Karnataka is the state where I have conducted most of my research and based my thesis on certain policies followed by the government. Therefore I thought it is appropriate to broadly describe this state especially to those with a limited awareness of it. The State of Karnataka is situated in the southern part of India.Karnataka lies between latitudes 11.31 and 18.45 degrees north and longitudes 74.12 and 78.40 degrees east, on the western part of the Deccan plateau. The state is the eighth largest in the country in both area and
population. Karnataka's plains, plateau and coastline cover 191,791 sq. kms. It was formed in 1956 by joining the old state of Mysore and its bordering areas where Kannada was spoken. Each of these territories had been under a different administrative system in the erstwhile states of Madras, Hyderabad, Bombay and Coorg so each had different levels of development. This is one of the significant reasons for the variation in development and infrastructure across the state. However after 1956 the state was brought under one administration and there has been an effort to improve services in the less developed areas. Today, Karnataka has a population of around 53 million people (Census 2001).
The state has four natural regions extending over 700 kms from the north to the south and 400 kms from the east to the west, with each having its distinctive characteristics. First the coastal area covering Dakshina Kannada (Mangalore district) and Uttara Kannada districts (Karwar District) is a narrow strip between the Western Ghats and the Arabian Sea. The region is characterised by heavy rainfall - 2500 mms to 3000 mms. Second, the coast is hemmed in on the east by the Western Ghats; the Ghat or malnad region covers the districts of Chikkamagalur, Hassan, Kodagu (Madkeri district) and Shimoga and the uplands of Uttara Kannada district. 43% of the forests of the state fall within this area. Plantations of coffee, pepper, cardamom and rubber are interspersed with dense forests. The maidan (plains or open spaces) region falls into two broad sections. The third natural region, the south maidan has rolling hills and is drained by the Kaveri and its tributaries- the Harangi and the Hemavathy-as well as by the Tungabhadra. Rice, ragi, coconut, sugarcane and mulberry are the principal crops. Fourthly the northern maidan is less developed, receives low rainfall and supports jowar (sorghum), cotton, oilseeds and pulses. The Krishna and its tributaries-the Malaprabha, Ghataprabha, Tungabhadra and Bheema -are the principal rivers of the northern plateau. Karnataka is India’s second most arid state. Statewide figures mask significant disparities: parts of Karnataka are quite developed; others, especially in the north, are backward. Administratively, the state is divided into 27 districts. Today, the state is best known for its software industry. Biotechnology is gradually emerging as a new area. Its capital, Bangalore, also called the Electronics city, is one of the fastest growing cities in Asia and is home to industries like
aircraft-building, international call-centres, telecommunications, aeronautics and machine manufacture (WHO 2005c).
Physical map of Karnataka. District Map of Karnataka.
The potential of medical education in Karnataka.
The numbers of medical colleges are much higher in Southern India when compared with the rest of India for the year 2000, if one considers dividing India into north and south regions. The states of Andhra Pradesh, Tamil Nadu, Karnataka and Maharashtra account for 81 of the 181 medical schools throughout India (PCI 2005). Karnataka has one of the highest numbers of medical colleges in India, having 29 recognised institutions at present and there is a further proposal to allow another 5 colleges subject to getting approved by various bodies and crossing other legislative hurdles. Maharashtra state has the highest number of medical colleges in India at present having 31 recognised institutions and a few more which will be recognised in the course of time. However the population of Maharashtra is 97 million nearly twice as much as Karnataka State. Therefore the proportion of medical colleges to the population is much higher in Karnataka than Maharashtra even though the latter has more medical colleges than Karnataka. Apart from having a high number of medical colleges Karnataka has 39 Dental colleges also a number of Pharmacy and Nursing Colleges. According to the Rajiv Gandhi University of Health Sciences (RGUHS1) Karnataka, a university created in effect to act as a conglomerate body with regards to health sciences.
“There are 242 colleges conducting undergraduate courses, 68 institutions conducting post graduation courses and 6 institutions offering super speciality courses in the field of health sciences such as medical, dental, nursing, pharmacy, physiotherapy, Ayurvedic, homeopathy, Unani, and paramedical under the jurisdiction of RGUHS. About 13,000 under graduate, 2000 post graduate students and 30 Super Speciality students are admitted in different faculties of health sciences from this university every year. About 10,000 teachers are engaged in different faculties of health sciences in this university”. As accessed
on web.
Karnataka State takes pride in being one of the leading states in India for providing medical education where it benefits not only the population of Karnataka but also many students from
1 RGUHS is a university created to over see and guides all educational institutions that are relevant to health sciences and research e.g. medical colleges, dental colleges, nursing and pharmacy colleges. It directs them with regards to setting the curriculum, setting standards, examinations etc.
all parts of India who come to access various courses. The fact that many students come from many states in India to Karnataka is mainly triggered by the fact that many states do not have enough medical institutions to cater for the apparent demand for medical education within each state e.g. Andhra Pradesh until recently had only 16 medical colleges for a population of 75 million, thus a lot of students from Andhra come to Karnataka to study medicine. Similarly Tamil Nadu has 17 medical colleges but has a population of 62 million. However in states like Andhra Pradesh there appear to be ongoing plans in the near future to recognise more institutions so that they can cater for their students within their state. The fact that the introduction of new medical institutions is not taking place at the rate of population growth in India is primarily due to the Medical Council of India and other relevant authorities. On the one hand they do not want to dilute the standards of medical education by allowing an unmanageable number of institutions. On the other hand the government’s failure to start new medical colleges is usually under the pretext of severe financial burden hence it has the option of asking private bodies to take up the opportunity. However allowing private bodies to start new medical colleges usually raises a lot of complex problems as there are vicious political wrangles involved with regards to whom the state allows to run medical colleges. This is because many medical colleges are run on a profit2 basis making it very lucrative. Hence a lot of people are keen to get permission to run such colleges. Quite often very powerful lobbies try very hard to find the favour of the government to fulfil their pursuit of managing medical colleges. Therefore it becomes quite hard for the government to choose a particular lobby; hence they prefer the status quo rather than siding with any particular group or institution.
Currently medical students are recruited under the government scheme into colleges after fulfilling the following conditions: after scoring 50% and above in their pre university exams and also after excelling (80% and above) in the Common Entrance Test (CET). There are some exceptions to these rules e.g. students who belong to scheduled castes or scheduled tribes can get in with 40% marks in their pre university exams and a lower score in the CET yet are allowed to apply for medical college. The Government of Karnataka (GOK) has a mechanism to ensure that private medical colleges take a significant number of medical
2 Profits of running medical schools are gained by offering medical seats for a premium fee usually in the guise of fees, donations, contributions etc. Currently it is in between £15000-£25000 for Indians and £25000- £40000 for non-resident Indians and foreigners. Private medical colleges usually offer medical seats under their own management i.e. the seats remaining after taking the required number of seats under government obligations. Those who are taken under government quota only pay about £5000 for their education.
students from the pool of students who have fulfilled the government criteria. There are three types of seats made available in various colleges within the State of Karnataka. 1) Free seats or merit seats 2) payment seats 3) management quota (5% Non Resident Indians NRI quota). Currently 50-80% of all those students studying in private medical colleges are recruited from those who fulfil the criteria set by the government. GOK has done this in order that the private medical institutions do not put medical education out of reach of the general public by charging enormous fees and donations, which most Indians cannot afford; therefore GOK has introduced a very structured fee norm and caps the amounts a college can charge depending on the category of seat each individual falls under. There are certain exceptions to the rules stipulating the number of seats private medical colleges should take from those who fulfil the government criteria under various clauses and reservations, for example institutions managed by minorities i.e. Christians and Muslims have been given much more flexibility, as they are given a leverage where they need not take in the stipulated number of students under the government list in order to cater for students of their faith.
However the present system of recruiting new students into medical colleges involves a practice where it is engineered so that a majority of seats are also reserved for those who have at least 7 years or above of academic studies in Karnataka. Only after filling all the seats available for students of Karnataka are other candidates given a preference. Karnataka has such a high number of medical colleges and all of them combined produce an estimated 2400 undergraduate medical doctors every year. However this apparent high number of medical institutions and high output of medical personnel does not appear to have any significant impact on the population in terms of improving health indicators compared to other Indian states.
Karnataka’s health indicators are only marginally better than the national average in certain aspects (see Table 1) and it is lagging behind some of its neighbouring states with respect to certain demographic indicators. Of course the high output of medical students in Karnataka will not necessarily mean that all of these graduates will stay in Karnataka after graduating, as many out-of-state graduates tend to migrate back to their own state after completing their studies. Another factor is that there is not an equal spread of medical colleges within the state and almost all these colleges are concentrated in urban areas and more affluent regions of the state, therefore mainly benefiting the urban population. In certain places many medical colleges are concentrated in a few cities whereas some towns are not represented. For
example in Bangalore there are 7 medical colleges and Mangalore 5 medical colleges whereas in many districts like Bidar there is no medical college (in 2007 a medical college was established in Bidar). The GOK is attempting to address the problem by issuing permission to start medical colleges in un-represented areas in the near future.
Karnataka has got the advantage over many states in India of being a centre for medical education and has the facilities and infrastructure to cater to postgraduate and other higher studies. However it is in its interest that it makes moves to ensure that the population benefits from this apparent advantage of having so many institutions of excellence.
Table 1 Certain demographic indicators of India comparing Karnataka with the neighbouring states. According to Census 2001 States/Union Territory Population (In million) Annual Exp. Growth Rate (%) Female Literacy (%) 7 yrs.& above Sex Ratio (Females Per 1000 Males) Crude Birth Rate (2000) SRS▼ Crude Death Rate (2000) SRS Natural Increase (CBR- CDR) SRS Infant Mortality Rate (2000) SRS Total Fertility Rate (1999) SRS India 1,027,015 1.93 54.20 933 25.8 8.5 17.3 68 3.2 Karnataka 52,734 1.59 57.45 964 22.0 7.8 14.2 57 2.5 Andhra Pr 75,728 1.30 32.70 978 21.3 8.2 13.1 65 2.4 Maharashtra 96,752 2.04 67.51 922 20.9 7.5 13.4 48 2.5 Tamil Nadu 62,111 1.06 64.55 986 19.2 7.9 11.3 51 2.0 Goa 1,344 1.39 75.51 960 14.3 7.4 6.9 23 1.0 Kerala 31,839 0.90 87.86 1058 17.9 6.4 11.5 14 1.8
Certain Poorly Performing States
Uttar Pr 166,198 2.30 42.98 898 31.6 9.7 21.9 80 4.7
Jharkhand 26,946 2.09 39.38 941 26.4 7.9 18.5 51 N/a
Rajasthan 56,507 2.49 44.34 921 30.6 7.7 22.9 78 4.1
Madhya Pr. 60,348 2.18 50.28 919 30.4 9.8 20.6 85 3.0
Orissa 36,805 1.48 50.97 972 23.2 9.8 13.4 87 2.8
Source: Department of Family Welfare GOI. ▼Sample Registrations Scheme (SRS)
Comprehending certain gender differences observed in Karnataka.
According to Table 1 a key statistical figure stands out amongst the various indicators. That is, the number of females is far less than males in India and most of its states. In this section I would like to discuss some aspects of the disadvantageous position the female population has in Indian society and aspects seen in Karnataka state. Before I examine aspects of gender differentiations I would like to state my position and views on this topic. I broadly agree with the view that unless there is a substantial improvement in the lives of the female population through far-reaching socio-economic, cultural and political change, it will be highly unlikely
to see women benefiting in Indian society (Asthana 1996). Declining female population is an ongoing problem and it is a serious issue that will need to be tackled in order to solve this imbalance. Interestingly unlike developed countries and even some of India’s neighbours India has more males than females, which in itself is quite alarming due to the adverse consequences that will occur if this trend continues. If one takes into account updated world estimates of the gender balance the male population is around one male to one female (UN2004). India portrays an unhealthy picture of showing such a high proportion of the male population over the female population; this is applicable to most states in India apart from Kerala and Pondicherry, which defy the norm and have a greater female population than male. The reason I say this is an unhealthy situation is because this occurrence has not happened due to natural causes or an isolated event. There appear to be many factors that have caused this feature to exist. There is a strong desire from families to promote males over females in the family as they are traditionally seen as the main breadwinners, protectors and custodians of the family line. At the same time women in Indian society are traditionally known as Praya-Dhan3 and seen as weak, vulnerable, an economic burden with regards to the expenses on dowry which is demanded by their husbands when they are married. In the existing culture most women in India are given a lower status than men and they have well defined roles that they are meant to fit into naturally for example aspects such as marriage, motherhood, catering to family needs which tends to include serving their in-laws and basically being subservient to their husbands in a broad sense. Of course there are exceptions to this assumption such as the Khasi people who predominantly live in the north-eastern state of Meghalaya have a matriarchal society where the women have greater power and sway in that society and men are married on a matrilocal basis without having the traditional rights e.g. to property or family name.
However the example of the Khasi people is an exception to the norm followed by the rest of India. The strong desire to promote males consciously or subconsciously caused quite widespread gender biases to exist. Although there has been quite a lot of reform in India, it is still a predominantly male dominated society where there is a lot of discrimination on the basis of gender. A study conducted by Borooah (2004) highlighted gender biases on the uptake of vaccination and food intake. According to the studies done by Borooah
3 Praya-Dhan means wealth that belongs to someone else. In the sense that although her parents will bring up a ‘girl’, eventually she will belong to her husband and his family and to them her loyalties will lie. Therefore a girl child may be born in a family, but she is seen to be there on a temporary basis, hence an asset that eventually belongs to someone else.
“In respect of vaccinations, the likelihood of girls being fully vaccinated, after controlling for other variables, was 5 percentage points lower than that for boys. In respect of receiving a nutritious diet, the treatment of girls depended very much on whether or not their mothers were literate: there was no gender discrimination between children of literate mothers; on the other hand, when the mother was illiterate, girls were 5 percentage points less likely to be well-fed relative to their brothers and the presence of a literate father did little to dent this gender gap. But the analysis also pointed to a broader conclusion which was that all children in India suffered from sharper, but less publicised forms of disadvantage than that engendered solely by gender. These were the consequences which stemmed from children being born to illiterate mothers and being brought up in the more impoverished parts of India”. p.1719.
The conclusion that Borooah has arrived at stands out quite clearly as the states of Kerala and Pondicherry have high literacy levels amongst their female population 87.86% and 74.13% respectively and these states have 1058 and 1001 females to a 1000 males. On the other hand there is another factor that could take some of the blame for the present lower levels of female population in India. This is the current widespread availability of technology to determine the sex of the unborn child, which could lead to the medical termination of female foetuses. The factors responsible for female foeticide are mainly influenced by the negative images that are associated with females in Indian society, combined with a strong preference for a son along with socio-economic adversities associated with females e.g. the evil of dowry. All of these factors are expedited with the easily accessible and affordable procedure for sex determination during pregnancy and unethical medical practices which are practiced with virtual impunity as only on rare occasions does one find anybody being prosecuted for such practices. To avoid this misuse of modern technology laws have now been passed that do not allow doctors to disclose the sex of children before they are born. However it is yet to be seen how well such laws are enforced.
States like Punjab and Haryana have a very bad record of having 876 and 861 females to