The rot in medical education runs deep
THE Central Bureau of Investigation (CBI) recently took the lid off a large-scale scandal involving several private medical colleges. It has found collusion between government officials and private medical colleges to manipulate the regulatory process of the National Medical Commission (NMC) — the central body in charge of regulating medical education in the country.
The list of 34 persons named in the FIR is startling — eight officials of the Ministry of Health and Family Welfare, a Joint Director of the National Health Agency (who earlier worked in the NMC), a former Chairman of the University Grants Commission, doctors deputed by the NMC to inspect medical colleges, a ‘godman’ with a large following in Chhattisgarh, and officials of colleges run by religious bodies in Gujarat and Andhra Pradesh. Six persons, including NMC inspectors, were caught red-handed in Nava Raipur while transacting bribes worth Rs 55 lakh.
This is not a rare incident. Just a couple of months ago, the CBI caught an NMC inspector while he was accepting Rs 10 lakh in bribe from the management of a private medical college. The NMC selects senior professors from government medical colleges and assigns them to inspect medical colleges seeking to expand the number of undergraduate and postgraduate seats or get their licences renewed, as well as those seeking to start new courses.
The modus operandi reported this time is similar to what has been used for decades. Private medical colleges collude with insiders in the health ministry and the regulatory agency through middlemen to subvert regulatory norms relating to faculty requirements, hospital beds, etc. In the latest CBI case, health ministry officials gained access to information about the regulatory status of medical colleges, like inspection dates and names of inspectors assigned.
The information was then shared with middlemen who alerted the medical colleges concerned. The colleges being inspected deployed ghost faculty and admitted fake patients to artificially project compliance during inspections, and bribed assessors in order to secure favourable inspection reports.
The case has once again shown that the rot in medical education runs deep and pervades all stakeholders — private medical colleges, the regulatory body, the health ministry and faculty members of government colleges.
High hopes were pinned on the NMC when it was formed in 2020 to replace the Medical Council of India (MCI), which was a self-regulatory body run by medical associations and state medical councils controlled by doctors. The MCI came into limelight in 2001 when its president Ketan Desai was caught for bribery and the Delhi High Court called the council ‘a den of corruption.’ The case dragged on for many years. After long-drawn discussions in parliamentary panels, expert committees, etc., it was decided to disband the MCI and replace it with a government-controlled NMC. The change was projected as a great reform, but barely five years down the road, we find that not much has changed on the ground.
The deeper malaise is the privatisation of medical education and the system of capitation fee (college managements selling seats at astronomical prices). The trend started with private colleges in Karnataka and Maharashtra in the 1990s, and is now a nationwide phenomenon. In the beginning, most colleges used to be owned or managed by politicians or trusts controlled by them. Then, the ambit expanded to include religious and spiritual organisations as well as local industrialists.
Overall, running a medical college became a highly lucrative affair despite a cap on ‘management quota’ of seats and norms about standard infrastructure like a mandatory teaching hospital. For instance, the annual fee in the Index Medical College (Indore) — one of the institutions named in the FIR — is Rs 16 lakh, compared to Rs 1 lakh in a government-run college, as per data compiled by the Department of Medical Education in Madhya Pradesh. The capitation fee charged at the time of admission is said to be between Rs 50 lakh and Rs 1 crore. Doctors churned out by such colleges directly feed the corporatised system of health delivery.
Private colleges are taking advantage of the demand-supply equation of doctors. At present, the annual intake for MBBS seats is about 118,000. India has 13 lakh registered practitioners, which translates to the doctor-to-population ratio of 1:1,263 as against the WHO norm of 1:1,000. Besides the overall shortage, a disproportionate number of doctors are in cities. In March, the government announced an addition of 10,000 medical seats during 2025 and set a target of adding a total of 75,000 seats over the next five years — without a clear roadmap.
The result is the hurried opening of private medical colleges and the expansion of the existing ones on the one hand, and pressure on the NMC to ease regulatory norms on the other. Unfortunately, the NMC has yielded to this pressure. For instance, it recently relaxed norms for the appointment of faculty to address the shortage and support the expansion of medical seats.
Instead of letting the NMC compromise on quality standards to meet government targets, the government should rethink the privatisation policy itself. Till every additional MBBS seat brings extra money for promoters of private colleges, corruption can’t be eradicated. Among many suggestions made by expert committees in the past, the one made by the High-Level Expert Group on Universal Health Coverage in 2011 is highly relevant. It recommended functionally linking medical colleges to district hospitals and mandating a substantial proportion of local student enrolment. This would have helped overcome the highly uneven distribution of medical colleges that has resulted in skewed and unequal availability of doctors. This, however, can’t be implemented with a centralised regulator and without involving state governments.
Corruption in medical colleges not only undermines the integrity of the regulatory framework but also jeopardises the quality of medical education and public health standards. To tackle this, we need a comprehensive policy review with regard to privatisation of medical education, over-centralisation of regulation and corporatisation of healthcare.
Dinesh C Sharma is a science commentator.
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