High school seniors must pass national board exams to graduate from high school. But those same board exams also serve as the rough equivalent of SATs for students applying to most programs in many universities, especially in the humanities. However, students applying to some universities, especially those with technical programs like engineering, must also take separate entrance exams.

Since admissions are based overwhelmingly on board and entrance exams, testing season has mutated into a period of excruciating pressure for students and their families. The pressure is so intense that a leading diabetes clinic in New Delhi this month attributed a sharp spike in patients with high blood sugar or elevated blood pressure to rising stress brought on by their children’s testing season. Last week, an 18-year-old student in New Delhi hanged himself from a ceiling fan at home after leaving a suicide note worrying that he had not done well on part of the 12th-grade board exam.

The mania over testing underscores a fundamental disconnect in Indian education: Even as elite Indian students have achieved remarkable success studying overseas, the Indian educational system is widely considered to be failing both the tens of millions of students at the bottom, who drop out before high school, and the smaller pool at the top, who are competing for entrance into universities that are too few and too underfinanced.

Education presents such a stubborn problem, especially access to quality education, that experts warn that the future advantages of India’s youthful population could become a disadvantage if the government cannot improve the system rapidly enough to provide more students a chance at college. Of the 186 million students in India, only 12.4 percent are enrolled in higher education, one of the lowest ratios in the world.