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LATEST NEWS UPDATES | New AIIMS: Quantity, not quality? -Rema Nagarajan

New AIIMS: Quantity, not quality? -Rema Nagarajan

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published Published on Mar 29, 2015   modified Modified on Mar 29, 2015
-The Times of India

It has become fashionable to announce the setting up of new AIIMS or AIIMS-like institutes in every annual union budget. After the first six were announced in 2006, finance minister Arun Jaitley announced the setting up of four more in the last budget and another six in the current one, taking the total number to 16, not counting the original one in Delhi. While announcing new AIIMS makes headlines, a look at the first six said to be `functional' shows that they are far from it and nowhere close to their model, the All India Institute of Medical Sciences (AIIMS) in Delhi, hailed as the premier institute in the country . Most of them are not even at the level of a state medical college yet.

Construction of those announced in 2006 started in 2009 and 2010 and equipment procurement is still on, though most institutes claim to have finished over 60% of the work. Not surprisingly , the delays have led to massive cost overruns. In the Bhopal AIIMS, the cost of construction is said to have doubled from its 2009 estimate of Rs 682 crore, and till today the hospital has no drainage system, no functioning central air conditioning system and only two temporary water connections. About Rs 70 crore worth of equipment purchased for this AIIMS lies unutilized as the building and infrastructure is incomplete.

It's the same story in Patna. "The delay in construction has led to severe shortage of floor space. We cannot do much. It is for the central government, contractor and project consultant to settle," said AIIMS Patna director Dr GK Singh.

However, the biggest challenge for these institutes seems to be the acute shortage of human resources, especially senior and junior residents. Despite offering the same salary structure as AIIMS Delhi, just about a quarter of the sanctioned faculty positions have filled in these institutes. The situation in nursing and technical staff is even more alarming. Most institutes are using contract labour or outsourcing nursing to external agencies. For instance, AIIMS Raipur has only 64 faculty members for the 24 non-clinical and clinical departments out of the required 41. The sanctioned strength is 305. Against the sanctioned 1,800 nursing posts, there are just 200 nurses working on contract. Similarly , in AIIMS Bhubaneswar, only 68 faculty members have been hired. To make matters worse, within a year of joining six faculty members quit the institute due to non-utilization of their services.

Most of the institutes lack super specialty departments such as cardiology , nephrology , endocrinology , neurosurgery , burns and plastics or even intensive care units (ICUs). AIIMS Patna does not even have a labour room, blood bank or emergency services. It has just one X-ray machine but none for CT or MRI. Situation is just as bad in AIIMS Raipur, which has no ICU, obstetric care or life support, and surgeries started as late as November last year in the four functional operation theatres.

In spite of such obstacles the institutes, which started by admitting 50 students each for MBBS in 2012, enhanced the intake to 100 the next year. By August 2014, the third batch too had joined even as 33 seats went empty in AIIMS Patna. Hostel facilities are incomplete and there is severe faculty short age. As the first batch of students needs clinical training, the in-patient facilities will have to be boosted significantly .

On an average, about Rs 800 crore has been set aside in each annual budget since 2009 under the head "establishment of AIIMS type super speciality hospitals-cum-teaching institutions and upgrading of state government hospital". With this allocation being shared by six AIIMS and a dozen state hospitals that are being upgraded, it does not amount to much. According to the minutes of a meeting to examine the progress of the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), which provides the funds for the setting up of new AIIMS and for upgradation of state hospitals, till December 2013 only about Rs 50 crore each had been provided for the six AIIMS. This year, the budget has jumped to Rs 2,156 crore, but it is meant for not just six but 16 AIIMS, plus upgradation of existing hospitals.

Choosing to sink crores into building big crores into building big medical college-cum hospitals in the context of a health budget that is grossly inadequate, rather than spending the money to upgrade existing hospitals and strengthen primary and secondary level healthcare, has come in for severe criticism. Yet, thousands of patients thronging to these six institutes despite the poor level of facilities available prove how desperately they are looking for affordable and quality healthcare.

"While there is no doubt that these facilities are needed, it is a farce to call them AIIMS. They can at best become good tertiary level care hospitals," said Dr T Sundararaman, former director of the government's National Health Systems Resource Centre. He felt that for even the six which are off the ground to become anything like AIIMS Delhi would take at least 15-20 years. "Buildings alone don't make an institute. The most basic problem of highly qualified human resource, especially faculty , has to be addressed for these to become truly AIIMS-level," he pointed out.

(With inputs from Banjot Kaur Bhatia, Patna; Jamal Ayub, Bhopal; Anuja Jaiswal, Raipur; Ashok Pradhan, Bhubaneswar and Syed Intishab Ali, Jodhpur)


The Times of India, 29 March, 2015, http://timesofindia.indiatimes.com/home/sunday-times/deep-focus/New-AIIMS-Quantity-not-quality/articleshow/46731948.cms


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