policies. Next to Canada, Indian students now prefer to pursue higher studies in the UK because of the Graduate Immigration Route. Students graduating from the UK would be able to work in the UK for up to two years
The cost of studying in the US is very high. If the cost of living is also factored in, to do an MBBS, a student would need to spend at least Rs 3 crore.
Sensing this massive need gap, countries like Malaysia, Thailand, China and Eastern European countries have moved in with their offerings. The maximum demand for MBBS is for destinations like Ukraine, China, Moldova and other Eastern European countries. Ukraine is a preferred destination because of the predominant European culture.
There are 33 medical colleges in Ukraine. The MBBS courses that are offered at these universities are recognised worldwide. However, the students who return to India need to clear the Foreign Medical Graduate Exam (FMGE) to practise medicine here. This brings us to the second part of Union Minister Joshi’s statement that “90 per cent of Indians who study medicine abroad fail to clear qualifying exams in India.”
While Indian students travel to countries like Ukraine in droves, the quality of education remains suspect. More than 4,000 students who have completed MBBS courses in Ukraine take the FMGE exams every year but less than half get through.
This time around the students might be taking a further hit in the form of insurance claims. They may not be able to file claims for any medical treatment, evacuation or study interruption either. This is due to the clause in insurance policies that excludes wars, invasion, war-like situations and so on from coverage.
Prime Minister Narendra Modi has asked the private sector to increase its participation and for state governments to make suitable policies with the aim of producing maximum doctors within the country.
Dr JK Sethi, eminent medical practitioner in Chandigarh, provided another dimension. She says, “Most doctors in India prefer to work in Government hospitals as the conditions and hours are conducive. There is less pressure compared to private hospitals where the revenue angle and excessive commercialisation takes its own toll.” This means the government has to face greater challenges in bolstering its medical infrastructure.
The clarion call has been struck. Implications are clear. Where the government and private sector take it from here is anybody’s guess.
The author is CEO of nnis. Views expressed are personal.
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