Trade-off Between Quality And Quantity: New AIIMS

It has become a fashion to announce the establishment of new AIIMS or AIIMS-like institutions in each annual union budget.

To date, the government has announced above 20 AIIMS-like institutions in a phased manner, but the projects under phase-I still have dearths and suffer from insufficient facilities.

As per a report of the Comptroller and Auditor General (CAG) of India, the lack of faculty posts ranges from 55 to 83 per cent in six new AIIMS, including Patna, Bhopal, Jodhpur, Bhubaneswar, Raipur and Rishikesh. The scarcity of non-faculty posts ranges from 77 to 97 per cent. In various AIIMS, the infrastructure required is available but super-speciality departments are not operational because of the acute paucity of the medical specialists and faculty.

This is an example of constructing buildings without base. With insufficient staff, the resources and infrastructure are lying unused and untapped. There is an urgent need to address this scarcity as it has a direct effect on the quality of healthcare service and medical education in the institutions.

Fluctuating budget allocations

The Union health ministry has failed to make an adequate financial assessment for setting up the new AIIMS-like institutions. The capital cost of each new AIIMS under phase-I of 'Pradhan Mantri Swasthya Suraksha Yojana' was calculated by the health ministry in 2004 to be Rs 284.50 crore (Rs 1,707 crore for all six AIIMS). In 2006, a revised capital cost of Rs 332 crore was allocated for each new AIIMS. Again in March 2010, the ministry got a revised approval of Rs 820 crore for each new AIIMS.

This fluctuating assessment reflects volumes of the ministry’s inefficiency in planning and failure to map out any operational guidelines for AIIMS-like institutions.

While announcement of new AIIMS makes headlines, a glimpse at the first six said to be 'functional' reveals that they are far from it and not at all close to their model, the All India Institute of Medical Sciences (AIIMS) in Delhi, hailed as the premier medical institute in the country. Most of them fails to attain the level of a state medical college yet.

Construction of those announced in 2006 started in 2009 and 2010 and equipment procurement is still in process, though many of the institutes claim to have finished most of the work. Unsurprisingly, the delays have resulted in enormous cost overruns. In the Bhopal AIIMS, the cost of establishment is said to have doubled from its 2009 estimate of Rs 682 crore and till 2015 the hospital had only two temporary water connections, no functioning central air conditioning system and no drainage system.

The story is same in Patna AIIMS. The delay in construction has resulted in severe shortage of floor space. Nevertheless, the biggest challenge for these institutions seems to be the lack of human resources, specially junior and senior residents.

Lack of faculty and other staff

In spite of offering the similar salary structure as AIIMS Delhi, just about one fourth of the sanctioned faculty positions have filled in these institutes. The situation in technical and nursing staff is even more frightening. Most of these institutes are using contract labour or outsourcing nursing from external agencies. For instance, AIIMS Raipur has only 64 faculty members for the 24 clinical and non-clinical departments out of the needed 41. The authorized strength is 305. Against the alotted 1,800 nursing posts, there are only 200 nurses working on contract. Likewise, in AIIMS Bhubaneswar, only 68 faculty members have been recruited. To make the situation grave, within one year of joining six faculty members left the institute due to unutilization of their services.

The ministry must make adequate and practical financial assessment with respect to the capital cost of new AIIMS-like institutions in successive phases.