Who Will Get Care? The Battle Over Andhra’s Medical Colleges
Hyderabad: The Andhra Pradesh government’s recent decision to hand over 10 newly established government medical colleges to private players under a public-private partnership (PPP) model has sparked a political debate in the state. The ruling Chandrababu Naidu government argues that the move is necessary to address fiscal constraints and ensure faster completion of these institutions. However, opposition parties, student unions and civil society groups have raised concerns about affordability, access and the long-term impact on public healthcare.
The PPP initiative is a departure from the state’s previous policy. Between 2020 and 2022, the Yuvajana Shramika Rythu Congress Party Congress Party (YSRCP) government had allocated about Rs 8,480 crore to establish 17 new medical colleges expected to add 2,550 MBBS seats. However, progress was limited. Official records show that only seven colleges were completed by 2023 and just five admitted new students before the Y.S. Jagan Mohan Reddy government was voted out of power. His government had claimed to have spent nearly Rs 3,000 crore of the proposed allocation.
Proponents of the earlier plan argued that each medical college was designed to function as a hub linking district hospitals, area hospitals and primary health centres. However, independent verification of the operational readiness and tangible impact of these institutions remains limited, raising questions about the effectiveness of the expansion.
Policy change under NDA
Following the change in government in mid-2024 – the Telugu Desam Party (TDP) under Naidu won the election and replaced the Yuvajana Sramika Rythu Congress Party led by Reddy – on September 3, 2024, the Andhra Pradesh Medical Services & Infrastructure Development Corporation (APMSIDC) instructed executive engineers to halt work at two under-construction medical colleges in Adoni and Penukonda.
The TDP had entered the Bharatiya Janata Party-led National Democratic Alliance (NDA) fold in March 2024, months before the state elections. Naidu has remained a constituent of the coalition ever since, including at the centre. In Andhra Pradesh, the coalition is termed Kutami, in which the TDP leads with 135 seats, the Janasena Party has 21 MLAs and the BJP eight.
A year later, in September 2025, the state cabinet formally approved the privatisation of 10 colleges – Pulivendula, Adoni, Markapuram, Amalapuram, Bapatla, Palakollu, Parvathipuram, Narsipatnam, Madanapalle and Penukonda – under the PPP model. A government order subsequently outlined the framework for private participation, inviting proposals from interested entities. With this move, Andhra Pradesh became the first state in India to convert government medical colleges into PPP-managed institutions, marking a significant policy shift.
State government rationale
The Andhra Pradesh government led by Naidu has consistently cited fiscal constraints as the main reason for adopting the PPP approach. The state has a high debt burden and officials argue that the exchequer cannot sustain the cost of salaries, hospitals and teaching infrastructure for all 17 new colleges. Chief Minister Chandrababu Naidu defended the decision, saying that completing and running all 17 institutions solely with government funding would be financially unsustainable.
“We are not abandoning public healthcare,” Naidu said in a statement in September 2025. “The PPP model allows private investment to complete the colleges faster while the government retains oversight and ensures quality standards. This is a practical solution to ensure students gain access to medical education without delays and patients benefit from functional teaching hospitals sooner.”
Naidu also emphasised that fee structures and hospital operations would be closely monitored, assuring that the PPP framework is designed to prevent profiteering and uphold public interest.
Public outrage
Once the privatisation decision was formally announced, civil society groups swiftly mobilised against it. Their protests prompted the YSRCP – initially silent after its electoral defeat – to openly criticise the TDP government, calling the move “a sellout of public healthcare in the name of fiscal reform”.
Reddy argued that the colleges initiated during his tenure were meant to provide affordable medical education and healthcare to the public. He announced a series of statewide protests against the decision. Critics also point out that no other state in India has privatised government medical colleges once they were established, and that earlier PPP experiments in Uttarakhand and Goa were rolled back after public opposition.
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There are fears that tuition fees could rise sharply – NRI quota fees in government colleges have already increased from Rs 20 lakh under the previous government to Rs 37.5 lakh. Higher fees combined with fewer government quota seats could make medical education less accessible to middle- and lower-income families. Critics also warn that teaching hospitals attached to privatised colleges may increase treatment charges, reducing access for poor patients.
Lessons from other states
PPP ventures in medical education in Goa and Uttarakhand were shelved following public protests. States like Tamil Nadu and Kerala continue to operate all government medical colleges under public management. Even in states such as Telangana, Uttar Pradesh and Madhya Pradesh, where private participation in healthcare is significant, government medical colleges remain under state control. In light of these experiences, the Andhra Pradesh government has struggled to address the concerns raised by civil society.
For students aspiring to study medicine, the privatisation policy represents a significant financial burden. Andhra Pradesh already sees many students opting to study MBBS abroad due to limited seats and high fees in private institutions.
Beyond education, critics warn that the policy could also affect healthcare delivery. If teaching hospitals raise their fees, lower-income patients may be forced to rely on overburdened primary health centres or private hospitals, undermining district-level healthcare access.
Several key questions remain unanswered. While Chief Minister Naidu has stated that tuition and hospital fees will be monitored to ensure affordability, it is unclear how effectively such caps will be enforced. Will private operators maintain educational and healthcare quality while prioritising public interest? How will accountability and oversight be ensured? The answers will determine whether this policy is remembered as a pragmatic reform or a setback for public healthcare in Andhra Pradesh.
The privatisation of government medical colleges in Andhra Pradesh has become a major policy and political flashpoint. While the government stresses fiscal responsibility, critics raise concerns about affordability, access and equity in healthcare and education. How these PPP arrangements are implemented and monitored will shape the future of medical education and healthcare delivery in the state and may set a precedent for others to follow – or avoid.
Balakrishna M. is a senior journalist.
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