Banjot Kaur 
New Delhi: Prime Minister Narendra Modi, in his speech in Karnataka’s Mandya district on March 13, claimed that his government has increased the number of AIIMS-like institutions by three times. Health minister Mansukh Mandaviya also tweeted on March 14 that in “Modiji ka zamana (Modi’s era)”, AIIMS-like institutions have gone up from seven to 22. The idea for more AIIMS-like institutions was conceived by the Narendra Modi-government soon after it came to power in 2014. But not a single one of these is ‘fully functional’ till date. This was revealed by health minister Mandaviya himself in a parliamentary reply given in the ongoing Budget session.
As many as 16 AIIMS-like institutions have been conceptualised since 2014 under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY). According to the reply given by Mandaviya in the Lok Sabha on February 3, 2023, the 16 AIIMS-like institutions are under ‘various stages of operationalisation’ and only limited out-patient department (OPD) and in-patient department (IPD) services are available.
Some of these 16 AIIMS-like institutions were announced in 2014 itself, for example, AIIMS Gorakhpur (Uttar Pradesh), AIIMS Mangalagiri (Andhra Pradesh), AIIMS Nagpur (Maharashtra) and AIIMS Kalyani (West Bengal). Yet, all of these institutions are offering only limited OPD and IPD services and do not figure in the ‘fully functional’ list.
Only the six AIIMS-like institutions conceptualised during the last NDA government under the leadership of Atal Bihari Vajpayee are fully functioning. They are in Bhopal, Patna, Raipur, Rishikesh, Bhubaneswar and Jodhpur.
While the government didn’t define what it means by the availability of ‘limited OPD and IPD services’, K. Srinath Reddy, honorary professor at the Public Health Foundation of India, said a fully functional OPD would mean all departments, as against a select few, are able to offer consultations to patients. Limited IPD services might include only a very few basic services – at par with or below what district-level hospitals offer.
“They have to give the numbers of patients they have actually seen to make clear what the status is,” Reddy said.
AIIMS Guwahati (Assam), the foundation stone for which Modi laid in 2017, and which celebrated its third institute day recently, is not offering any OPD or IPD services, according to the institute’s website.
In fact, the website says the institute does not have a single clinical department running. Media reports quoted Assam chief minister Hemant Biswa Sarma as saying in December last year that the institute will be formally inaugurated to become operational in 2023.
Though the establishment and running of these institutions is the responsibility of the Union government, the health minister added in his reply that state governments too have a role to play, albeit limited. “The Ministry closely monitors the progress of new AIIMS projects. [The] completion of works depends upon various factors including transfer of encumbrance free land by the state government, regulatory clearances and site specific issues,” he said in the reply.
“An AIIMS-like institute is not merely brick and mortar. To make it fully functional, there have to be human resources [faculty members, resident doctors and nurses] as well,” T. Sundararaman, former head of the Union Ministry of Health and Family Welfare’s National Health Systems Resource Centre, said.
He added that the lack of faculty along with many other infra-related issues can lead to suboptimal functioning of these institutions. “Otherwise, on average, it shouldn’t roughly take more than five years to make them function as per their full capacities,” he added.
Whither human resources?
Both Reddy and Sundararaman stressed that the lack of faculty might be a major speedbump in making these hospitals and colleges functioning. Their apprehensions are reflected in the numbers as well.
According to a reply given by minister of state in the Ministry of Health and Family Welfare in the Rajya Sabha Bharti Pravin Pawar on December 20, 2022, many of these 16 institutions are reporting a shortage of faculty members by half of the sanctioned strength or more. AIIMS, Rajkot has 40 faculty members in place as against a sanctioned strength of 183.
Even the situation of the six AIIMS-like institutions conceptualised under Vajpayee’s regime and termed fully functional in Mandaviya’s reply is poor when it comes to faculty strength. For example, according to Pawar’s reply, AIIMS, Patna, has 162 faculty posts filled as against sanctioned strength of 305 members to be posted on a regular basis.
On the front of non-faculty posts, which may include resident doctors, nurses and paramedical staff, the situation is far worse. In AIIMS, Guwahati, for example, only 95 such posts are filled as against the sanctioned strength of 1,026. In AIIMS, Mangalagiri, conceptualised in 2014, the filled posts are 474 as against 1,054.
Answering a question on why these premier institutions are facing a high shortage of human resources, Pawar said in the Rajya Sabha on March 22, 2022, “As high standards have to be maintained in selection, keeping in view the stature of these Institutes of National Importance, all the advertised positions could not be filled up.”
In another reply given in the Rajya Sabha on March 29, 2022, Pawar admitted that in order to have more faculty members, some of the posts of additional and associate professors have been ‘downgraded’ to assistant professors (so that people with less experience could also be taken on board).
She added the government was carrying out a slew of measures, including temporary diversion of faculty members from one department to another on a ‘loan basis’ and filling up of AIIMS posts by taking serving faculty members from other government medical colleges there on a deputation basis.
However, what also seems to have hurt the prospects of these institutions is the government’s proclivity to employ doctors in AIIMS on a contractual basis. There are many advertisements up for recruitment in these institutions even now in such a format, even though a parliamentary committee report recommended strongly against this in 2015 about AIIMS, Delhi.
“Contract employment leads to career insecurity for the individual and unstable workforce for the organisation as the contract employee has to search for new jobs constantly,” it said.
“Contract appointments should be discouraged as they distort the system goals by negatively affecting security and career development opportunities of employees,” it added.
AIIMS, as a matter of principle, does not allow doctors to practice privately. “While this is a good idea, if on top of that one asks doctors to take up jobs in an insecure environment, why would they stick to them?” wonders Reddy. He said many young doctors, therefore, might just want to gain experience in an AIIMS-like environment and quickly shift jobs.
“There is a need for centralised recruitment for all these institutions rather than on a piecemeal basis done by them individually,” Sundararaman opined.
Ramifications of half-baked functioning
Amidst all these trials and tribulations, in a majority of these 22 AIIMS, MBBS courses are up and running (see the map above).
Roughly speaking, an MBBS course can be run if a college has anatomy, biochemistry and physiology departments running while offering basic training in surgery and gynaecology and obstetrics – though this may not subscribe to the guidelines.
Running MBBS courses in a not fully prepared medical college is bad news for patients and also harmful for students. And that’s why we see many seats for these courses remain vacant in these premier institutions, Reddy added.
Back to square one: Why were these institutions conceptualised – precisely one in each state? To better the healthcare systems in cities far away from the metros. “Strengthening the infrastructure and providing basic specialists at district hospitals and community health centres or CHCs [as per mandated guidelines] can also go a long way in achieving this aim at a primary level,” Reddy said. The recently released Rural Health Statistics, 2022 stated there is an 80% shortfall in the required four basic specialists at CHCs in the country.
Edited by Jahnavi Sen.