Rx: More medical colleges

From lowering the infrastructure focus meaningfully to harnessing existing healthcare capacity for training medical personnel, the government has many options.

The All India Higher Survey of Higher Education (AISHE) 2019-20 shows that just seven states in the country—Tamil Nadu, Karnataka, Maharashtra, West Bengal, Telangana, Gujarat and Kerala—account for 65% of the country’s 315 medical colleges. Uttar Pradesh, whose projected 2021 population is close to three times that of Tamil Nadu and seven times that of Kerala, has a lower number of medical colleges than both; Tamil Nadu, with 42 medical colleges, has the highest number.

UP is not the only big state to record low numbers; Bihar, Madhya Pradesh, Rajasthan, and even Andhra Pradesh, seem to suffer from a deficiency of medical education infrastructure. The AISHE is based on responses from the institutions in the states, so there could be some under-counting. Nonetheless, the picture for most states is unlikely to get drastically altered if the institutions that missed getting counted in the survey are factored in.

Against India’s 66 medical education universities offering an MBBS intake capacity of around 80,000 a year, the now-defunct Medical Council of India recognised degrees from 45 medical universities from China alone. No wonder, thus, in 2019, 21,000 of 23,000 Indian students studying in China were pursuing medical degrees. India’s deficiency is of particular import in the context of Covid-19, where trained manpower is crucial to management of the pandemic even as experts like Dr Srinath Reddy of PHFI and Dr Devi Shetty of Narayana Hridayalaya have flagged the chronic shortage of healthcare personnel across domains (doctors, nurses and other paramedics, etc).

The lack of medical education infrastructure, apart from contributing to the shortage of doctors, has also led to a host of other problems—the stiff competition for seats has meant many students who are far more deserving don’t make the cut while management quota seats are, in a manner of speaking, sold to the highest bidders; experts estimate money flowing through the capitation-fee route, not all of it ‘white’, could run into many thousands of crores of rupees.

This is linked to the restrictive standards that India sets for approval of medical colleges. While an infrastructure-focus is necessary, India’s is too acute, resulting in large costs incurred in setting up medical colleges.To highlight the problem, Dr Shetty has often contrasted it with 35 Cuban medical colleges of under 50,000-sq-ft area training medical graduates for the US.

Some solutions should have been clear to the government by now; indeed, this newspaper has highlighted expert-advice on the matter on many occasions. From lowering the infrastructure focus meaningfully to harnessing existing healthcare capacity for training medical personnel, the government has many options.

Turning district hospitals into medical colleges, subsidising private hospitals with 300-plus beds, run by charities/trusts, to offer graduate medical education, 100-bed hospitals to offer nursing courses, etc, are all workable solutions. If medical education in the country continues to be an elite affair—with a first-world regulatory structure, as Dr Shetty put it an Idea Exchange interview—it is only India’s healthcare that will suffer.