Suicides by three students in India early this month once again brought into focus the many issues affecting the National Eligibility Entrance Test (NEET), and the resultant pressure it places on medical students.

The NEET is an admission test for undergraduate and postgraduate studies set by most medical and dental colleges in the country. Ever since its inception in 2013, it has been embroiled in a variety of issues.

This year, more than 1.3 million students sat the examination in attempts to qualify for a mere 60,000 seats throughout the country. When results were announced on June 4, a spate of suicides were reported.  Soon after learning she had failed the examination, 17-year-old S Pratibha committed suicide by eating rat poison in the southern state of Tamil Nadu.

In the capital Delhi, 19-year-old Pravar Mehandirata jumped from the 8th floor of his residential building, hours after discovering he had failed for a second time. A suicide note found in his room disclosed that he had lied about his result to his parents, officials at the scene said.

The following day, in Hyderabad state, 18-year-old Jasleen Kaur Saluja jumped ten storeys to her death. Police suspect her low rank in the test prompted the suicide.

Attack on federal structure

The NEET exam is based on a curriculum prescribed by India’s national-level education board — the Central Board of Secondary Education (CBSE). However, every individual Indian state also has its own education board, with major differences in both the syllabus and the languages of instruction. As a result, students studying under state boards end up heavily disadvantaged while studying for the NEET.

To make matters worse, students studying under state boards far outnumber those studying under the CBSE. In Maharashtra state, for example, the number of students studying in the 12th grade state board alone is more than the number of students covered by the CBSE country-wide.

Southern and eastern Indian states, thus, see the NEET as an exam unduly advantageous to north-Indian elites. State governments also say a centralized test like NEET is an attack on the diverse country’s federal structure as it handicaps states which institute tests that reflect their socio-political and linguistic differences.

Take the case of 17-year-old Shanmugam Anitha, who committed suicide over her NEET result in 2017, becoming the face of Tamil Nadu state’s fight against the entrance test.

Daughter of a poor, rural Tamil Nadu laborer belonging to the historically oppressed Dalit caste, Anitha scored 1,176 out of 1,200 in her standard 12 state board exams. The result would have secured her a seat at a prestigious medical college, if the NEET wasn’t the sole standard by which medical university places are decided. Anitha even filed, to no avail, a suit in the Supreme Court seeking a stay on the introduction of NEET. A score of 86 out of 720 on the NEET prompted Anitha to hang herself.

Legal tussles and poor management

Recent suicides have prompted Tamil Nadu advocate AP Suryaprakasham to file a petition at the Madras High Court. The suit seeks to invoke contempt proceedings against the state government for not taking adequate steps to prevent students from making “wrong decisions,” as directed by the same court in August 2017. “The Tamil Nadu government said they constituted special cells (to counsel and guide students), but they have not taken any effective steps on the ground. Everything remains on paper,” Suryaprakasham told Asia Times.

Legal tussles are also making things worse for students. For example, until 2012, Maharashtra conducted a Common Entrance Test (CET) based on the state education board’s syllabus and pattern. Then, in 2013, the students were selected through NEET. But that same year, the Supreme Court declared NEET unconstitutional following appeals from several states and medical colleges. So, in 2014, Maharashtra went back to CET, but this time the examination was based on the NEET syllabus. In 2015, the state changed the CET syllabus again to a state-board based one. Even that only stayed in place until 2017, when NEET was brought back.

“Students prepare for two years to appear for their medical entrance tests. Due to constant last-minute changes to the syllabus, there was no certainty in our preparation. I did not attempt to take the test again to improve my scores as these poorly planned revisions happen every year,” Jasraj Divkar, a medical student from Mumbai, told Asia Times.

The Medical Council of India, which was responsible for the introduction of the NEET, also faces a legal challenge at the Supreme Court for capping the eligibility age at 25 years. Students have termed this limit as “completely arbitrary”.

Until this year, the medical body had also instituted papers in various regional languages, which had different questions. This led to a disparity in difficulty levels, and students appearing for the exam in languages other than English argued that their tests were more difficult.

The NEET also suffers from glaring operational failures. A lack of test centers in some states forces students to travel great distances, which is especially tough for poor students. The father of one applicant, who had to travel more than 300 kilometers from Tamil Nadu to Kerala state, died of cardiac arrest while his son was taking the exam. Reports of fraud and corruption also plague the test.

Students appearing for the NEET this year were also subjected to harassment. An 18-year-old student was forced to remove her bra because it had metal hooks, students wearing long-sleeved shirts were forced to shorten their sleeves, and the pants and pockets of some students were torn to remove buttons, among other incidents.

Such issues affecting the NEET are even more problematic when one considers the acute shortage of doctors in India, where there are just 0.76 physicians per 1000 population.

To rectify these issues, in 2017 the Indian government established a National Testing Agency (NTA) to relieve the CBSE and other bodies of the responsibility of conducting entrance tests and to bring in greater reliability and uniformity across exams. The agency is yet to perform any functions.

The CBSE, meanwhile, has informed the Supreme Court that only one set of question papers would be drafted from this year, which will then be translated into different languages. It will also conduct the NEET twice a year.

Repeated attempts to reach CBSE and Tamil Nadu state officials failed to elicit replies.