There are times when politics is learning without education. When panic-stricken medical students stranded in war-torn Ukraine were fighting for survival, Union Minister Prahlad Joshi sneered publicly that 60 per cent of Indian students who go abroad land up in China, Russia and Ukraine because the fees and cost of living are low. Being election time, the unprecedented Operation Ganga was launched by New Delhi to repair the damage. As Russian missiles rained down on Kyiv and other cities, several Union Ministers were dispatched to Ukrainian border posts to offer roses to the helpless students and to get them out safely. After all, one smile from a thankful student is worth a thousand votes or more. And there were 20,000 of them.
The irony is that Joshi was speaking the truth. The sickness started in his state Karnataka in the late ‘70s, which mastered the art of minting money from medical colleges by inventing capitation fees. Since then, India’s health system has deteriorated, unable to create an affordable health infrastructure and new hospitals to cope with the growing demand. As of now, we have just one doctor per 1,500 citizens as against the WHO norm of 1:1,000. This shortage is directly related to the growing gap between demand and supply for medical personnel. The skewed distribution of medical colleges and a heterogeneous fee structure have led to maximum distortions in seat admissions.
The diagnosis is dismal — India is one of the worst countries in terms of number of seats in proportion to its huge population and it presents the biggest source of corruption in the system. As of last year, there were only 90,000 MBBS seats available in the 600-odd private and government medical institutions. An additional 28,000 seats were available for Bachelor of Dental Surgery. For 1.10 lakh seats, over 16 lakh candidates registered for NEET last year. MBBS seats are almost equally divided between the government and private colleges. The dispersal of medical institutions has led to major unrest among candidates seeking admission. Though admissions are now centralised through competitive examinations, they still cause heartburn among various states which feel that the examination system is weighted against regional languages and aspirations.
Too busy with vote geography, linguistic cartography and ideological imperatives, India’s policymakers never considered health education a priority. The symptoms are endemic — a country of over 1.25 billion people lacks well-equipped hospitals in rural districts. World class institutions are confined to metropolitan cities or developed states. Of the 90,000 medical seats, over one third is in the five Southern states of Tamil Nadu, Karnataka, Kerala, Andhra Pradesh and Telangana. Karnataka has over 9500 seats. West India is better off than the North and the East. Maharashtra and Gujarat together have 15,000 seats.
On the other hand, UP, Bihar, Madhya Pradesh, Rajasthan, Haryana, Himachal etc — which house around half of the national population — have barely 20,000 seats. Uttar Pradesh having 20 crore population, offers only 7,500 seats. West Bengal has barely 5,000. An added complication is that Indian medical colleges cannot supply enough medical staff to hospitals across the country. At present, India has around 70,000 big and small hospitals with over 12 lakh beds. The majority of them don’t have enough doctors to treat patients on a regular basis. This abysmal shortage was evident during the pandemic.
It isn’t the shortage of medical seats alone that sends our youth to study abroad. It is the filthy admission architecture coupled with caste-based reservations which have driven many out of India. Moreover, the cost of medical education is stratospheric as compared to other countries. Though the fee structure is regulated, it is still exorbitant vis-a-vis Bangladesh, Ukraine, Romania, Poland, China and Russia. All of them together offer over 20,000 seats to Indian students. Their annual fee is one-third of what an Indian private college charges. Moreover, students get better infrastructure facilities abroad.
Bureaucracy is a growing tumour; any graduate of a foreign medical college must take a test before being allowed to join the profession or practice as a doctor. India has mastered the art of imposing conditions and restrictions on academic admissions at every stage, thereby allowing the medical mafia to profit. The system of granting permission to establish new colleges gave unfettered power to babus in the Health Ministry or the Medical Council of India (MCI) who sabotaged well-deserved applicants. On the other hand, during the ’80s, some new medical colleges were opened without doctors. Crooked operators moved medical staff, beds and equipment from one hospital to another for official inspection.
Moreover, the MCI and other agencies have provided impractical and expensive guidelines for establishing new colleges — almost over Rs 180 crore for an MBBS institution. Obviously, a private medical entrepreneur will want to recover the cost from the students. The system is so sick that an Indian medical college can churn out only 133 medical graduates — the lowest number at highest cost in the world. A medical college in Western Europe produces 150 doctors a year, East Europe 225 and China 930. The cancerous Indian bureaucracy created artificial scarcities in healthcare. Instead of generating more seats, they allowed institutions to raise the fee. The concept of capitation fee is now back, reborn in a higher fee structure. Since a large number of private colleges are owned by influential political and corporate titans, the institutions operate on a profit only basis.
New ways to make money are cooked up regularly by the healthcare gang; private medical institutions have been granted NRI quota priced up to Rs 1 crore per seat. Many rich, powerful Indians have falsely obtained these seats for their children through relatives abroad. The disease is also social. Many middle-class Indians see their children as dowry magnets, since a doctor is the second most sought after bridegroom after an IAS officer. To get admission into a college of his or her choice, the Indian student must cross both the financial hurdle and the caste barrier. But other nations aren’t bothered about caste and community.
India spends around Rs 70,000 crore annually on its students studying abroad. PM Narendra Modi wasn’t off the mark when he said that the failures of the past establishment are responsible for our students leaving to study in smaller countries. ‘’In 2014, our country had 387 medical colleges. In the last seven years, this number has gone up to 596. This is an increase of 54 per cent. There were only seven AIIMS before 2014 but now, the number of AIIMS approved has increased to 22,” he said.
A nexus of greed and power ails the Indian health system. It is time to swallow the bitter pill and streamline a competitive, confident and clean process to produce the doctors of tomorrow to deliver a powerful Swasth, Swachh, Atmanirbhar and Samppan Bharat.