Dr Sanjay Bhasin
A communiqué of H&ME deptt bearing No.: HD/Pl/50/2019 went viral on Wednesday with caption of, “Establishment of New Medical Colleges at Handwara and Udhampur-identification of land thereof”. The daily newspapers presented the news to readers with a caption, “Government approves 2 New Medical Colleges at Udhampur and Handwara”. As per the official communiqué it states, “…….GOI at New Delhi has asked the J&K State to submit a proposal for establishment of two (02) more New Medical Colleges on the first come first serve basis out of the available kitty of 75 New Medical Colleges to be established throughout the country.” Surprisingly, news reports have suo motto sanctioned two colleges. It reminds me of, the UPA Government with Ghulam Nabi Azad as Health & Family Welfare Minister who sanctioned 58 Rural Medical Colleges and being from J&K he allotted 05 Medical Colleges (Rajouri, Anantnag, Baramulla, Doda and Kathua) for the state. The intent was to give boost to rural health services and to produce doctors suitable for providing services in rural India. In all probabilities, these 75 New GMCs shall also see light of the day and in view of political competition, J&K shall definitely get two more GMCs, Minister in PMO being from J&K; but question is, up to what extent the concept of mushrooming of GMCs in India and J&K is a valid concept technically. It has been seen that so many Medical Colleges as well as few AIIMS erected in different states of the country have till now failed to become “Institutions of Desire” leave aside being “Institutions of Excellence”. So let us discuss some vital areas to be considered in policy formulations to run these institutions smoothly for overall benefit of patients and medical education.
Medical Education versus Health Care: Producing quality graduate (MBBS) and postgraduate (MD/MS,MCh/DM) doctors is the sole responsibility of Medical Colleges in addition to doing research and providing referral healthcare. Unfortunately in last two decades, the medical institutions have been relegated to the positions of healthcare delivery centers rather than becoming Institutions of Excellence for Medical Education. Lack of proper infrastructure and equipment, forced burden of patient care due to unnecessary referral from Sub-district and District hospitals, has directly affected the academics and research work. Overcrowding coupled with associated factors make doctors handicapped in providing quality services to the patients at Sub District and District hospitals, and in the event treatment part is thrusted upon the Medical Colleges instead of revamping health care at these centers. There is no second thought that medical education in India is on downhill course and sooner the policy makers realize and decide that research and teaching should be the focus in medical institutions and not primarily the patient care better it is for all. So focus should be on strengthening Sub-District and District hospitals for patient care and Medical Colleges for teaching, research and tertiary care.
Lack of Qualified Faculty versus Less Emoluments: Engaging best teaching faculty for Medical Colleges and even AIIMS/PGIMER has become a great challenge in the era of Corporatization of Health sector in India. The situation of faculty in 05 already sanctioned new GMCs is too grim and due to lack of infrastructure and trained faculty and other manpower, GMC Doda could not get permission to start first batch of MBBS, however other 04 got it with riders. Less pay/perks being offered to the medical/paramedical manpower also keep medical manpower away from joining Government Medical Colleges. At contemporary posts there is huge gape of pay/perks between corporate hospitals and government run institutions. The basic problem of highly qualified Human resources especially teaching faculty and paramedics need to be sorted out well before erecting buildings and purchasing equipments. Buildings alone and pre hand purchase of costly equipments cannot make an institute.
Medical Equipments: Purchase of new and good quality medical equipment to cope up with the growing trends in medical science has always remained a great problem for already established GMC’s. Even repair of the equipments needing very small amounts is a great problem in Government run institutions. This not only hampers patient care but also becomes a big block in research and academic activities. Long and tedious purchase processes need to be simplified and given in the honest hands to tackle this very important aspect of healthcare delivery system. Medical equipment should be purchased after the trained manpower is recruited, otherwise these costly equipments/machines gather dust/rust by the time they are put in use new variants reaches market. Hence the purchase of machinery and equipments should be in the last leg of establishment of these GMC’s.
Autonomy to the Medical Institutions: For smooth running of medical institutions, they should be given greater autonomy in the sense that there should not be unnecessary political and bureaucratic interference and influences. A high powered College Council/ Institution council needs to be established with medical persons of highest integrity and qualities as members of the council including Dean/Principals of all medical institutions and all HOD’s. The annual budgets should be kept at the disposal of the council with a well placed accounts and planning department whose head should preferably be an HOD of major specialty. Head of medical institution should preferably be from major specialties and the process of selection should be streamlined and unbiased. All Medical Colleges needs to be brought under the domain of a medical University.
In nutshell, although the decision to establish 02 more medical colleges in J&K is a well come step, yet highest level of political will to establish them as institutions of repute and giving greater autonomy to them is a big question of debate. A medical university, qualified and dedicated manpower, quality equipment, accountability and answerability to the patient and the system, best academic feast and very good pay/perk and no private practice shall be the hall mark of these institutions. A high power committee of dedicated and well qualified experts need to be constituted and a time bound task should be handed over to them with a pre-condition that derelictions from the real issues can even punish the concerned officials. Without proper foresight, will and intent, mushrooming of New GMCs shall not do wonder in improving Health & Medical Education in India.
(The author is Senior Surgeon & Honorary Secretary J&K Chapter of Association of Surgeons of India (JAKASI)
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