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  Controversies in Medicine

Do We Need More All India Institute of Medical Sciences ‑ Type

Institutions?
 Keshav Desiraju*
Formerly Secretary, Department of Health & Family Welfare, Government of India

The All India Institute of Medical Sciences (AIIMS) New Delhi, Gandhi Government General Hospital, Chennai, probably
set up under the AIIMS Act, 1956, has a well‑earned reputation draw larger numbers.
as a medical centre which aspires and often attains the highest
The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
standards of treatment, teaching and research. Even a quick
of 2006 established the framework under which the AIIMS
reading of the Act makes it clear that its primary focus is medical
model would be repeated across the country with new
education and teaching. It was believed that well‑trained
‘AIIMS‑type’ institutions in Rishikesh, Patna, Bhopal, Raipur,
graduates and post‑graduates from AIIMS would, in their turn,
Jodhpur and Bhubaneswar. The selection of the locations of
help in staffing and running government medical colleges across
the new institutions was made even earlier, during the time of
India. Significantly, the AIIMS was kept out of the purview of
the NDA government (1999–2004), even if the scheme was
the Medical Council of India (MCI), set up around the same
finalised during the time of UPA 1 [2004‑2009] and fund flow
time through the Indian Medical Council Act, 1956, a prescient
only began in UPA 2 (2009–2014). It is important to note that
move given the baleful influence the MCI came to exercise on
the key determinant of where a new ‘AIIMS‑type institution’
medical education in India in later years.
would be set up was whether the proposed location already had
Not everything worked out quite as expected. The AIIMS is passable hospital care facilities. Since the bulk of the patients
certainly regarded as one of the best medical colleges in India, crowding the wards of AIIMS, New Delhi, were from the
but very many of its graduates, after handsomely availing of its relatively underserved states of North India, the selection of
highly subsidised facilities, far from helping to set up medical locations, where the state governments provided substantial
colleges across the country, have fled its shores. A 2006 report parcels of land, was unexceptionable. The PMSSY recognised
found that 52.81% of AIIMS graduates over 1956–2003 were the need to correct ‘the imbalances in the availability of
working abroad, mainly in the USA, and within the USA, affordable healthcare facilities in different parts of the country
mainly in New York and California.[1] A later study of graduates in general, and augmenting facilities for quality medical
over 1989–2000 found over 54% of them settled abroad.[2] If education in the underserved States in particular’.[4]
AIIMS graduates had actually fanned out over the country and
Funds were made plentifully available. Each of the six new
contributed to medical education in the states, the question
AIIMS had a revised approved budget of Rs. 820 crores in
of new ‘AIIMS type institutions’ would never have arisen
2010, which amounts had not yet been fully spent as of 2018.[5]
50 years later. In another development, the reputation of
Of the total of 5760 beds in all, with 960 beds in each of
AIIMS has grown not only as a premier teaching institution
the institutions, a total of 4802 have been set up.[4] MBBS
but as possibly the country’s best treatment facility, with the
education began in 2012 with an annual admission of 100 in
result that huge numbers of patients who ought, in any sensible
each institution. Sixty students per year are also admitted to
public health system, to have accessed quality secondary and
the B.Sc. Nursing course at each of these institutions.
tertiary care at their district hospitals or at the state capitals,
find themselves in the hopelessly overcrowded outpatient There have been issues with the establishment of the new AIIMS
wards of the AIIMS, if not on the pavements outside. A daily institutions, not least to do with construction and time and cost
load of 8000 was cited in 2019.[3] AIIMS, New Delhi, is not
alone in this. Safdarjung Hospital, New Delhi, and the Rajiv
Address for correspondence: Keshav Desiraju,
E‑mail: keshavdesiraju@gmail.com
Received: 09‑03‑2021  Accepted: 24‑03‑2021  Available Online: 25-04-2021

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DOI:
10.4103/JME.JME_32_21 How to cite this article: Desiraju K. Do we need more All India Institute
of Medical Sciences ‑ Type Institutions? J Med Evid 2021;2:71-2.

© 2021 Journal of Medical Evidence | Published by Wolters Kluwer - Medknow 71

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Desiraju: Do we need more AIIMS-Type Institutions?
overruns, but it is believed that these issues have been largely
resolved. A more serious problem is to do with the availability
of qualified teaching faculty, though even this is expected to
improve with time, as also the commencement of a high standard
of post‑graduate teaching and medical research. As per the most
recent information, AIIMS Rishikesh, has 238 faculty in position
as against 331 sanctioned positions.[6] We may presume a similar
shortfall in the other AIIMS. It is for the medical profession
to assess whether clinical, academic and research standards at
the new AIIMS institutions are on a par with those at AIIMS,
New Delhi. Subject to this caveat, we may reasonably say that
the broad intentions of the PMSSY have been served, at least for
now, and may hope that the institutions will continue to receive
the same support that AIIMS, New Delhi receives.
The question before us is whether we need any more of these
AIIMS institutions. This is now only of academic interest
as in addition to New Delhi and the six we have discussed,
another 11 (Rae Bareli, UP; Mangalagiri, AP; Nagpur,
Maharashtra; Kalyani, WB; Bathinda, Punjab; Deoghar, Bihar;
Bibinagar, Telangana; Rajkot, Gujarat; Vijaypur, Jammu and
Kashmir; Bilaspur, HP and Guwahati, Assam) have been
established and have commenced functioning. Another four
(Madurai, TN; Darbhanga, Bihar; Awantipore, Jammu and
Kashmir and Manethi, Haryana) are approved.
Three points are stand out. One, the principle of supporting
underserved states has clearly been abandoned. Second,
obviously, political considerations have outweighed every
other criterion in the selection. And third, and this is not
necessarily a bad thing, the centre seems quite willing, at least
in principle, to fund activities in the states.
Health care is a subject on the state list under the constitution
and medical education on the concurrent list; states are,
however, always glad to accept central money. Large sums have
been approved under the PMSSY. Where the first six AIIMS
were sanctioned Rs. 820 crores each, the newly sanctioned
AIIMS have twice as much, with Mangalagiri, Nagpur, and
Kalyani kicking in at Rs. 1618 crores, Rs. 1577 crores and Rs.
1754 crores, respectively.[4] These are huge expenditures in a
situation where there are other priorities. It is undeniable that the
centre has a responsibility to contribute to the states’ resources,
but states need money for primary care, for well‑equipped
and well‑staffed primary health centres, for quality training of
nurses, midwives, ASHAs and allied health staff, for upgrading
the standard of district hospitals, trauma centres, blood banks
and for drug purchases throughout the public health system.
Huge expenditures on construction and land‑related works will
only encourage rent seeking and corruption and for precisely
this reason, are extremely popular with all governments. More
72
importantly, establishing AIIMS institutions in every state
only serves to reinforce the point that the only treatment of
any standard is to be found high‑infrastructure tertiary care
centres. The emphasis should rather be on proving that PHCs
and district hospitals can between them cater to a wide range
of complaints with only those cases actually needing tertiary
care being referred elsewhere.
There is a related issue. The AIIMS are central institutions
and are funded by the centre. AIIMS, New Delhi, receives
annual support through the central budget and, in due course,
if the newly established institutions begin to perform at
capacity, a similar order of central funding will be necessary
and on a permanent basis. The signs at present are that
these massive commitments will not be met. The recently
announced union budget for 2021–2022 provides a BE of
Rs. 3800 crores (a small increase over the RE 2020–2021 of
Rs. 3489.96 crores) for AIIMS New Delhi. However, for all the
other 17 functioning AIIMS and the four under construction,
the BE is Rs. 7000 crores (a small decrease against the
RE 2020–2021 of Rs. 7517.25 crores).[7] The break up across
institutions is unclear, but what is clear is that there is no
sense in establishing institutions to pacify immediate political
interests and then letting them starve.
A case could yet be made for new ‘AIIMS‑type institutions’
if it could be established that the new graduates from these
new institutions are actually joining the faculty of medical
colleges and hospitals in the states, though it is possibly too
soon to establish this.
There is no denying that health infrastructure needs major
overhaul, not to mention the need to strengthen and revitalise
health systems. Pouring resources into mega‑building activities
is not the answer.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Chauhan  C. More AIIMS Pass‑Outs Work Abroad. The Hindustan
Times; December 26, 2006.
2. Kaushik M, Jaiswal A, Shah N, Mahal A. High‑end physician migration
from India. Bull World Health Organ 2008;86:40‑5.
3. Perappadan BS. AIIMS to Shift Its OPD to More Spacious
Accommodation. The Hindu; January 14, 2019.
4. PMSSY Annual Report 2019-20, MInistry of Health & Family Welfare.
5. Lok Sabha Unstarred Question N. 1750 Answered on July 27, 2018.
6. E‑mail from AIIMS Rishikesh; February 19, 2021.
7. Expenditure Budget 2021-22, Ministry of Finance.
Journal of Medical Evidence  ¦  Volume 2  ¦  Issue 1  ¦  January-April 2021