24 new medical colleges: Moving away from greenfield AIIMS to Brownfield upgradations

Finance Minister, Arun Jaitley's Union Budget 2018 will herald many new beginnings with the announcement of Universal Health Coverage, 24 new medical colleges, and strengthening of health and wellness centers. New beginnings indeed as medical colleges, in every state will come through up-gradation of district hospitals. On the other hand, the universal health coverage plan would elevate the medical status of the deprived. The strengthening of health & wellness centers meanwhile, would make access to medical treatment a better reality.

The budgetary announcement of 24 new medical colleges ensures at least one medical college, for every three parliamentary constituencies. This also implies a minimum of one government medical college in each state of the country.The other significant aspect of this announcement is up-gradation of district hospitals into medical colleges.

The Finance Minister through this is also promoting the concept of 'Brownfield' investments, wherein a government entity purchases or leases existing production facilities to launch a new production activity; in this case, district hospitals being converted into medical colleges. This upgradation is indeed in sharp contrast to earlier policy of announcing the development of medical colleges from scratch

Moreover, in a way the Finance Minister's announcement of turning district hospitals into medical colleges is an effort on cost savings. In this case, the structure already stands in terms of a hospital and therefore, does not call for the building of a new facility and workings on building permits and connecting utilities. All it calls for is faculty recruitment and seat strength decisions, which in itself, is an onerous task.

The introduction of Brownfield projects for increasing medical colleges in the country is contrary to the one of Greenfield projects, followed by the government, earlier. These entailed government building its operations from the ground upwards. This change from Greenfield to Brownfield projects for the introduction of new medical colleges, to overcome the paucity of doctors, is also stemming from the government's experience over the past years of trying to introduce new AIIMS all over the country to decongest established medical institutions.

The Ministry of Health in its attempt of establishing new AIIMS in various parts of the country has had to come to terms with the reality that money can procure campuses and infrastructure; however, it can do little when it comes down to recruiting staff for these facilities. Thereby, leading to the slowing down of the setting up processes of new AIIMS, considerably, in all parts of the country.

The six regional AIIMS are struggling to find faculty and non-teaching staff. In July 2017, of the 1,830 sanctioned faculty posts a mere 583 (31%) were filled, and 3,862 (17%) of the 22,656 non-teaching appointments were made. The fate of the recently sanctioned 8 with the latest, a Rs. 1,350 crore allocation in Bilaspur not likely to meet a much different fate from its earlier counterparts.

Meanwhile, the MCI has now come out with a unique solution to enable the conversion of 300 + bedded government hospitals into medical colleges.

The MCI gazette notification addressing the problem of faculty recruitments at these hospital turned colleges states that the Medical Council of India with the previous sanction of the Central Government has made amendments to the "Minimum Qualifications for Teachers in Medical Institutions Regulations, 1998", thereby providing a unique opportunity to senior Post Graduate consultants/specialists in various fields to be eligible/equated for faculty posts at setting up of medical college at the respective hospitals.

The apex medical body specifies the equating a Consultant or Specialist to corresponding faculty positions at medical colleges for a minimum 300 bedded non-teaching District Hospitals owned and managed by State Govt/Central Govt, which are to be converted into medical colleges.

Read also: Consultants, Specialists Can Now become Medical Faculty: MCI Gazette Notification

With the Ministerial announcement over, the ball now lies in the Ministry of Health and the Medical Council of India's court. Firstly, the Ministry will have to identify which district hospitals are to be converted into Medical Colleges. This would then have to be followed by the MCI supervising the herculean task of ensuring that the new institutions get geared up in terms of infrastructural needs, equipment, and faculty recruitments.

The Ministry, on its part then will have to continue to maintain a vigil on colleges and course approvals, recommended by the MCI for the 24 new institutions to ensure that students get a fair deal in course completions and the country its many sought-after medical practitioners.