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Commenting on the plight of Indian students stuck in Ukraine, mostly pursuing medical education, Prime Minister Narendra Modi said, “Our children today are going to small countries for study, especially in medical education. Language is a problem there. They are still going. Can our private sector not enter this field in a big way?”
The Ukraine war is not the first overseas crisis in which Indian medical students abroad have been caught. When the COVID-19 virus broke out in Wuhan, in late 2019, hundreds of Indian students had to be airlifted and brought back home. It was only in January 2020 that the government managed to bring home a large contingent of Indian students studying medicine in Chinese universities. The airlifting of medical students from Ukraine and neighbouring countries, following the Russian invasion of Ukraine, has helped bring the fact of large-scale student migration in search of medical education to the attention of the prime minister.
Indian students travelling to several middle income countries in the Asian region is not new. The preferred destinations are China, Russia, Uzbekistan, Kyrgyzstan, Ukraine and, more recently, the Philippines. The estimated numbers are quite large and the students who travel are mostly from southern and western Indian states.
An important question that arises is why students are choosing to go to these countries when there is a fairly large number of public and private medical colleges in India. Studies have shown that the lower cost of medical education is an important reason for students travelling to these countries.
A 2019 study of students travelling to China for medical education provided some very interesting insights. This author was one of the study’s authors. It revealed that there is an aspirational middle and lower middle class with rising expectations from urban and rural areas. Parents are financing their children’s professional education by taking loans and selling assets.
Medicine, like engineering, is seen as enhancing one’s social status and chances for making money. For many who travel for medical education abroad are the first generation educated in their families. The entrance to medical schools in India is constrained by numbers, quality and cost. Nearly 60% of medical colleges are in the private sector at the national level. The proportion of private colleges are higher in the southern and western states compared to the northern and eastern.
The aspirants for the available seats is high and those who are able to muster the common entrance exam constitute only a small proportion of applicants. Those with high scores get admission into better ranking colleges. The remaining have to pay high capitation fees to private colleges or travel abroad for medical education. The latter is much cheaper than the Indian private colleges after accounting for tuition fees, travel and living costs.
Most students who travel to middle income countries return to India but have to pass the foreign medical graduate exam that qualifies them to practice. Over the last few years the pass percentage of this exam has been very low, which has resulted in rising anxieties and frustration among students who travel abroad to study medicine.
The recently constituted National Medical Commission (NMC) has not made it easy for these students who were forced to return due to COVID-19 from China and now the Ukraine crisis. Those who are currently enrolled in Chinese medical colleges have only the option of doing online courses due to travel restrictions. The NMC has categorically stated that they will not recognise online classes. The NMC has also not responded to the request of these students to be absorbed by medical colleges in India to complete their education.
With the Ukraine crisis, it is most urgent that the government and NMC find ways of rehabilitating these displaced students. Apart from rehabilitating the displaced students, there are many neglected aspects in medical education policy that require urgent attention. These include regulating the quality of medical education in public and private sectors, regulating the cost of education in the private sector and capping capitation fees.
Also, an important step that needs to be taken is to have a common qualifying exam for all medical graduates, irrespective of whether they are trained in Indian or foreign institutions, to practice. While the priority of the government is to ensure safe passage to Indian students in Ukraine, there are several issues that will need to be addressed to assuage the concerns of displaced students.
Expanding the private sector in medical education, as suggested by the prime minister, is a knee-jerk response to a systemic crisis that requires a hard look and serious policy response.
Rama V. Baru is a professor at the Centre of Social Medicine and Community Health at Jawaharlal Nehru University.