The Emperor had inherited a peaceful and prosperous kingdom at a young age after the untimely death of his father. A few months later a man arrived at court. He stated that he was from a far-off land and had the gift of foresight. He impressed the Emperor with his witty remarks and was appointed a courtier. The Emperor and those at court all enjoyed hearing accounts of his travels. One day the newly appointed minister said, “Your Majesty, you are destined for great things. It is written in the stars. I have learnt the art of fortune-telling. Do not be content with your kingdom alone. Travel, see the world and conquer. There are many who are oppressed. They will bless you for rescuing them from the tyranny of their rulers.” The Emperor was stunned to hear this but he refused to discuss the matter at the time. The courtiers too were astonished to hear this and began debating among themselves. “It is true.” they said, “Our Emperor’s father was a great warrior and he ruled wisely. Perhaps there is truth in this.”
So the newly appointed courtier shrewdly planted the idea of waging war against other kingdoms at court. After hearing several repeated arguments in favour of this idea the Emperor finally agreed. He was a young man and a battle seemed to be exciting and an adventure. So the newly appointed minister planned the first campaign against a smaller neighbouring kingdom. The Emperor knew the ruler was cruel and felt justified in waging war against him. Having the superior army he easily defeated the king. Everyone celebrated. But the campaign did not stop there.
With every victory, the new minister would urge the Emperor on to the next battle. The soldiers grew tired after over two years at war but did not complain out of respect and loyalty to their ruler. Meanwhile, the situation in his kingdom began to deteriorate. With no one to look after the daily administration and to resolve disputes, signs of neglect began to be seen. The Emperor was no longer bothered if he was freeing the oppressed when he attacked a kingdom. He would plunder their riches to fund his wars. The new minister who was in charge of these funds kept a large part for himself and grew richer.
An old man who had been a minister in the Emperor’s father’s court grew worried and decided to do something about this situation. A few days later when the Emperor was out riding in the forest he suddenly saw the old man. He greeted him like an old friend and inquired what he was doing there. The man pointed to two owls in the trees. “I am listening to their conversation”. “What are they saying?” the Emperor asked unbelievingly. “They are negotiating the marriage of their children. The first owl wants to know whether the other will be gifting his daughter fifty villages on her wedding day. To which the second one replied that he would have to gift her one hundred and fifty as the villages were in ruins and as such were worthless but with the Emperor as ruler there would be many such villages.” When the Emperor heard this he realized the error of his ways. He returned home immediately, rewarded the old minister putting him in charge of reconstructing the ruined villages and dismissed the fortune teller from his court.

One day while talking to his ministers, the Emperor, on a whim, ordered that all the merchants of the city would have to guard the city at night. The merchants were deeply concerned to hear this. How could they, who had been selling goods for years suddenly take up the duty of guarding the city? For hours on end, they discussed the matter. At last, one of them said, “We have no alternative but to obey the Emperor’s orders. Let us go to the old commander who lives near the palace and ask him to guide us how to fulfil this task.” His idea was met with approval by the other merchants and they proceeded to the commander’s house. Upon hearing the merchants’ dilemma, he said, “Relax. There is no need to worry. Do as I tell you”. The merchants agreed. The next evening, as instructed, they wore their armour back to front, carried their weapons in baskets on their heads and began to chant, “It is our turn now.” Soon a crowd gathered and people began to laugh and point at the strangely dressed merchants. Word of this reached the Emperor’s ears. He ordered merchants to be rounded up and brought to the court. Red-faced the Emperor commanded angrily. “Explain this odd behaviour!” The commander had told them what to say when they met the Emperor. The leader of the merchants, accordingly, folded both his hands and politely said. “Your Majesty, we are merchants, deft in business, in purchasing and selling, in keeping accounts and making profits. We cannot patrol the kingdom. We did not mean any disobedience but this task is simply beyond our capability. We have no training”. The Emperor said, “I am pleased with your truthful reply and appreciate your ingenuity.” “Thank you. Your Majesty, but the credit goes to the retired commander,” was the merchants’ reply. “I think I shall visit him. He deserves a reward for his sound advice. The order stands withdrawn from this day onwards!” announced the Emperor.

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.

“Uncle” said Luke to the old Sean. “You seem to be well-fed, though I know no one looks after you. Nor have I seen you leave your residence at any time. Tell me how do you manage it?”
“Because” Sean replied, “I have a good feed every night at the emperor’s orchard. After dark, I go there myself and pick out enough fruits to last a fortnight.” Luke proposed to accompany his uncle to the orchard. Though reluctant because of Luke’s habit of euphoric exhibition of extreme excitement, Sean agreed to take him along.
At the orchard, while Sean hurriedly collected the fruits and left, Luke on the other hand at the sight of unlimited supply of fruits was excited and lifted his voice which brought the emperor’s men immediately to his side. They seized him and mistook him as the sole cause of damage to the orchard. Although Luke reiterated that he was a bird of passage, they pounded him mercilessly before setting him free.

One day while talking to his ministers, the Emperor, on a whim, ordered that all the merchants of the city would have to guard the city at night. The merchants were deeply concerned to hear this. How could they, who had been selling goods for years suddenly take up the duty of guarding the city? For hours on end, they discussed the matter. At last, one of them said, “We have no alternative but to obey the Emperor’s orders. Let us go to the old commander who lives near the palace and ask him to guide us how to fulfil this task.” His idea was met with approval by the other merchants and they proceeded to the commander’s house. Upon hearing the merchants’ dilemma, he said, “Relax. There is no need to worry. Do as I tell you”. The merchants agreed. The next evening, as instructed, they wore their armour back to front, carried their weapons in baskets on their heads and began to chant, “It is our turn now.” Soon a crowd gathered and people began to laugh and point at the strangely dressed merchants. Word of this reached the Emperor’s ears. He ordered merchants to be rounded up and brought to the court. Red-faced the Emperor commanded angrily. “Explain this odd behaviour!” The commander had told them what to say when they met the Emperor. The leader of the merchants, accordingly, folded both his hands and politely said. “Your Majesty, we are merchants, deft in business, in purchasing and selling, in keeping accounts and making profits. We cannot patrol the kingdom. We did not mean any disobedience but this task is simply beyond our capability. We have no training”. The Emperor said, “I am pleased with your truthful reply and appreciate your ingenuity.” “Thank you. Your Majesty, but the credit goes to the retired commander,” was the merchants’ reply. “I think I shall visit him. He deserves a reward for his sound advice. The order stands withdrawn from this day onwards!” announced the Emperor.

One day while talking to his ministers, the Emperor, on a whim, ordered that all the merchants of the city would have to guard the city at night. The merchants were deeply concerned to hear this. How could they, who had been selling goods for years suddenly take up the duty of guarding the city? For hours on end, they discussed the matter. At last, one of them said, “We have no alternative but to obey the Emperor’s orders. Let us go to the old commander who lives near the palace and ask him to guide us how to fulfil this task.” His idea was met with approval by the other merchants and they proceeded to the commander’s house. Upon hearing the merchants’ dilemma, he said, “Relax. There is no need to worry. Do as I tell you”. The merchants agreed. The next evening, as instructed, they wore their armour back to front, carried their weapons in baskets on their heads and began to chant, “It is our turn now.” Soon a crowd gathered and people began to laugh and point at the strangely dressed merchants. Word of this reached the Emperor’s ears. He ordered merchants to be rounded up and brought to the court. Red-faced the Emperor commanded angrily. “Explain this odd behaviour!” The commander had told them what to say when they met the Emperor. The leader of the merchants, accordingly, folded both his hands and politely said. “Your Majesty, we are merchants, deft in business, in purchasing and selling, in keeping accounts and making profits. We cannot patrol the kingdom. We did not mean any disobedience but this task is simply beyond our capability. We have no training”. The Emperor said, “I am pleased with your truthful reply and appreciate your ingenuity.” “Thank you. Your Majesty, but the credit goes to the retired commander,” was the merchants’ reply. “I think I shall visit him. He deserves a reward for his sound advice. The order stands withdrawn from this day onwards!” announced the Emperor.

The Emperor had inherited a peaceful and prosperous kingdom at a young age after the untimely death of his father. A few months later a man arrived at court. He stated that he was from a far-off land and had the gift of foresight. He impressed the Emperor with his witty remarks and was appointed a courtier. The Emperor and those at court all enjoyed hearing accounts of his travels. One day the newly appointed minister said, “Your Majesty, you are destined for great things. It is written in the stars. I have learnt the art of fortune-telling. Do not be content with your kingdom alone. Travel, see the world and conquer. There are many who are oppressed. They will bless you for rescuing them from the tyranny of their rulers.” The Emperor was stunned to hear this but he refused to discuss the matter at the time. The courtiers too were astonished to hear this and began debating among themselves. “It is true.” they said, “Our Emperor’s father was a great warrior and he ruled wisely. Perhaps there is truth in this.”
So the newly appointed courtier shrewdly planted the idea of waging war against other kingdoms at court. After hearing several repeated arguments in favour of this idea the Emperor finally agreed. He was a young man and a battle seemed to be exciting and an adventure. So the newly appointed minister planned the first campaign against a smaller neighbouring kingdom. The Emperor knew the ruler was cruel and felt justified in waging war against him. Having the superior army he easily defeated the king. Everyone celebrated. But the campaign did not stop there.
With every victory, the new minister would urge the Emperor on to the next battle. The soldiers grew tired after over two years at war but did not complain out of respect and loyalty to their ruler. Meanwhile, the situation in his kingdom began to deteriorate. With no one to look after the daily administration and to resolve disputes, signs of neglect began to be seen. The Emperor was no longer bothered if he was freeing the oppressed when he attacked a kingdom. He would plunder their riches to fund his wars. The new minister who was in charge of these funds kept a large part for himself and grew richer.
An old man who had been a minister in the Emperor’s father’s court grew worried and decided to do something about this situation. A few days later when the Emperor was out riding in the forest he suddenly saw the old man. He greeted him like an old friend and inquired what he was doing there. The man pointed to two owls in the trees. “I am listening to their conversation”. “What are they saying?” the Emperor asked unbelievingly. “They are negotiating the marriage of their children. The first owl wants to know whether the other will be gifting his daughter fifty villages on her wedding day. To which the second one replied that he would have to gift her one hundred and fifty as the villages were in ruins and as such were worthless but with the Emperor as ruler there would be many such villages.” When the Emperor heard this he realized the error of his ways. He returned home immediately, rewarded the old minister putting him in charge of reconstructing the ruined villages and dismissed the fortune teller from his court.

One day while talking to his ministers, the Emperor, on a whim, ordered that all the merchants of the city would have to guard the city at night. The merchants were deeply concerned to hear this. How could they, who had been selling goods for years suddenly take up the duty of guarding the city? For hours on end, they discussed the matter. At last, one of them said, “We have no alternative but to obey the Emperor’s orders. Let us go to the old commander who lives near the palace and ask him to guide us how to fulfil this task.” His idea was met with approval by the other merchants and they proceeded to the commander’s house. Upon hearing the merchants’ dilemma, he said, “Relax. There is no need to worry. Do as I tell you”. The merchants agreed. The next evening, as instructed, they wore their armour back to front, carried their weapons in baskets on their heads and began to chant, “It is our turn now.” Soon a crowd gathered and people began to laugh and point at the strangely dressed merchants. Word of this reached the Emperor’s ears. He ordered merchants to be rounded up and brought to the court. Red-faced the Emperor commanded angrily. “Explain this odd behaviour!” The commander had told them what to say when they met the Emperor. The leader of the merchants, accordingly, folded both his hands and politely said. “Your Majesty, we are merchants, deft in business, in purchasing and selling, in keeping accounts and making profits. We cannot patrol the kingdom. We did not mean any disobedience but this task is simply beyond our capability. We have no training”. The Emperor said, “I am pleased with your truthful reply and appreciate your ingenuity.” “Thank you. Your Majesty, but the credit goes to the retired commander,” was the merchants’ reply. “I think I shall visit him. He deserves a reward for his sound advice. The order stands withdrawn from this day onwards!” announced the Emperor.

One day while talking to his ministers, the Emperor, on a whim, ordered that all the merchants of the city would have to guard the city at night. The merchants were deeply concerned to hear this. How could they, who had been selling goods for years suddenly take up the duty of guarding the city? For hours on end, they discussed the matter. At last, one of them said, “We have no alternative but to obey the Emperor’s orders. Let us go to the old commander who lives near the palace and ask him to guide us how to fulfil this task.” His idea was met with approval by the other merchants and they proceeded to the commander’s house. Upon hearing the merchants’ dilemma, he said, “Relax. There is no need to worry. Do as I tell you”. The merchants agreed. The next evening, as instructed, they wore their armour back to front, carried their weapons in baskets on their heads and began to chant, “It is our turn now.” Soon a crowd gathered and people began to laugh and point at the strangely dressed merchants. Word of this reached the Emperor’s ears. He ordered merchants to be rounded up and brought to the court. Red-faced the Emperor commanded angrily. “Explain this odd behaviour!” The commander had told them what to say when they met the Emperor. The leader of the merchants, accordingly, folded both his hands and politely said. “Your Majesty, we are merchants, deft in business, in purchasing and selling, in keeping accounts and making profits. We cannot patrol the kingdom. We did not mean any disobedience but this task is simply beyond our capability. We have no training”. The Emperor said, “I am pleased with your truthful reply and appreciate your ingenuity.” “Thank you. Your Majesty, but the credit goes to the retired commander,” was the merchants’ reply. “I think I shall visit him. He deserves a reward for his sound advice. The order stands withdrawn from this day onwards!” announced the Emperor.

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.