Quality healthcare workforce through paradigm shifting reforms in Medical Education
-Shri Sudhansh Pant
India’s commitment to meet the targets of provisioning universal healthcare under the Sustainable Development Goals (SDG 2030) and also to realise the aspirations projected under ‘Heal by India’ scheme where the country provides skilled healthcare workforce to meet global demands is heavily dependent on our potential and capacity in medical education. This is in itself pillared on the twin requirements of ensuring easily accessible and affordable quality education in various streams of medicine. With an ambitious vision of leading from the forefront in adequately meeting our domestic needs for primary, secondary and tertiary healthcare services (across public and private sectors) and also those of other countries, the medical education landscape has witnessed a paradigm shift where the focus has moved from input-based to outcome-oriented approaches.
The Government of India has, over the last few years, taken several landmark initiatives for reforming and rehauling the medical education sector in the country. As a pivotal step and a long-awaited reform, the National Medical Commission Act was enacted in 2019. The Act did away with the Medical Council of India (MCI) which was facing several structural and functional challenges and replaced it with an autonomous and transparent National Medical Commission (NMC), the apex regulatory body for medical education. This Act has also resulted in lowering the cost of medical education by regulating the fee structure in private institutions. Restructuring of the medical licensing system, ranking of medical colleges and standardization of entry requirements in all Medical Colleges across the country have also been envisaged in the Act.
In order to meet the requirements of a large workforce, giant strides have been taken to provide quality education to a larger population by creating higher number of seats. Till some years back, there were only about 51,000 undergraduate (UG) MBBS seats. Notably, this has doubled to over 1 lakh seats in 2023. Likewise, the number of Medical Colleges which was less than 400 in 2015, has substantially increased to more than 700 in 2023. Even in the matter of postgraduate (PG) MD/MS and DNB seats, there has been a more than 125% increase from about 31,000 seats in 2014 to more than 70,000 seats in 2023. This has been possible due to consistent policy changes and support of the Central Government in launching schemes for establishment of new Medical Colleges and augmenting UG and PG seats by providing financial support.
The Government of India has also approved 157 new Medical Colleges in the public sector. Of these, 108 are already functional while the remaining 49 colleges are at advanced stages of completion. The funding for each medical college has progressively increased from Rs.189 crore to Rs.325 crore per college. This kind of large-scale funding support by the Central Government for new Medical Colleges under a Centrally Sponsored Scheme is unprecedented. The States have largely benefitted by upgrading their medical education infrastructure under the Scheme. Concerted efforts have been made for multifold regional expansion with focus on under-served areas to correct regional imbalances and to address lack of accessibility. States such as Uttar Pradesh, Rajasthan, Madhya Pradesh and West Bengal have been sanctioned 27, 23, 14 and 11 Medical Colleges respectively, under these Schemes. For the first time since Independence, Medical Colleges have been established in Andaman & Nicobar Island, Nagaland, Arunachal Pradesh, Mizoram and Ladakh. 447 districts of the country now have at least one Medical College catering to a large extent to both the aspiring students and the patients in the nearby districts. Every State and different regions of the country can now have the benefit of a Medical College in the vicinity.
There has also been an effective revamping of the regulatory structures in order to make medical education more affordable. The NMC has imposed the regulation of fees to cap tuition fees for 50% MBBS and postgraduate medical seats in private Medical Colleges and Universities. One of the most significant reforms pertains to the streamlining of regulations for the establishment of Medical Colleges. The new Minimum Standards of Requirements for Postgraduate Courses (MSR) 2023 have relaxed the requirements for setting up of a Medical College in terms of requirement of land, number of beds, departments and faculty positions.
Introduction of the Foreign Medical Graduate Licentiate (FMGL) Regulations 2021 aims to make the medical education system more transparent, accountable and consistent. Physicians who have received their training in India or overseas will be required to take the NExT (National Exit Test) to be qualified to apply for a practicing license in India and be considered for merit-based seat distribution in broader specialties. NMC has been conferred with the coveted World Federation for Medical Education (WFME) recognition status for a tenure of 10 years. This accolade provides Indian students with an opportunity to pursue their career anywhere in the world, while also making India an attractive destination for international students due to our globally recognized standards.
The District Residency Scheme is another initiative to improve health services at the district level. Here, 2nd and 3rd year PG students are required to complete a three-month training programme in district hospitals; they will be exposed to a variety of cases in the district health system thereby enriching their skills. This will also help to address the medical personnel crises often found in district hospitals.
In order to deal with problems of ghost faculty and to gradually remove assessor/human interface and have real time data for monitoring medical colleges, latest technology and IT driven interventions have been taken. The Aadhaar Enabled Biometric Attendance System (AEBAS) has been implemented across hospitals, whereas the Hospital Management Information System (HMIS) is being used by attached teaching hospital. CCTVs installed in Medical Colleges are providing video feed in real time.
The slew of reform measures undertaken recently has further strengthened the medical education sector. India stands at the threshold of leading the world in provisioning of universal healthcare through its trained and skilled healthcare force while also ensuring that our workforce is an integral part of the global healthcare sectors.
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Author is Secretary, Union Ministry of Health & Family Welfare. Views expressed are personal.