Within this context, what does the RPD Act say about reservation in education? And does the current eligibility for nursing courses discriminate against persons with disabilities?

Background

Nursing stands out as a significant segment within the health care industry. The practice is regulated by the INC, an autonomous body under the Ministry of Health and Family Welfare, established by the Central government under Section 3(1) of the Indian Nursing Council Act, 1947. Its primary aim is to set uniform training standards for nurses across the country.

In 2020, the INC implemented a new regulation, which was complemented by a notification from the National Testing Agency (NTA), the body responsible for conducting examinations. This regulation stipulated the reservation of 3% of total seats for individuals with disabilities, limited to those with lower limb disabilities ranging from 40% to 50%. However, this provision contradicts the RPD Act of 2016, which mandates a minimum reservation of 5% of seats in higher education for individuals with benchmark disabilities (Section 32), defined as at least 40% disability of any type recognised under the RPWD Act 2016, which includes low vision, hearing impairment and locomotor disability, amongst a list of 21 such disabilities.

These exclusionary policies stem from misguided perceptions regarding the capacity of persons with disabilities to contribute to the health care system. They manifest as legislative, systemic, procedural, and attitudinal hurdles, impeding the inclusion of individuals with disabilities from a range of professional roles, particularly in health care related occupations. Such barriers not only obstruct access but also undermine the potential of a diverse and inclusive health care workforce, thereby necessitating a critical reevaluation of existing policies and practices.

History of reservation for PwDs

Satendra Singh, a leading figure in the disability rights movement, has filed this petition challenging the regulation of the INC as arbitrary and discriminatory. “A barrier at the entry level incapacitates many persons with disabilities, rendering all subsequent employment safeguards ineffective. If persons with disabilities are prevented from pursuing nursing education, it not only hinders their professional growth but also undermines the principle of equal opportunity, and non-discrimination,” Singh said.

Historically, PWDs in India have been pushed to the margins, and often not considered by policymakers. This excludes them from several key aspects of leading a meaningful life.

The 15th report of the Standing Committee on Social Justice and Empowerment (2014-15) of the 16th Lok Sabha emphasises the significance of the RPD Act, 2016, which replaced the earlier 1995 version of the legislation. While lauding the new legislation, the report noted, “… the disabled group in our country still remains an invisible group in the mind of policymakers. A vast number of the disabled are excluded from the existing services and programmes. No country or society can ever progress or develop ignoring [the] needs and aspirations of millions of its people…”

The RPD Act aimed to ensure that the diverse and heterogeneous needs of persons with disabilities are reasonably accommodated, as they navigate through inaccessible social barriers. It expanded the reservation from the earlier 3% for seven categories of PWDs to now 5% for 21 recognised PWDs.

Effect of discriminatory INC regulations against PWDs

The seemingly tokenistic reservation offered by the INC, which reserves seats for a specific disability based on narrow criteria, could stem from the necessity of assessing the competencies of PWDs to fulfil the operational requirements within the medical profession. It also raises ethical and safety concerns related to the patients. Nevertheless, without substantial evidence demonstrating that individuals with disabilities pose a threat to patient safety, and with advancements in health care technology, such classifications are outdated.

The RPD Act, 2016 maintains a broad and adaptable concept of 'reasonable accommodation' to address the diverse contexts impacting the lives of PWDs. Ensuring reasonable access to the medical profession involves delicately balancing the potential health and safety risks with the rights of disabled individuals within existing structures and practices. The objective should be to minimise barriers to learning and performing health care services, rather than implementing restrictive and unsubstantiated eligibility criteria, thereby further marginalising the rights of PWDs.

Furthermore, facilitating access for persons with disabilities to the nursing profession is crucial for realising the SDG of universal health coverage. India, along with numerous other African and Southeast Asian nations, grapples with a shortage of nurses. The World Health Organization (WHO) recommends a ratio of three nurses per one thousand population, yet India faces a deficit with only 1.96 nurses for every 1000 individuals. With the courses that the INC offers, it makes space for approximately 2 lakh people to enter the graduate nursing course every year, and if the 5% reservation, as mandated under the RPD Act, 2016 is considered, it would make space for the potential additional entry of 10,000 persons with benchmark disabilities each year.

The judiciary has played a significant role, along with PWDs in striking down barriers in the medical graduation courses. They have positively responded to challenges in the past and compelled the Medical Council of India to introduce significant changes to its admission criteria for PWDs in 2018. It is the result of litigation challenges that under the new notification, persons with benchmark disabilities within the range of 40%-80% can pursue MBBS, in the absence of specified gross sensory impairments. However, ironically, while one may be eligible to pursue MBBS given their impairments, the same person under the current restrictive INC criterion is not eligible to become a nurse.

The recent directives from the Delhi HC present the INC with a unique opportunity to re-imagine the entry of PWDs in the nursing profession. Through its decision, the court has effectively offered to the INC to reconsider its arbitrary eligibility criteria that overlook the strengths and potential of individuals with disabilities and to shift towards a more scientific and inclusive approach, fostering a more equitable and diverse health care workforce.

Shrutika Pandey is a lawyer and researcher specialising in access to justice. She engages in developing strategies to advance the rights of undertrial prisoners through legal representation, research, and advocacy. The author was amongst a team of lawyers who represented the petitioner in court. The views expressed are personal.