The Dravidian Model of Public Health : Daily Current Affairs

Relevance: GS-2:Functions and responsibilities of the Union and the States, issues and challenges pertaining to the federal structure; Government policies and interventions for development in various sectors and issues arising out of their design and implementation; Issues relating to development and management of Social Sector/Services relating to Health.

Key phrases: OBCs quota in NEET, All-India Quota (AIQ) seats for undergraduate and postgraduate, Dravidian Model, reservation for in-service doctors, public health infrastructure, Primary Health Centres, superannuation bond, brain drain,

Why in News?

  • The recent Supreme Court Judgement on OBCs quota in NEET, is a landmark in the history of social justice in the country. In the light of this crucial judgement, it is high time that we demystify the narrow definitions of merit.


  • Supreme Court judgement upheld the constitutionality of reservation for Other Backward Classes (OBC) in National Eligibility cum Entrance Test (NEET)‘s All-India Quota (AIQ) seats for undergraduate and postgraduate medical and dental courses.
  • Supreme Court bench observed that, “The propriety of actions and dedication to public service should also be seen as markers of merit, which cannot be assessed in a competitive examination.”
  • Merit should be socially contextualised and reconceptualised as an instrument that advances social goods like equality that we as a society value.

Key Points on Dravidian Model:

  • In this regard, the practices followed by Tamil Nadu, where the notion of merit has taken into account the role of historical privileges instead of an illusory inborn ability, can be replicated to facilitate social advancement throughout India.
    • Successive governments in Tamil Nadu have had a broad and an inclusive understanding of ‘merit’ and its social implications.
    • Hence, affirmative action to provide reservation for in-service doctors has stood the test of time for well over four decades.
  • The introduction of the scheme reserving 50% of the postgraduate and super-specialty medical seats for government doctors ushered in a commendable shift in providing tertiary health care in government hospitals.
    • It resulted in the expansion of public health infrastructure in the State.
    • This reform paved the way for ensuring the availability of specialists in multiple disciplines such as gynaecology, anaesthesia, general medicine, paediatrics, general surgery and orthopaedics, which were scarce in almost every district headquarters hospital across the State 40 years ago.
    • This was complemented by super-specialty departments like Urology, Nephrology, Cardiology and Neurology in the Madras Medical College (MMC) in the 1960s and 1970s.
    • The provision of reservation for government doctors in super-specialty courses contributed to a steady rise in the availability of multi-specialty experts not only in metropolitan cities like Chennai, Coimbatore and Madurai, but also Tier-2 cities as early as the 1990s.
  • Today, the public health sector in Tamil Nadu has 900 super-specialists in different disciplines, a number comparable only to a few European countries.
  • The unique scheme had a dual effect:
    • It encouraged young MBBS graduates to serve in rural areas, as serving for three years in Primary Health Centres (PHCs) in rural areas is an eligibility criterion for graduates to avail themselves of the reservation policy.
    • As a consequence, State PHCs and government hospitals never witnessed a shortage of doctors and people got better healthcare facilities at their doorsteps.
  • The healthcare managers in the Tamil Nadu government were not short-sighted while formulating the policy.
    • They unveiled a unique superannuation bond for these government doctors to ensure that those who secure postgraduate or super-specialty seats by availing themselves of in-service reservation will serve the government till their retirement.
    • This legal binding has ensured that a vast majority of the specialists continues their service in the government sector throughout their career.
    • The main aim of this superannuation bond was to prevent the brain drain either to the private sector or to places abroad.
    • It has proved to be a win-win situation for doctors and the government.
    • This unique scheme is present nowhere in the country.
  • Experts suggests that if one attempts an objective analysis of the contribution of two prestigious institutions — MMC and IIT-Madras —where ‘bright’ and ‘meritorious’ students land, in societal advancement and regional development, MMC would shine largely due to its adoption of reformatory policies that are consistent with the societal needs of Tamil Nadu.


  • With the introduction of NEET and Regulation 9 by the Medical Council of India (MCI), the admission policy has undergone a sea change. The weightage for government doctors who serve in rural areas has reduced.
    • The MCI has framed a policy of giving only 50% of postgraduate diploma seats to service doctors, exempting postgraduate degrees.
    • Besides lack of consultation with stakeholders, critics suggests that the policymakers in Delhi are yet to put forth their rationale for this myopic view in the public domain.
  • The Union government is opposing the idea in light of the regulations of MCI, a regulatory watchdog without any legal teeth to formulate policy.
    • Union government has even filed affidavits opposing in-service reservation before the Madras High Court and Supreme Court when the new rule was challenged by the Tamil Nadu Medical Officers Association.
  • The State government argues that dismantling incentives to serving doctors would jeopardise healthcare delivery system in the State.
  • Critics argue that this move by the Union government has put the rural healthcare delivery system in peril and pushed young doctors, who find it difficult to compete with their urban counterparts who have access to niche coaching institutes, out of the system to prepare for competitive exams instead of serving the poor in rural areas.
    • As per them, the affidavits filed by the Centre on both the OBC reservation and the government in-service doctors reservation cases in the court are based on a narrow reading of what constitutes merit rather than an inclusive prism called public health.
    • Instead government should widen the scope of a time-tested practice, which would ensure robust supply of specialist and super-specialist doctors to strengthen public health care.
  • Criticism has also been on the lament attitude of Union about the unwillingness of doctors to work in rural areas and its attempt to push them to take up compulsory rural service after MBBS or to introduce a bridge course for AYUSH doctors to incarnate them as rural physicians is purely rhetorical.
  • In continuation of the maladies of NEET, from 2017, it became compulsory for individual States to surrender all the seats of super-specialty courses to the central pool for common counselling, forgoing the domiciliary needs (15% of MBBS seats, 50% of postgraduate seats but 100% of super-specialty seats are surrendered to Centre, which is known as AIQ) and also abolishing government doctors’ reservation.
  • Disposing of a case filed in the Madras High Court by members of the Service Doctors and Postgraduates Association for the reintroduction of 50% service doctors’ reservation in super-speciality courses, the court has directed the Centre to provide reservation for service doctors in super-specialty courses.


  • The government should act in accordance with the recent judgement of the Supreme Court, which has advocated a broader definition of the concept of merit by facilitating a smooth reintroduction of in-service doctors and domiciliary reservation for respective States in super-specialty courses from the current academic admission year.

Source: The Hindu

Mains Question:

Q. Competitive exams do not reflect the economic social advantage accrued to some classes over a period of time and that merit should be socially contextualised. In this context discuss the need for reservation and suggest reforms if any.