In February 2010 the Medical Council of India announced a major change in the regulation governing the establishment of medical colleges. With this change, corporate entities were permitted to open medical colleges. The new regulation also carried the following warning: “permission shall be withdrawn if the colleges resort to commercialization”. Since the regulation does not elaborate on what constitutes “resorting to commercialization”, this will presumably be a matter left to the discretion of the Government.

A basic requirement for a new medical college is a pre-existing hospital that will serve as a teaching hospital. Corporate entities have hospitals in the major metros and that is where they will have to locate medical colleges. The earlier mandated land requirement for a medical college campus, a minimum of 25 acres of contiguous land, cannot be fulfilled in the metros. Not surprisingly, yet another tweak has been made in the regulation, prescribing 10 acres as the new minimum campus size for 9 cities including the main metros. With this, the stage is set for corporate entities to enter the medical education market.

Until now, medical education in India has been projected as a not-for-profit activity to be organised for the public good. While private bodies can run medical colleges, these can only be societies or trusts, legally non-profit organizations. In opening the door to corporate colleges, thus, a major policy change has been effected without changing the law or even a discussion in Parliament, but by simply getting a compliant MCI to change the regulation on establishment of medical colleges. This and other changes have been justified in the name of addressing the shortage of doctors. At the same time, over 50 existing medical colleges, including 15 runs by the government, have been prohibited from admitting students in 2010 for having failed to meet the basic standards prescribed. Ninety percent of these colleges have come up in the last 5 years. Particularly shocking is the phenomenon of government colleges falling short of standards approved by the Government. Why are state government institutions not able to meet the requirements that have been approved by the central government? A severe problem faced by government-run institutions is attracting and retaining teaching faculty, and this is likely to be among the major reasons for these colleges failing to satisfy the MCI norms. The crisis building upon the faculty front has been flagged by various commissions looking into problems of medical education over the years.

An indicator of the crisis is the attempt to conjure up faculty when MCI carries out inspections of new colleges, one of its regulatory functions. Judging by news reports, the practice of presenting fake faculty – students or private medical practitioners hired for the day – during MCI inspections in private colleges is common. What is interesting is that even government colleges are adopting unscrupulous methods. Another indicator is the extraordinary scheme, verging on the ridiculous that is being put in place by the MCI to make inspections ‘fool proof’. Faculty in all medical colleges are to be issued an RFID-based smart card by the MCI with a unique Faculty Number. The card, it is argued, will eliminate the possibility of a teacher being shown on the faculty of more than one college and establish if the qualifications of a teacher are genuine. In the future, it is projected that biometric RFID readers will be installed in the colleges that will enable a Faculty Identification, Tracking and Monitoring System to monitor faculty from within the college and even remotely from MCI headquarters.

The picture above does not even start to reveal the true and pathetic situation of medical care, especially in rural India. Only a fraction of the doctors and nursing professionals serve rural areas where 70 percent of our population lives. The Health Ministry, with the help of the MCI, has been active in proposing yet another ‘innovative’ solution to the problem of lack of doctors in rural areas. The proposal is for a three-and-a-half-year course to obtain the degree of Bachelor of Rural Medicine and Surgery (BRMS). Only rural candidates would be able to join this course. The study and training would happen at two different levels – Community Health Centres for 18 months, and sub-divisional hospitals for a further period of 2 years – and be conducted by retired professors. After completion of training, they would only be able to serve in their own state in district hospitals, community health centres, and primary health centres.

The BRMS proposal has invited sharp criticism from some doctors’ organizations on the grounds that it is discriminatory to have two different standards of health care – one for urban and the other for rural areas, and that the health care provided by such graduates will be compromised. At the other end is the opinion expressed by some that “something is better than nothing”, that since doctors do not want to serve in rural areas, the government may as well create a new cadre of medics who will be obliged to serve there. The debate will surely pick up after the government formally lays out its plans. What is apparent is that neither this proposal nor the various stopgap measures adopted so far address the root of the problem of health care.

The far larger issue is government policy, the low priority attached by the government to the social sector as a whole and the health sector, in particular, evidenced in the paltry allocations for maintaining and upgrading medical infrastructure and medical education and for looking after precious human resources.

Once upon a time, there was a royal elephant which used to reside in the premises of the king’s palace. The elephant was very dear to the king, so he was well-fed and well treated. There was also a dog who lived near the elephant’s shed. He was very weak and skinny. He was always fascinated by the smell of rich sweet rice being fed to the royal elephant.

One day, the dog could no longer resist the aroma of the rice and somehow managed to sneak into the elephant’s shed. He ate the grains of sweet rice that fell from the elephant’s mouth. He liked the rice so much, that he started going there daily to eat the rice. For days, the huge elephant didn’t notice the small dog as he was busy enjoying the delicious food. Gradually, the dog grew bigger and stronger eating such rich food. Finally, the elephant noticed him and allowed him access to the food.

The elephant enjoyed the company of the dog and started sharing his food with him. They also started spending time with each other and soon became good friends. They ate together, slept together and played together. While playing, the elephant would hold the dog in his trunk and swing him back and forth. Soon neither of them was happy without the other. They became great friends and didn’t want to be separated from each other.

Then one day, a man saw the dog and asked the elephant-keeper, “I want to buy this Dog. What price do you want for it?” The elephant keeper didn’t own the dog but sold it and extracted a sum of money from this deal. The man took the dog to his home village, which was quite far away. The king’s elephant became very sad after this incident. He missed his friend a lot and started neglecting everything. He didn’t want to do anything without his dear friend so he stopped eating, drinking and even bathing.

Finally, the elephant-keeper reported this to the king; however, he didn’t mention anything about the dog. The king had a wise minister, who was known for his keen understanding of animals. The king ordered the minister, “go to the elephant shed and find out the reason for the elephant’s condition”. The intelligent minister went to the elephant shed and found the elephant very sad. He examined the elephant and asked the elephant-keeper, “There is nothing wrong with this elephant’s body, then why does he look so sad? I think this elephant is grief-stricken, possibly due to the loss of a dear friend. Do you know if this elephant shared a close friendship with anyone?”

The elephant-keeper said, “There was a dog who used to eat, sleep and play with the elephant. He was taken by a stranger three days ago”. The minister went back to the king and said, “your majesty, in my opinion, the royal elephant is not sick, but he is lonesome without his dear friend, the dog”. The king said, “you’re right, friendship is one of the most wonderful things of life. Do you know where the dog is?” The minister replied, “elephant keeper has informed me that a stranger took him away and he doesn’t know his whereabouts”. The king asked, “How can we bring back my elephant’s friend and make him happy again?” The minister suggested, “your majesty, make a declaration, that whoever has the dog that used to live at the royal elephant’s shed will be penalized”. The king did the same and the man who had taken the dog, instantly turned him loose when he heard the proclamation.

As soon as he was freed, the dog ran back as fast as he could to the elephant’s shed. The elephant was so delighted to see the dog that he picked his friend up with his trunk and swung him back and forth. The dog wagged his tail, while the elephant’s eyes sparkled with happiness. The king was content to see the elephant happy once again and rewarded the minister for his wise judgment.

Once upon a time, there was a royal elephant which used to reside in the premises of the king’s palace. The elephant was very dear to the king, so he was well-fed and well treated. There was also a dog who lived near the elephant’s shed. He was very weak and skinny. He was always fascinated by the smell of rich sweet rice being fed to the royal elephant.

One day, the dog could no longer resist the aroma of the rice and somehow managed to sneak into the elephant’s shed. He ate the grains of sweet rice that fell from the elephant’s mouth. He liked the rice so much, that he started going there daily to eat the rice. For days, the huge elephant didn’t notice the small dog as he was busy enjoying the delicious food. Gradually, the dog grew bigger and stronger eating such rich food. Finally, the elephant noticed him and allowed him access to the food.

The elephant enjoyed the company of the dog and started sharing his food with him. They also started spending time with each other and soon became good friends. They ate together, slept together and played together. While playing, the elephant would hold the dog in his trunk and swing him back and forth. Soon neither of them was happy without the other. They became great friends and didn’t want to be separated from each other.

Then one day, a man saw the dog and asked the elephant-keeper, “I want to buy this Dog. What price do you want for it?” The elephant keeper didn’t own the dog but sold it and extracted a sum of money from this deal. The man took the dog to his home village, which was quite far away. The king’s elephant became very sad after this incident. He missed his friend a lot and started neglecting everything. He didn’t want to do anything without his dear friend so he stopped eating, drinking and even bathing.

Finally, the elephant-keeper reported this to the king; however, he didn’t mention anything about the dog. The king had a wise minister, who was known for his keen understanding of animals. The king ordered the minister, “go to the elephant shed and find out the reason for the elephant’s condition”. The intelligent minister went to the elephant shed and found the elephant very sad. He examined the elephant and asked the elephant-keeper, “There is nothing wrong with this elephant’s body, then why does he look so sad? I think this elephant is grief-stricken, possibly due to the loss of a dear friend. Do you know if this elephant shared a close friendship with anyone?”

The elephant-keeper said, “There was a dog who used to eat, sleep and play with the elephant. He was taken by a stranger three days ago”. The minister went back to the king and said, “your majesty, in my opinion, the royal elephant is not sick, but he is lonesome without his dear friend, the dog”. The king said, “you’re right, friendship is one of the most wonderful things of life. Do you know where the dog is?” The minister replied, “elephant keeper has informed me that a stranger took him away and he doesn’t know his whereabouts”. The king asked, “How can we bring back my elephant’s friend and make him happy again?” The minister suggested, “your majesty, make a declaration, that whoever has the dog that used to live at the royal elephant’s shed will be penalized”. The king did the same and the man who had taken the dog, instantly turned him loose when he heard the proclamation.

As soon as he was freed, the dog ran back as fast as he could to the elephant’s shed. The elephant was so delighted to see the dog that he picked his friend up with his trunk and swung him back and forth. The dog wagged his tail, while the elephant’s eyes sparkled with happiness. The king was content to see the elephant happy once again and rewarded the minister for his wise judgment.