DOES KARNATAKA STATE NEED MORE MEDICAL COLLEGES
Item
- Title
- DOES KARNATAKA STATE NEED MORE MEDICAL COLLEGES
- extracted text
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DOES KARNATAKA STA
EED
RE MEDICAL COL
ES?
[/Xz/es’ and concerns requiring an urgent 'public initiative’ to counter the gross
co\mercialisation and devaluation of medical education^ the Government of
S
Karnataka]
by
I
Community Health Cell,
The Society for Community Health Awareness, Research and Action,
‘SrinivasaNilaya’ Jakkasandra 1stMain,
1st Block, Koramangala,
■
Bangalore - 560 034
\
Phone : (6X^553 15 18 & 552 53 72
dl: sochara@vsnl.c0.
Fax : (080) 552 53 72
DRAFT
NOT FOR CIRCULATION
Ref: CHC: 15.1:99
Dear
A Note of Concern
Sub: Does Karnataka State Need More Medical Colleges?
a)
The Government of Karnataka recently finalised a list of 20 new medical colleges
to be set up and sent it to the Medical Council of India for approval (Deccan
Herald News Service, Bangalore, September 3). Apart from 1 medical college to
be opened by government, the other 19 educational trusts represent an
assortment of old and new trusts and institutions; some with little or no
experience in professional education; and many with caste and communal
affiliations. This is the largest number ever of applications to which essentiality
certificate has been accorded by the State government.
b)
A Expert Committee (Prof. Savadatti Report) presented a report to consider
intake of existing professional colleges and need to start new professional
colleges in the state. This report has some very dubious assumptions to justify
further expansion and has not been subject to adequate professional / policy
debate. This is urgently required.
c)
This populist move, verging on irresponsibility, needs to be challenged by all
right thinking people who value medicine, quality of health care, medical
education and professional standards in higher education both in the State and in
the country.
d)
We need to challenge our State government to be:
i) more accountable in its decisions and hence give reasons regarding needs and
priorities that have determined such a decision;
ii) justify how such permission will improve:
a) the quality of medical education and medical practice in Karnataka;
b) reduce the ‘glut of doctors’ and increasing under-employment among them
in urban areas and continuing vacancies in rural areas;
c) how the decision is in the interest of professional education / higher
education / medical education in the State;
d) how it is in keeping with national norms, priorities and policies;
e) how it will solve the current health human power development problems of
the State;
1
e.
We feel that we should all suggest that the State Government review this
‘populist decision’ by involving all these expert and professional bodies who
would help to ensure that the policy on medical college expansion be determined
by wholistic planning considerations like health manpower needs, quality7
standards and norms rather than leave it to considerations of populist
politics or market driven compulsions. The Savadatti Report should be
reviewed once again by a small expert group. Perhaps the Rajiv Gandhi
University of Health Sciences-Karnataka could be requested to set up such a
'think tank'.
f
Your involvement to put public and professional pressure on the State
Government is urgently requested. As citizens and concerned persons and
professionals, we owe it to the people and to the goal for Health for All.
g-
We enclose a short report which has been evolved from a summary of our
Society’s recent research projects and reports submitted by us to the Independent
Commission on Health in India; and to the recently constituted Sub-Committee
on Medical Education of the Parliamentary Standing Committee on Human
Resource Development. We have tried to address some of the key issues about
Medical Education in Karnataka.
These are however relevant to other
professional institutions as well. Dental, Nursing, Pharmacy - the trends are
similar in these groups - perhaps even worse.
d)
We invite you to join us in a campaign to ensure that the over medicalisation and
commercialisation of Health Care and health human power development in
Karnataka does not become ‘a vested interest in the abundance of ill health’.
We remain in solidarity,
Yours sincerely,
for SOCIETY FOR COMMUNITY HEALTH AWARENESS,
RESEARCH AND ACTION
Thelma Narayan
V. Benjamin
C.M. Francis
Ravi Narayan
3
The Society for Community Health Awareness, Research and Action (SOCHARA)
is a multidisciplinary professional think-tank that among other issues in Health care
has been seriously researching the issue of Medical Education in the country and
looking at alternative policies and options for Health human power development.
Community Health Cell is the functional unit of the Society. In the 1990s, the Society
has:
1.
Undertaken an All India Survey of Strategies for Community Orientation and
Social Relevance in medical colleges. It identified 30 colleges with some
innovative experiments, documented these and then focussed on 6 pacesetter
colleges to arrive at strategies for action andfactors that promote and or obstruct
curriculum innovation (three publications from this study are now available).
2.
Undertaken a detailed review of Medical Education in India for the Independent
Commission on Health in India looking at issues such as : situation analysis,
regional distribution, commercialization, norms, qualitative decline in standards,
admission requiremens, curriculum development, cost /financing, corruption, PG
courses, continuing education and so on. The report also reviewed all the
innovative experiments in Medical Education and expert comittee
recommendations. It identified 6 issues for further dialogue and evolved a 12
point programme for improving the quality of Medical Education in the country
and countering the unhealthy commercialization and decline in standards and
quality.
This formed a chapter on Perspectives in Medical, Nursing and Para Medical
Training and Education in The Report of the Independent Commission on Health
in India submitted to the Prime Minister recently.
3. Participated in some workshops of the newly established Rajiv Gandhi University
of Health Sciences in the State in restructuring the curriculum.
4. Facilitated a continuing dialogue with a host of medical colleges in the country
and in neighbouring countries of Nepal and Bangladesh on evolving mechanisms
to operationalise strategies for change.
5. Submitted a memorandum to the Sub-Committee on Medical Education of the
Parliamentary Standing Committee on Human Resource Development,
Parliament House Annexe, New Delhi - 100 001 (on 14th November, 1998).
The summary offacts and notes are extracts from these publications. Copies of the
publication are available on request from the Society.
CONTENTS
Pages
Particulars
SLNo.
A.
Growth of Medical Education in India
6
B.
Regional Distribution
6
C.
Commercialization : Beyond Privatization
7
D.
Supreme Court Judgement and Thereafter
9
E.
Implications of Government’s Recent Decision
10
F.
Issues Raised in Recent Debate in Media
12
G.
Some Additional Trends of Relevance to Medical
13
Education Expansion
H.
Wrong Type of Doctors
13
Braindrain - External and Internal
15
Corruption in Medical Education
15
The Medicine - Industrial Complex
16
Teaching Faculty Vacancies
17
Quality Control
17
The Way Ahead - Some Suggestion for Action
17
APPENDICES
1.
Notification of Medical Council of India &. Medical
20
Education in India, 1995
2.
Proceedings of Government of Karnataka - Intake of I
21
MBBS and I BDS for Medical Colleges in Karnataka 1996-
97
3.
Relevant Extract from letter of Secretary, Medical Council
23
of India
4.
Extracts from the Expert Committee Report to consider
24
intake of existing professional colleges and need to start
new professional colleges in the state
5.
A
Submission to The Sub-Committee
Education
on
Medical
46
of the Parliamentary Standing Committee on
Human Resource Development at Bangalore, on 1/101
14'
November 1998
6.
Newspaper Reports on New Medical Colleges
51
5
State of Medical Education in Karnataka
Facts, Figures and Notes of Concern
A. Growth of Medical Education in India
1.
Medical Education in India has shown remarkable growth in numbers since
independence (1947-93). From 22 medical colleges in 1947 with an
admission of 1983 we have increased to 145 medical colleges with an
admission of 16,200 students in 1993. A 600% expansion in colleges and
800% expansion in admissions (see Appendix A). The estimate of The
Medical Council of India in 1996 was 162 medical colleges!
2.
The world has a little over 1400 medical schools - so presently India has 10%
of the world’s medical schools (the data on admissions is not known).
Karnataka has 13% of the medical colleges in India and presently 1.3% of the
colleges in the world. With the recent decision it could potentially have
nearly 23% of the colleges in India.
3.
The increase was gradual till 1975 with a predominant increase in
‘government run and sponsored medical education’ during the earlier phase.
Following the Srivastava Report 1975, (3) there was a plateau till 1985 and
then another phase of expansion till the Presidential Ordinance of 1993 - a
phase which was characterised as the ‘commercialisation and private sector’
phase of medical college expansion.
4.
Significantly, three states contributed most to this privatization and
commercialisation of medical education - namely Maharashtra, Karnataka
and Tamil Nadu, opening 18, 8 and 5 colleges respectively since the 1980s all the new colleges being in the private sector.
B. Regional Distribution
5.
The Mudaliar Committee of 1969 (3) recommended the norm of one college
with 100 seats per 50 lakh (5 million) population. A review of the present
regional distributions of colleges taken against the 1991 census (see Appendix
B) show some important trends:
a) Karnataka, Maharashtra and Tamil Nadu show a number far beyond their
' entitlement and requirement against this norm :
State / Population
Karnataka 45 million
Maharashtra & Goa 80.1
million_______________
Tamilnadu & Pondicherry
56.7 million
Entitlement
Entitlement 9
Actual
Actual 19
Excess
Excess 10
Entitlement 16
Actual 30
Excess 14
Entitlement 11
Actual 15
Excess 4
6
b) Karnataka and Maharashtra, the ‘commercial medical education belt’ in India
also have the largest admission ratios thereby proving the economy of scale
theory7 - more admissions, more income and more profits! (2)
c) It is important to note that the Srivastava report (1974), had recommended a
series of steps for qualitative improvement in medical education rather than
further quantitative expansion (3). The special study group set up by the
Indian Council of Social Science Research and Indian Council for Medical
Research (Health for All : An alternative Strategy, 1981) consisting of
internationally renowned National Experts had also categorically stated as
early as 1980 that :
i)
“There should be no new medical college and no increase in the intake
of existing medical colleges”
ii) “There is no need at all to set up neyv and additional institutions to train
additional doctors through short term courses”
d)
The Bajaj Report which later became the National Education Policy for
Health Sciences has also recommended primarily qualitative changes in
standards and no further quantitative expansion. (4)
e)
A report of the Medical Council of India in 1996 (5) has noted that “..... it is
evident that there is no shortage of doctors in the country and there is really
no need for starting more medical colleges for production of more doctors,
except perhaps in certain States 'which do not have any medical college as
yet. With the amendment of the LM.C. Act, 1956, in 1993, (under the
provisions of which no medical college can he established, no new
postgraduate course can he started or increase of seats in medical colleges
allowed, without the prior permission of the Central Government), it is
hoped that the much needed breaks for the mushroom-growth of medical
colleges in the country, will he applied”.
C. Commercialization — Beyond Privatization
6.
In terms of ownership and governance there has been a gradual increase in the
number of medical colleges run by the Private Sector (Trusts or Societies)
from less than 5% at Independence to 30% in 1993-94.
7.
In Karnataka, the percentage in the late 1970s was 33% private (2 out of 6)
and by 1993, it was 78.9% (15 out of 19).
8.
All serious, quality oriented policy makers and professional associations are
concerned about the ‘commercialised’, ‘unhealthy trends’ that this private
sector take over of medical education represents, namely :
a) All the new private medical colleges belong to the ‘capitation’ fee
charging variety of medical colleges with capitation fees rising from 5
lakhs in the 1980s to 35 lakhs in the 1990s.
7
b) All were initiated by trusts and societies with either caste or communal
affiliations or by individuals and groups representing specific sectoral
lobbies in agriculture and other areas (sugar barons in Maharashtra, and
other pressure groups in Karnataka and Andhra Pradesh), with little or no
involvement in higher education and health care.
c) In the 1993-94 Ministry of Health and Family Welfare (Government of
India) Annual Report, 26 colleges out of 146 were unrecognised by The
Medical Council for shortfall in standards (but recognised by state
government and local universities!). All belong to this group of
commercial capitation fee colleges.
d) In Karnataka, the power of the commercial medical education lobby has
been significant. Some of the policy decisions they had been able to
facilitate at state or university level have been
•
In the beginning, fixing of the level of capitation fees rather than
banning or opposing it, even after banning was on the political election
manifestos of all the recent governments (this also meant a permissible
fees that' had been regularised and not surprisingly, exceeded by
irregular and unofficial means);
•
contracting out public sector government hospitals to private sector
colleges for use of clinical facilities at a fee per bed which was most
often not collected; since these medical colleges did not have the
necessary clinical facilities to begin with;
•
permission to allow government college professors to go on deputation
to private medical colleges for varying periods of time with lien on
their jobs, thereby losing the services of experienced teachers in a
situation where there were not enough teachers.
e) The NRI Quota - the Non-resident Indian quota allowed by the
government permitted NRIs to be charged 1,00,000 USS for a seat in a
private college. A few years ago at the instance of a Union Health
Minister and to counter growing opposition to the ‘commercial medical
education lobby’ an NRI quota has been suggested even in government
colleges with the proposal that the money so collected would be used to
upgrade the technological facilities in the government teaching hospitals!
f) There is reason to believe, from an informal survey of examiners, that the
‘commercial factor’ has also begun to affect examination systems with
payment for ‘ensuring success’ being required at different levels - within
the department, or within the institution and/or at the examiner level.
While this has been a feature reported sometimes even in government
institutions, this is more in the ‘commercial colleges’ where the
availability of resources is greater among the students. Also with the focus
on quantity rather than quality there is an increasing phenomena of
substandard teaching producing substandard students who are unable
to pass exams in the normal way and have to ’purchase’ a pass.
Alternatively with the availability of monetory resources among these
8
capitation fee paying students, examiners and institutions are also
indulging more in unethical market-economy processes.
This commercialization is contributing to a fall in qualitative standards by
allowing money, power and political influences to affect results.
D. Supreme Court Judgment and Thereafter
9. To place the above trends in context, it is important to take note of the
Supreme Court Judgement in a special writ petition from Andhra Pradesh on
Capitation Fees, which recorded that -
Capitation fees as it is practiced today
Violates the right to education under the Constitution....
is wholly arbitrary; is unconstitutional according to
Article 14 — equality before law;... is evil unreasonable,
unfair and unfit... and enables the rich to take
admissions yvhereas the poor have to withdraw due to
financial inability... and therefore is not permissible in
any form....'
10. The Supreme Court judgment effectively put a legal brake on this unhealthy
trend. State governmentals and state politicians had to come to terms with it
and so after much dialogue and lobbying a differential fees scale has now been
introduced allowing private ex-capitation fee colleges to charge substantially
higher fees for ‘paying students’, with government quota introduced into all
the private colleges as well with some exceptions.
In a Government Order dated 21-11-96, the Government of Karnataka has
now fixed the intake of all colleges and fixed numbers in four quotas - free
(merit seats); Karnataka (payment); Non-Karnataka (payment); and
NRI/others (See Appendix)
There is need to review this whole recently evolved fees system. Apart
from it being inequitous and very much supporting the market economy
in medical education, there is reason to believe that once again it is also
being circumvented by unofficial means.
11. The Medical Council of India was also directed by the Supreme Court
judgment of 9-8-1996 to evolve a fee structure keeping in mind the student
community management and also the location of the colleges. The Executive
Committee of MCI gave its recommendations to the Central Government in
September 1996.
While appearing to rationalise the fees issue this
recommendation (see Appendix) has further strengthened the market economy
by justifying differential fee structure from 15,000 for free merit seats (for 18
months) to 1.5 lakhs per course for 18 months and $75000 for NRl and foreign
students The ethics, legality and ‘commercialisation’ trend generated by
this recommendation is still to be reviewed and there is need for a urgent
professional / public dialogue on it.
9
12. The recent controversy about the ‘illegal’ expansion of seats in some
government and private medical colleges in the state in the 1990s through the
permission of the state government against the norms of recognition by the
Medical Council of India are well known including the judgement of the
Supreme Court, declaring it illegal. This has vindicated the increasing
concerns about the nexus between commercial lobby and professional political
leadership but has also put a legal impediment to this state sponsored
illegality.
13. In the light of the above trends in the market economy driven medical
education in Karnataka there is need for an urgent study on the potential nexus
between the commercial lobbies and the medical education policy makers and
leadership at state / central levels to understand the active and continuation of
the trend. In the light of this, the recent announcement of a list of 20 medical
colleges being given essentiality certificate by the Government of Karnataka
is a matter of serious concern.
E. Implications of Governments Recent Decision
14. In the previous sections, we have outlined the situation, the trends in the
development of Medical education, the concerns regarding the growth of
‘capitation fees’ and commercial medical education culture and the dangers
of the ‘market economy’ related transformation of medical education
planning in the state. It is obvious that thedecision to give ‘essentiality’
certificates to 20 more colleges initiatives will worsen these trends.
However, even if the ‘market economy’ factors were to be regulated or
controlled there are other implications that have just not been given adequate
consideration by the State authorities.
15. Teaching Faculty-from where?
The Medical Council of India recommendations on teaching faculty for a 100
seat medical college requires a minimum of 100 faculty of varying grades Professors/Associate/Assistant Professors, Lecturers/Demonstraters, etc. 20
new colleges means 2000 new faculty. Where are these large numbers of
adequately trained faculty going to come from? especially when recent
medical council surveys themselves record shortage of faculty all over the
country! Such a massive expansion will only lead to recruitment of
inadequately qualified staff; movement of qualified staff from existing
institutions to the new ones often due to the lure of enhanced salaries;
irregularities such as the appointment of part-time staff or the same staff
appointment being shown in two different institutions. All these are already
taking place and are no longer in the realm of hypothesis!
10
16. Teaching Hospital Beds - where is this available?
The Medical Council of India recommendation of teaching hospital beds per
student is 7 and hence a 100 seat medical college requires 700 hospital beds
for recognition purposes . For 20 new medical colleges, we need 14,000
hospital beds. Where is this resource available in the state? It is important
to emphasise that these guidelines are ‘minimum’ with the proviso that
anything less would severely jeopardise the quality of medical education since
adequate ‘teaching hospital beds’ are an important pre-requisite to bed side
clinical teaching, which in the training of doctors is absolutely crucial. Any
alternative arrangements like showing other government hospitals, private
hospitals, district and taluka level hospitals to add up adequate numbers
without upgrading facilities and services in these hospitals and making them
suitable for ‘medical education’ will be a disservice not only to the medical
students who will become ‘guinea pigs’ subjected to substandard medical
education but also to the state resulting in the production of sub-standard
doctors.
17. Ethos of Higher Education
Medical Education is a serious professional challenge and trusts, organisations
and institutions that are given the essentiality certificate must be (i) those that are
capable of understnading the professional complexities of medical education
including the essentiality of maintaining quality and standards (ii) have some
previous experience of running higher educational initiatives (iii) have the
resources and experience in health care - not just financial but in terms of human
expertise (iv) have credibility in operationalising social ventures in the public
interest and so on. Do the 20 organisations in the recently announced list of
potential medical colleges meet these requirements? What yvere the criteria on
which the state government gave the essentiality certificate? The professionals
and general public have a right to know and the state government should be
invited to be more transparent and evidence based in its planning.
18.
Complexity of Recognition and Affiliation
The recent announcement by the State government and its reporting in the media
has confused the complexity of recognition and affiliation of Medical Education.
Since the Presidential Ordinance of 1993 and the recently updated Medical
Council of India Act, the National standardisation and recognition and
monitoring of Medical Education has become the responsibility of the Medical
Council of India. When the state gives an essentiality certificate, it only
authorises an institution / association or trust to apply for permission to MCI. An
essentiality certificate cannot a guarantee MCI recognition. However, some of
the organisations in the recently announced list of 20 have already announced
recruitment of staff (see Appendix) which is rather unusual!
The MCI requires proof of adequate resources including land, access to hospital
beds and other facilities. The MCI inspects the institution before giving the
green signal. All this taken times and any rush, over confidence, shown by
organisations contemplating such a venture can only be based on inadequate
understanding of the complexities of the process.
11
Incidentally, only 5 out of the 20 applicant managements
hospital.
have a teaching
F. Issues raised in Recent Debate in Media
19. Since the state government announcement there has been a spate of letters to
the editors of newspaper and frequent pronouncements by various policy
makers especially the Minister of Higher Education of the State that has
further confused the issues.
Some of these need clarifications (see
Appendix)
20. MCI has a dominant role in the functioning of medical colleges and the
state government is unhappy with in (refer appendix) The Hindu, 29-11-98 Government seeks more powers on medical admissions.
The State Government has to realise that it is precisely because of the
‘irresponsibility’ that previous governments of Karnataka and Maharashtra
have shown in the past vis-a-vis promotion and collusion with capitation fee
medical colleges and with standards in general, that the Presidential
Ordinance and the MCI Act of 92-93 was brought in. The Training of
Doctors were seen as too important to be left completely to these forms of
state sponsored changes in framework and standards.
21. “As per the MCI rules, the intake of under-graduate medical course could
not be more than 150”.
The state government must note that the guidelines on Medical Education
standards for colleges, teaching faculty are based on colleges with low seats.
Medical Educationists all over the world have come to realise that 50-100
seats in the maximum number to be handled by a college if complex quality
/ requirements teaching standards have to be maintained. Keeping in mind
the Indian situation, there has been some relaxation to 150. However, mass
production of doctors is not called for. The previous state governments have
already shown their irresponsibility in increasing the intake of students for
above this limit in a number of colleges in the state with no increase in
teaching faculty or faculties. That the Supreme Court had to intervene to
regulate this state sponsored illegality and degradation of medical education
in the state is a matter of great concern. It is high time that policy makers
stopped making a mockery of the production of doctors as if they were a
‘commodity’ whose production can be enhanced or reduced according to
market demand.
Another important MCI Guidelines is the enhanced use of small group
learning methods. Clinics are supposed to be organised in small group not
more than 10 students per teacher. Group discussions are encouraged with
not more than 20 students in a group. A 100-150 seat medical college means
simultaneously 10-15 clinical units to be involved in teaching or 5-8
simultaneous group discussion. This itself is quite a load. Mega educational
effort 150 to 300 make small group work near impossible.
12
22.
“One medical college for every district”
The government has recently justified part of the applications given
essentiality certificate on the basis of ‘districts where medical college are
being established for the first time’ - these being Raichur, Bidar, Bangalore
Rural, Hassan and Bagalkot.
While ‘one medial college per district’ may sound a good decentralised
proposition especially if the medical college and its teaching hospital was
closely involved as an apex referral hospital for other secondary and primary
health care centres in the district, this is not a practical proposition in the
existing skewed and disparate situation of medical college distribution in the
state.
Already, Bangalore has 5, Mysore-2 and Bijapur-2 each.
Bangalore in the list.
5 more from
Unless seats are reduced in these colleges further and transferred to new
medical colleges in new districts - the college per district lobby will only be a
convenient and populist proposition to increase the number of colleges / seats
irrationally.
23. There are many more issues of relevance some highlighted in the letters of
concern appearing already in the media. These three issues were given as
examples to show that the State Government seems to have gone ahead with
the matter without any evidence based planning, rational norms of
doctor/population ratio, medical college/population ratio, state needs or
regional disparities. This is a very sad reflection of the non-serious and adhoc
nature of state planning in spite of the presence of a multidisciplinary state
planning board and a capital city which is considered the Science capital of the
country!!
G. Some Additional Trends and the Relevance of Medical Education Expansion
in the State in that Context
24. To understand the context and appropriateness of Medical Education
expansion in the state or country four other well established trends need to be
understood as well. There are :
a) the continuation of the production of the wrong type of Doctor for India
and the State;
b) the problem of Brain drain and student wastage;
c) corruption in Medical Education; and
d) market economy and medical education.
25. Wrong type of Doctor
a) It is now well documented that majority of the doctors who graduate from
the existing 145 medical coleges In India are not motivated to primary
health care, public health or rural service and opt for urban clinical
practice and / or furthur specialisation.
13
The Srivastava Report surveying the Indian scene in
1974 had identified the problem as “stranglehold of
the inherited system of medical education, the
exclusive orientation towards the teaching hospital
(urban), the irrelevance of the training to the health
needs of the community, the increasing trend towards
specialisation and acquisition of post graduate
degrees, the lack of incentives and adequate
recognition for work within rural communities and
the attraction of the export market for medical
manpower”.
b) The WHO South East Asia report in 1988 reviewing the medical schools
of this region including those in India noted :
“Medical schools in the Region were, for the most
part, originally modelled on European-American
institutions. They have functioned within a clinical,
scientific and administrative system which retains
much of its colonial inappropriateness, and aspire to
international9 (i.e., often irrelevant) standards of
excellence. Medical students are liable to be selected,
formally and informally, for upper middle-class career
aspirations, and then trained in high-technology
curative biomedicine. They look fonvard to working
alone or with other physicians, in an urban setting,
with predominantly middle class patients. The science
and values to which they are exposed emphasize the
old biology, and it is this, together with the credo of
their profession, which shapes their behaviour”.
c) A decade later the situation has not charged drastically. While the recently
established Rajiv Gandhi University of Health Sciences is trying to
restructure curriculum and improve quality, the recent move by the State
government may fuel counter productive trends which will worsen the
situation drastically.
d) The doctor population estimates used by planners are further skewed by
this ‘irrelevant doctor’ factor. So we have an increasing number of wrong
type of doctor concentrating in the urban situation and a continued
shortage in rural area. Not surprising the Bajaj Report of 1994 has noted
“The state of Maharashtra which accounts for almost one fifth of the
total national outturn of doctors annually, has about one fourth of the
sanctioned pasts of doctors at rural PHCs lying vacant as of 1st January
of the current year”.
14
26.
‘Braindrain’ - Internal and External
Estimates of Brain drain’ both external (from India to the developed world)
and internal (from the public sector to the profit oriented private urban sector)
is variable but on the whole have been showing an increasing trend.
In 1986-87, it is estimated that 5304 doctors representing 30% of the
annual output migrated from India. The trend today is similar or slightly
increased.
Studies are beginning to show that the tax-payer supported governmental
medical education sector benefits the private sector in the country and the
health service sector of the established market economies of the western
world, more than the health services of the government and this is
probably even more significant in Karnataka and Maharashtra.( )
There is therefore neither a shortage in the country nor any evidence that
increase in numbers either in public or private sector will improve the health
care in the underserved regions of the state or country.
Any expansion can therefore only be justified as a response to ‘market
economy forces’ not state priorities or peoples health needs.
27. Corruption in Medical Education
Corruption and graft have become the bane of public and private life in India
and Medical Education is no exception particularly in Karnataka State. Apart
from the commercialisation problem engineered by the ‘capitation fee’
concept which has now been temporarily regulated by the Supreme Court
Judgment and the MCI Recommendations other forms of corrupt practices are
becoming quite common.
Influence of money power and power politics in the selection of medical
college admission and postgraduate seats have been rife (recently
regulated by centralisation of admission tests and allotments! for
undergraduates only)
Influence of money power and politics at examinations at various levels;
From anecdotal and often experiential evidence and media reports.
It is however surprising how reports and studies undertaken by
professional researchers and numerous internal and external reviews, fail
to highlight or even mention this fall in ethical standards in medical
colleges. One wonders whether the ‘conspiracy of silence’ has a
professional / class bias as well;
Increasing concern that other practices are becoming fairly common;
Extraneous influences in promotions and transfers of medical college
teachers in government colleges;
15
Growth of private practice values in patient care in government and
private teaching hospitals.
There is growing evidence that the situation in Karnataka in this area is
probably among the worst in the country and at least one contributory
factor would have been the growth of the ‘capitation fees related
commercial medical college culture’.
28
The Medicine - industrial complex
Commercialization of Medicine is rampant in India with the country in
recent years becoming the ‘Mecca’ for the medical-industrial complexes of
the world especially since the new economic policy has ushered in the
triple force of Liberalisation, privatization and Globalisation. Many
important trends in the state are symbolic of this new development and the
inroads that these market forces are make into existing medical education
infrastructure is a cause for concern.
a) Private Practice
While MCI and state / central government and most professional
bodies have endorsed in the past the need for teachers of medical
colleges to be full-time non-practicing, this situation is changing
rapidly with clandestine or officially sanctioned private practice,
becoming common place.
Under pressure of the Medical profession, who are getting more and
more involved with lucrative and competitive practice, more colleges
are beginning to reconsider this rule and allow various forms of
practice, to the detriment of the medical educator’s primary
commitment. The ‘teachers status’ is now becoming a status symbol to
help the competition in private practice rather than as a vocation of
commitment. This trend is very significant in Karnataka and will be
further accentuated by the state Governments promotion of
‘commercialised medical education’.
NRI Phenomena
b) The recent phenomena of NRIs from the ‘US’ promoting High
technology Diagnostic Centres in the country is reflective of the MNCs
in the ‘west’ opening new market avenues for high tech gadgets whose
sale in the ‘west’ has shown a slump in recent years. Thus while the
NRI process in Health care is often portrayed in the media and policy
formulations as an ‘altrustic process’ in reality it is also a ‘market
economy process’ and is strengthening the commercialisation trend.
There is urgent need to dialogue with NRI groups to share these
concerns and ensure that NRI support the social/societal
needs/priorities as well.
16
29.
Teaching Faculty vacancies
While data on current availability and the actual shortfalls are not
easily available at state or central level, there is increasing concern that
this is becoming a major problem. In states like Karnataka, with the
unchecked proliferation of private capitation fees colleges the
depletion or shift of faculty from Government colleges to private
colleges in the lure of better pecuniary benefits has become a serious
problem. In the near future, this could lead to a situation of potential
derecognition, of the government colleges itself.
30.
Quality control
In the context of the Norms available at present, MCI inspectors tend
to concentrate primarily on infrastructure and staff position rather than
quality / methodology / orientation of medical education. Hence even
in colleges which have been certified as being recognition worthy on
the basis of infrastructure and faculty norms, the quality of medical
education has been declining.
The decline in standards, that have been seen in more recent years,
have been quite remarkable and it would not be ‘rash’ to state that if an
objective evaluation were to be made of the 19 medical colleges
presently recognised by the MCI, using its own minimum requirements
norms, then at least 50% of the colleges would have to be
derecognised immediately. Perhaps this would be true even at the
country level!
Since MCI norms are published documents, professional groups and
consumer / peoples organisation can make their own studies to confirm
the veracity of these facts.
H. THE WAY AHEAD
31. Finally in the light of this recent dramatic decision by the State Government,
and response to the complex mosaic of factors that are actively distorting the
role, scope, goals, objectives and context of medical education today we
recommend the following agenda for action:
32
BAN ON MEDICAL COLLEGE EXPANSION
A comprehensive and total ban on Medical College expansion today till the
controversies and distortions are tackled legally and supported by the
strengthening of the monitoring of standards structures in the state with the
full involvement of the Rajiv Gandhi University of Health Sciences.
The ban should be further supported by ensuring that colleges with ‘mega’
educational efforts (150-300 seats) that were regulated recently maintain that
level gradually bring down to 100 seats for undergraduate medical education
17
to improve standards and quality of the programmes by reaching better
staff/student ratio and student/hospital bed ratios.
33.
EDUCATIONAL TRANSFORMATION - Focus on Process and Quality
For too long, educationists and health human power development consultants
and experts have been preoccupied with the content of change rather than the
‘structure’ and ‘process of change’. The emphasis has been on changing the
components of the curricula - the topics and nitty gritty of what is taught often under the mistaken notion that the irrelevance of the conventional
curriculum is primarily a ‘content’ irrelevance. There is now a growing
realisation that medical education is too teacher centred, too top down, too
preoccupied with practice and too ivory towered. There is an urgent need
to change it to become learner centred, student and situation driven,
community oriented and geared to skill development.
From the ‘banking type’ of education when facts and minutiae are banked in
the students mind, to be recalled when the need demands it, there is a shift of
emphasis of learning experiences to become problem oriented and problem
solving in their approach, linked to real-life field experiences.
This
pedagogical transformation is absolutely crucial for change and in the
absence of this understanding much of the community based experience has
been affected by orthodox educational attitudes - that miss the ‘woods for the
trees’.
The Rajiv Gandhi University of Health Sciences has already begun this
process in right earnest supported by the new 1997 recommendations of
Medical Council of India and should be fully supported in this process.
34.
REGULATION OF PRIVATE SECTOR / PRIVATIZATION
HEALTH CARE / MEDICAL EDUCATION TRENDS
IN
There is an urgent necessity to set up a state level ‘think tank’ committee or
some such review mechanism to undertake a detailed stud}> of Health Care and
Medical Education in the state and the role of the private sector. The study
should explore all aspects of the growth of this sector to assess its existing and
evolving contribution. The study should also identify the negative trends; the
problems, this sector faces in making a contribution to the state effort; and
means by which its efforts can be regulated by the development of standards and
technical guidelines so that its role is positive rather than negative.
35.
ENHANCING PUBLIC DEBATE ON ISSUES
For too long the Medical Profession and Medical Education sector have been
directed by professional control and debate. It is time to recognise the important
role of the community, the consumer, the patient, the people in the entire debate.
Bringing Medical Service under the purview of the Consumer Protection Act
has been the first of the required changes. Promoting public debate, review and
scrutiny into the planning dialogues for reform or reorientation has to be the
next step. This could be brought about by the involvement of peoples /
18
consumers representatives at all levels of the system - be it sendee, training or
research sectors. However, all these steps can never be brought about by a top
down process. What is needed is a strong countervailing consumer and
professional movement initiated by health and development activists, consumer
and people’s organisations that will bring health care and medical education and
their right orientation high on the-political agenda of the country’.
All those concerned about ‘peoples needs’ and ‘peoples health’ will have to take
on this emerging challenge as we approach the end of the millenium. Our
efforts today, will determine, whether in 2000 AD, Health Care and Medical
Education will primarily respond to the peoples health needs and aspirations, or
will market phenomena continue to distort the process?
“MARKET” ECONOMY or PEOPLE’S HEALTH? What Should be Our State
Government’s Choice?
NOTE:
This report was written before the Expert Committee
appointed by the Government (Savadatti Report) was
available. The justification in the expert report are rather
dubious. The section on Medical Colleges is included as
an appendix to this report to enable the debate process. A
chart commenting on the expert committee propositions is
being prepared.
19
APPENDICES
Medical Council of India and Medical Education in India - 1995
Dr. P.S. Rugmini & Dr. M. Sachdeva
systems o, med™, are stltt In existence end b,l„g prXd
™^8““S
teen
<A"°P='^) has
TnT "eaT'p T'T
mXXXTX
CaMamd
Medical Colleges in the country & medical manpower.
had hicraasetHo a^t'the U™ XI
tonnd esXS ”
°'lh'
“» "™to »' ™«»»l «*ses
?“
L
Year
"
------ ;--------------------- ----------- --------__________ _______ __________________________ Number of Medical Colleges
1835
—--------------------------------------------
1906
1947
1951
1961
1971
1981
1991
had been set up^to laTdown^
1
5
25
30
67
101
111
..
,46
upto March 96, 162
^946^ and Mudliar Committee (1961)
ratio now works out to approximately 1'1800eTh ned(ab°Ul 5 lakhS)' 1116 doc,or ; Population
number of practitioners o otheTsvstem. Sm h' °eS nOt ‘ake int° consid^ation a great
and Homoeopathy (aTout 6 lakhs)
35 'h^" SyStemS °f Medicine
1
no nidXXXe' meXl X? °'
,he
a"‘1
» '“»y
in certain States which do not have anv9med?ra?r0^|lJC1,0n °f m°re doctor5' excePt Perhaps
l-M.C. Act 1956 in 1993 (under the nrnvi ' d 1 c°lle9e as Vet- With the amendment of the
no new postgraduatei course can! be st°
n° mediCal COllege can be established,
6
2-0
Appendix 2
Sub: Intake of I MBBS and I BDS for Medical and Dental colleges in Karnataka 1996-97.
Proceedings of Government of Karnataka
Read Interim Order of Hon’ble High Court of Karnataka dated 14-11-1996 in Writ Appeal No. 8413/96 etc.
GO - NMF 212 MSF 96 Bangalore dated 12-11-1996.
SI.
Name of the College
No.
1.
_________ 2_________
1.
Bangalore
Medical
College, Bangalore
Mysore
Medical
College, Mysore______
K.I.M.S. Hubli (subject
to die result of the appeals
pending before the Hon’ble
High Court of Karnataka in
W.A. No. 8413/96 etc.)
(except AIG filled through
CBSE)_______________
V.I.M.S. Bellary
J.J.M.
Medical
College, Davanagere
(subject to the result of the
appeals pending before die
Hon’ble High Court of
Karnataka in W.A. No.
8413/96 etc.)___________
J.M. Medical College,
Belgaum
(subject to the result of the
appeals pending before the
Hon’ble High Court of
Karnataka in W.A. No.
8413/96 etc.)
(except AIG filled through
college_______________
M.S.Ramaiah Medical
College, Bangalore
Sri
Devaraja
Urs
Medical
College,
2.
3.
4
5.
6.
7.
8.
Kolar
Total
Seats
Free
(Merit)
seats
Payment
seats
Karnataka
4
5
3
Payment
seats
Non
Karnataka
6
NRI /
others
7
150
150
100
100
50
50
100
100
150
75
30
22
23
(95)
(48)
(19)
(14)
(14)
130
65
26
19
20
(70)
(35)
(14)
(10)
(H)
150
75
30
22
23
100
50
20
15
15
(25)
(10)
(07)
(08)
(subject to the result of the
appeals pending before the
(50)
Hon’ble High Court of
Karnataka in W.A. No.
8413/96 etc.)
2J
9.
10.
11.
12.
13.
14.
15.
L*
Adi
Chunchanagiri
Institute of Medical
Sciences, Bellur_____
Dr.
Ambedkar
Medical
College,
Bangalore
J.S.S.
Medical
College, mysore_____
Kempegowda Institute
of Medical Sciences,
Bangalore__________
M.R. Medical College,
Gulbarga
B.L.D.E.A. Medical
College, Bijapur_____
Siddartha
Medical
College, Tumkur_____
TOTAL:
100
50
20
15
15
12(F;
60
24
18
18
100
50
20
15
15
120
60
24
18
18
100
50
20
15
15
150
75
30
22
23
130
65
26
19
20
1750
1075
270
200
205
* Nos. in paranthesis excluded
22-11-96
Sd/N.O. Palekar
Under-Secretary to Government
Health and Family Welfare Department
Appendix - 3
Relevant Extract from letter of Secretary, MCI.
To: All the members of the Council.
No. MCI-34(4I)/96-Med./18457/Medical Council of India.
Subject : Evolution of the structure for unaided professional institutions in light of
Supreme Court’s Judgment delivered on 9-8-1996.
“..The Executive Committee noted that the Constitutional Bench of the Hon’ble Supreme
Court of India in W.P. No. 317/93 dated 9-8-1996 has stated that the Central Govt, and the
authorities concerned shall be free to fix fee structure in such an appropriate manner as they
think just and equitable to all concerned. Further they have stated that this would be done
keeping in mind the student community, management and also the location of the colleges”
The Executive Committee decided to classify the medical institutions under the following
heads
a)
b)
c)
Institutions with their own hospital
Institutions utilising the facilities of Govt, as well as their own hospital
Institutions utilising the facilities completely as provided by Govt, hospitals.
Taking into consideration the above classification, the following fee structure is
recommended:
Rs. 1.5 lakhs per Prof. Course (18 months)
institutions/medical colleges belonging to category (a).
per
student
for
medical
I
2. Rs. 1.3 lakhs per Prof. Course (18 months)
institutions/medical colleges belonging to category (b).
per
student
for
medical
4
3.
Rs. 1.1 lakhs per Prof. Course (18 months)
institutions/medical colleges belonging to category (c).
per
student
for
medical
4.
Rs. 15,000/- for each Prof. Course per student for free seats belonging to medical
institutions/medical colleges falling under the categories (a) (b) and (c).
1.
<
<
5. $75,000/- to be charged from NRI/foreign students for the complete MBBS course.
■I
However, the institutions which are running post-graduate courses and admitting more than
50% of the students at their own discretion in clinical specialities and Pathology, 25%
relaxation in the fees stated above will be given.
For the following non-clinical courses the institutions will charge no fee - Anatomy,
Physiology, Biochemistry, Microbiology, Forensic Medicine, P.S.M. & Pharmacology.
a
4
a
<
The Executive Committee also recommends that the Govt. Colleges be allowed to admit upto
a maximum of 15% of the total seats by NRI/foreign students. The committee was of the firm
opinion that the funds collected by these admissions should be utilized for the development of
the particular institutions”.
Since the Hon’ble Supreme Court directed the authorities concerned to submit its
recommendations within 3 months relating to fee structure, the decision of the Executive
Committee quoted above was communicated to the Central Govt, vide Council letter dated
18-9-1998 as directed by the President”
Sd/Mr. M. Sachdeva,
Secretary.
fi
Appendix • 4
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I
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24
3
FOREWORD
The Government appointed this committee to go into the entire issue of
Professional
education
in
the
state
keeping
in
view
the
man
power
requirement of • the state and also the fact that students from outside
Karnataka come to the state for education and some of the students of
Karnataka after the completion of: education may go out of Karnataka and
report on policy decisions for the next ten years. The whole canvas of
professional education includes Medical, Engineering,
Dental, Pharmacy,
Ayurveda, Homeopathy, Nursing and other Paramedical courses, the last one
being a cluster of number of subjects.
The committee tried to obtain the man power requirement for the
state/country from possible sources. It happens that some systematic data
are available for engineering and some data are available for medical and
1
inadequate data exist for Dental, Pharmacy and Nursing and absolutely no
dependable data exist for paramedical courses. The job of this committee
became more complicated since the norms that were suggested by various
Ji
committees (National & International) were more in the nature of achievable
recommendations rather than scientifically evolved requirements. There is no
data system available except for Engineering to know the employment
profiles of professionals. A large number of these professionals are either
self employed or employed in private establishments wherein it .is not feasible
to know the remuneration package. Hence the committee had to rely on
general-indications as to what the people in the field say or what some
graduates say. Another very important factor taken into consideration is the
s.
|i!
quality of the professional education which is
badly hurt because of
unplanned and rapid expansion.
With this background the committee has endeavored for the last seven
months to arrive at the recommendations which are. in the best interest of
establishing quality institutions. The reason for this emphasis on quality is
Ai
H
that institutions without quality are ruining the quality institutions. The
as
committee appreciates that the Government thought it fit to appoint a committee
and to have a serious look at the situation. The committee while appreciating
the opportunity given to its members to examine the status of professional
education, it hopes that the government would take serious note of the
J
.. •/ piimdii:;.;;
.: j
mm
mm’ .
- ■
recommendations made in the report
The committee wishes to place on record the assistance it has received from
many sources. It is a pleasure to thank Prof.' D.M.Nanjundappa, Chairman,
Planning Board and Prof. Ashokchandra, Director, Institute of Applied Man
power research, New-Delhi for discussion
on man power & perspective
planning.
The committee
appreciates
the support
member secretary
of the
Dr.C.R.
Thirumalachar, Director of Medical Education and his team particularly Mr.
A.N.Vishwanath, Professor of Statistics, Bangalore Medical-college and Mr. H.
ShivaKumaraswamy for putting in efforts beyond the call of duty to see that
the
committee
had
adequate editorial
and
secretarial
departments' of Government particularly Health,
Planning
support.
and
.
The
Education
through their Secretaries and Directors have rendered useful assistance.
The committee wishes to appreciate Mr. R.Shankara, and Mr. L.Shama:Sundar
of Karnataka Govt. Computer center for their quality design and nice printing of
the report
The chairman appreciates the active support of all the members.
Bangalore
September 24,..1997
(Prof. M.I.SAVADATTI)
Chairman
EXPERT COMMITTEE
I
v<A
I
f
J
i
PART I
FR l@^R®®feiSE (S
27
REPORT OF THE EXPERT COMMITTEE TO CONSIDER
INTAKE OF EXISTING MEDICAL COLLEGES AND THE NEED TO START
NEW MEDICAL COLLEGES IN THE STATE.
The Cabinet sub-committee constituted to look into the question
of granting permission for starting new medical, dental, engineenng,
ayurvedic, homeopathic and unani colleges and determine the intake not
only of existing institutions but also of new institutions, set up an expert
committee headed by Professor M.I.Savadatti, former Vice Chancellor
and member UGC, comprising experts from different related disciplines
I
in
Government
Order no.
HFW350MSF96,
dated:7.10.96 with
the
following terms of reference.
"The Expert Committee should go into all the factors determining
the
need for medical, paramedical and
engineering
manpower in
different systems of medicine and engineering in the State for the next
ten years,
keeping in view the fact that many of the students who are
trained in the existing institutions do not
stay in Karnataka but go
elsewhere."
The Committee was requested to give its findings within a period
of two months. A list of members of the committee is given below:
1
1. Prof.M.I.Savadatti
Retd. Vice Chancellor.
Chairman
2. Dr.S.Kantha
Vice Chancellor
Rajiv Gandhi University of
Member
Health Sciences
3. Dr.C.M. Gurumurthy
Retd. Special officer,
Health University
Member
II
4. Shri.R.N. Shastri
Secretary-ll, Health and
Family Welfare Department.
Member
5. Director,
Manpower and Employment
Division, Planning Dept.
Member
6 Dr.Renuka Viswanathan
Secretary to Government,
Planning Department
Member
7 Dr. N.R. Shetty
Vice Chancellor,
Bangalore University
Member
8 . Dr.Rame Gowda
Former Vice Chancellor,
Karnataka University
Member
9 .Prof.M.H.Dhananjaya
Director, J.T.E.
Mysore.
Member
10. Dr Chennabasappa
Retd.Prof, of surgery
Member
11. Dr.Thirumalachar C. R.
Director. Medical
Education
Member Secretary
Expert Committee deliberations:
The Expert Committee met on 7.11.96 and decided to get
first hand information about professional colleges, how they are
run.
their
requirements,
needs,
problems
and
possible
expansion. It was decided to visit three medical Colleges: the
Bangalore Medical College (government), J.N.Medical Collage,
Belgaum(private),
and
the
Adhichunchanagiri
Institute
of
Medical Sciences, Bellur (private/rural).!n the second meeting
held on 20.11.96,the committee reviewed data on the number of
•a
<29
graduates passing out from different medical colleges in the
State upto 1995. Manpower and Employment Division, Planning
Department was requested to help the committee in working out
the
demand and supply of medical
account
the
government
graduates taking
private
sector,
sector and
into
self-
employed professionals. In the 3rd meeting heldon 10.12.96 the
methodology, of perspective planning for various sectors with
particular reference to the need for medical graduates was
discussed at length and it was agreed that Planning Department
should forecast the requirements of doctors taking into accout
the estimated needs of the State and the estimated number of
students seeking medical education from outside the State and
outside the country. It was also agreed that the report of the
Planning Department should clearly state the methodology
adopted, the assumptions made and the limitation involved
taking into account similar studies made at the National level. In
the
4th
meeting
held
on
10.1.97
the
report
of Planning
Department was discussed and it was decided that reports
submitted by similar committees be studied. At the 5th sitting of
28.1.1997,the
recommendations
of
various
reports
were
discussed and it was decided that a draft report be prepared
based on all the above discussions. The Committee decided to
take up the assessment of medical and engineering manpower
for the next 10 years on top priority and go into the question of
the
manpower
requirements
of
other
professional
and
paramedical personnel paramedical personnel in the second
phase.
3>o
Present Status:
r
!•
The Expert Committee reviewed the
medical
education
present status of
in the State in terms of the
number of
institutions and their intake and the out turn of medical students.
j
Karnataka had only two medical colleges in 1956 with an intake of
200. At present there are 19 medical colleges in the state. Of these
19, two colleges K.M.C., Manipal and K.M.C., Mangalore have
I
become part of MAHE and only 63 seats are available for the state
quota. With the remaining seats being filled on all india basis with
their own
>
i
College,
entrance
Bangalore
examination.
Similarly
St.John s
also
on
basis
admits
the
Medical
its
of
own
examination on an All India basis. Therefore in effect the intake for
the state is for 16 Colleges plus 63 seats from MAHE. Details of
total intake and outurn in these institutions are as below.
Expected Outturn
Intake
Year
Total
1992- 93
1993- 94
1994- 95
1995- 96
1996- 97
In this
NK
KAR
Total
NK
402
2049 382
2382
694
3076
1952 441
2159
801
2960
1946 435
2158
790
2948
323
1402 _______
1541 ________
587
2128 ______________
2755
730
2025
1820
KAR
1418
1667
1511
1511
1079
table total intake for the state is arrived at by
excluding admission in
MAKE (except 63 seats given to state by
MAKE and in St. John's,. Bangalore)
Many of the Colleges have postgraduate programmes and
some have superspecialisation and
Phd. Programmes. These
colleges attract students from other states and countries and
have been by and large providing training as per the norms of the-
Medical
Council of India . Except for four Government Medical
31
Colleges,
they
are
self-financing,
The
for
demand
medical
education is high as available seats are filled soon leaving
thousands of qualified aspirants disappointed . In the last five
years no new medical colleges has been started in the State under
I
1
the assumption that the number ot colleges is Optimum, despite
increasing demand for admission to medical Colleges.
private managements have applied to universities and the state
government for permission to start new medical colleges.
i
Many
There
are instances of applicants and managements moving the High
Court for directions to process such applications.
There have
been many court cases because of the huge demand for mod,cat
i
education.
i
Mpfhodological options:
The expert committee did a quick review of a recent study
made
by
the
planning
department
of
the
requirements
manpower in medical, dental paramedical and pharmacy colleges
in the state. The study had assessed the requirement for the Sth
plan period on the basis of the end users method. The study was
however confined to the period 1992-97, while the cabinet sub
committee wanted an assessment of the next 10 years i.e. 1997-
2007.
■
To assess the requirement of medical manpower, the Expert
Committee had to adopt a methodology that would result in a
reasonably reliable estimation of public and private sector doctors
,1
needed over the period 1997-98 to 2006-07.
Broadly
the
Expert
Committee
had
the
following
methodological options available.
32.
1,
I
I
Methodology based on the incidence of morbidity:
According to this methodology, demand for doctors can be
estimated on the basis of morbidity patterns, duration of
sickness by disease etc.
2. Another approach considered was the end users approach
with estimates of demands for doctors in terms of different
components public sector, private sector and self
employment requirements.
3. The third methodology that was considered was the
normative approach based on the doctor population ratio
under which demand for medical doctors is estimated on
the basis of the desirable population to be covered per
doctor.
The major constraint in selection of methodology was the
time factor of two months given for completion of the report.
Approaches 1 and 2 require detailed sample surveys based on
schedules and can be completed only over at least 6 months.
Hence the committee opted for the normative approach of the
doctor population ratio hoping to base its findings on any ratio
accepted
by
National
level
committees,
policy
makers
of
International agencies and also make comparisons with the ratios
prevailing in other countries.
Report of the Planning Department:
I
I
The Expert Committee requested the planning department
to prepare the prospective of medical doctors for Karnataka for a
period of ten years (1997-98
to 2006-07). It was also suggested
that in the demand projections factors such as migration, drop
outs and replacement requirements should be taken into
consideration.
The
Committee
also
suggested
that
while
assessing the requirement of medical doctors, the intake level
prescribed by the Medical Council of India for 1996-97 was to be
adopted and the exercise restricted to only
Karnataka students.
33
The Director of Medical Education was requested to provide data
on the intake and out run of medical students (excluding non
Karnataka students) from 1992-93 and the 1996-97 intake level
I
based on MCI standards.
As regards the desirable doctor
population ratio to be adopted, the Expert Committee requested
the Director of Medical Education to provide National Health
!
I
Policy norms if available.
The Planning Department prepared a paper on the health
man-power prospective
for
medical
doctors
(Allopathic)
for
Karnataka for the period 1997-98 to 2006-07, utlilising data already
I
available in the department and data furnished by the Director of
Medical Education on the intake and out turn of medical students
since 1992-93. For the desirable doctor population ratio the ratio
as recommended by the various committees was adopted to get a
feel for the situation. The expert committee on health man-power
popularly known as the Bajaj Committee which is the most recent
expert committee on health at the National
level
1987 also
recommends 1:3000 as the ratio. No report goes into detail about
the determination of a ratio.
Universally
accepted
The Bajaj report says, “there is no
method
of
assessing
the
future
requirements of health professionals and para-professionals. The
techniques of health manpower forecasting are yet at the stage of
infancy. Nonetheless, three methods are available for estimating
the projections viz., (1) the normative approach which is the most
common method for projecting requirements of doctors and
nurses based on norms(2) the medical user approach which takes
into consideration the willingness and capacity of people to pay
for medical services.
Demand in economic sense is realted to
price and would generally be limited by the financial resources
of the family.
There is relationship between family income and
expenditure on health services.
On the basis of the household
.3^
si
data on common expenditure, the perspective planning division of
the planning commission has worked out the income elasticity of
household expenditure on medical services to be 2.3. This means
that if per capita income goes up by 1 percent, households are
I
inclined to increase their expenditure on health services by 2.3
(3) Finally the third viz., the Component or pragmatic
percent.
approach for projecting the demand for health professionals
*
requires a clear outline of the development of integrated and
I
comprehensive medical health services in the country over a
I
period of 15 to 20 years”.
The Bhore committee of 1946 or the Health Survey and
Development Committee with Sir Joseph Bhose as Chairman, had
recommended 1: 3000 as the norm of doctors to population. While
making
this
suggestion
he
mentioned,
“the
possibility
of
achieving the target one doctor for 1000 population seems to be
t
very remote”. Adopting this norm and projecting population up to
2006-07
using demographic projections
made by the
Expert
Committee on Demographic Projections headed by the Registrar
General of Census operations based on the 1991 Census, the
following inferences were arrived at.
1. The total number of doctors (active stock) in Karnataka
is estimated at 23727 for 1997-98 which gives a doctor population
i
ratio of 1:2110. This is slightly better than all India ratio of 1.2460
for 1990
2. The cumulative stock of doctors for the period ending
2006-07 estimated at 33393 which gives a doctor population ratio
of 1:1682.
p: '
3. Demand projections show that for 1997-98 the number of
doctors required
as per the ratio of
1:3000
is 16687 and for
2006-07 shall be 18727.
4. A comparison of supply and demand projections shows
that there would be a cumulative surplus of 7040 doctors during
1997-98 and a cumulative surplus of 14666 doctors by 2006-07.
5. The total supply of doctors of the year period (1997-98
and 2006-07) is estimated at 10740 and the total demand for
doctors during the period is 2040 leaving a surplus of 8700
doctors.
Doctor-population ratio: how effective is the norm:
There
are
different
views
expressed
on
the doctors-
population ratio as a norm to estimate the requirement of doctors.
Several organisations such as the World Bank and the Planning
commission at the national level have extensively relied on the
doctor-population ratio in their publications as macroindicator of
health services and as an instrument for estimation of the demand
projections of doctors.
The World Development Report 1993- investing in Health, makes a
reference to the minimum requirement of number of doctors
required per thousand population (refer page 139 of report) it is
mentioned in the report that “Public health and minimum esential
clinical interventions require about 0.1 physicians per thousand
population. There is no optimal level of Physicians per capita.”in
the same report an International comparision has been made for
countries with different levels of economic development and
respective ratio per physician. A selected list of countries is given
in the following table.
9
*
I
{
I
I
Low income economics
1. Tanzania_________
____ 2. Nepal
________
____ 3. India_____________
____ 4. Nigeria _________
5. Egypt
6. Ghana _________
Middle income economies
7. Uzbekistan_______
8. Kirgystan________
9. Georgia__________
Upper middle Income
I
10, South Africa______
11, Korea____________
High Income:_________
12, Spain____________
13, Singapore________
14, Italy_____________
15, USA_____________
16, Sweden:_________
World
Aww
6760
350 ____
100 ____
180_____
330_____
340 ____
610_____
400_____
2480 ____
1350 ____
1550_____
1640 ____
3530_____
2560_____
6330_____
31050_____
12450____
14210____
18520_____
22240____
25110____
4010
24880
17700
2460
4240
1320
22970
2060
280
280
170
640
1750
1370
420
280
820
210
420
370
3980
Source World Development report 1993. Investing in Health,
World Development Indicators, Basic Indicators (page
238 and 239) and health and nutrition (pages 292 and
293)
37
<
The above inter-country comparison shows the disparities
in health service as reflected in the indicator of population
covered per doctor.
The ranges in doctor-population ratio for
each income group are as below:-
Population covered per physician XI"? )
I
Highest
Lowest
Low Income countries
72990”
1450
Lower middle income countries
17650
250
Upper middle income countries
5150
210
High income countries
820
210
India falls within the group of low income countries its
I
doctor population ratio is the best within the group after Nicargua.
The Indian ratio is equivalent to the average ratio of lower middle
income countries.
Bhore committee norm of 1:3000 population
was
adopted during the first and second five year plan periods.
For
The
the third plan, the guiding factor was the report of the Health
Survey and Planning Committee popularly known as the Mudaliar
Committee 1961.
This Committee recommended a target of one
doctor for every 3000/3500 population at the end of the Fourth
Plan. A component approach to estimate the demand for doctors
was adopted for the fourth and fifth plan periods.
The Medical
and Health Care Policy for the fifth plan has observed that "in
regard to minimum public health facilities, generalised norms
such
as
improvement in
doctor population
ratio
and
bed
population ratio or per capita expenditure on health are not
adequate"
(refer
report of
the
Working
Group
on
Medical
33
Employment
Manpower,
and
Manpower
Commission, GOI, September 1973 p.3).
Division,
Planning
The National Health
Policy - 1983 Government of India has not set any targets for the
country in terms of doctor-population ratio.
Although several organisations both at international and
f
national levels and several expert committees have relied on
doctor population ratio both as a health services indicator and as
a norm to estimate the requirement of medical personnel, there
are views which are against using it as a norm to estimate the
ii
requirement of medical personnel.
i-
t
I
One criticism is that the doctor-population ratio is a gross
figure of medically qualified persons which includes a large
number of doctors who are engaged in administration, teaching,
family
planning
etc.,
and
are
not
providing
direct
medical
5
I
services.
The
doctor population
norm
does
not take
into
consideration the distribution pattern of doctors According to an
IAMR study (IAMR Report on 2/1966 page 20) only 33 per cent of
doctors serve 80 percent of the country’s population which lives
in rural India.
This shows that all doctors do not cater to the
needs of equal segments of population.
Further the number of
doctors registered at the Karnataka medical council over the year
were:
39
Year
Number registered
(January to December)
till 1985
~
25571
1985
1020
1986
1028
1987
1206
198
1262
1989
1516
1990
1527
1991
1785
1992
2110
1993
2528
1994
2439
1995
2596
1996
2727
The mean number of doctors registered during the last 5 years
works out to 2478 of which if emigration, non karnataka and mortality is
taken into consideration (36%) roughly 1586 doctors stay in Karnataka in
a year.
Although the doctor-population ratio is a useful tool in the
estimation of the requirement of doctors, this ratio by itself is not
exhaustive and there are other factors which influence the demand for
doctors.
4(9
n ■
Other Factors which influence demand for doctors:
Demand for medical care and for medical manpower is the net
result of a number of factors such as demographic changes, social
economic and technological factors. Important among these factors are
growth in population and its age and sex composition and economic
growth which affects per capita income and standard of living including
demand for medical services. According to the Bajaj Committee there is
a
between family income
relationship
and
expenditure
on
health
services. On the basis of household data on consumer expenditure the
Perspective Planning Division of the Planning commission has worked
out the income elasticity of household expenditure on medical services
to be 2.3 which means that if per capita income goes up by 1 percent
household expenditure on health services goes up by 2.3 percent. This
shows
that
proportionate
as
personal
income
goes
up
there
is
more
than
increase in demand for health services' w/iictr crsatbo'
additional demand for medical personnel.
The Expert Committee felt that factors other than demographic
changes which influence demand for medical doctors have to be
considered taking into account location development,
I
nearness to
similar facilities and possibilities of contribution to education health
care and economic and social development of region. These factors can
be measured on the basis of data derived from a detailed survey
covering users, medical personnel and applicants to medical colleges
but at least 6 months would be necessary for conducting the survey and
analysing results.
Given that the committee is expected to furnish its
recommendations within two months, such as detailed study would not
be possible.
44
4
The
following additional factors were
also of concern to the expert
committee:a medical college on
the impact of establishing
surrounding
delivery system in
improvement of the health care
i)
.areas.
/ i of medical college to the socio
the contribution
including .
d cultural development of an area
economic development
ant-----and
sectors
like
catenng
indirect
transport.
i>)
the facilities offered by a medical college tor jobs and
personnel
iii) innovative training programmes for medical
i-
and others.
the medical college as
iv)
development imbalances.
v)
an instrument for correcting
the attraction of quality medical college for s‘ude^
from abroad leading to the export ot^educahon and
help these colleges give to our local students.
student .
vi)
t
accessibility to education and
saS^ed^a^a^^es^^s
SSX’S and capabie of meeting
the costs.
vii)
-n of a new medical college not becoming
the importance
a burden on the
t..~ State exchequer.
the responsibility of the Medical
Viii
Council of India for
the maintenance of quality.
Feasibility and dgsirability:
desirability for a new medical college has to be deci
The
location
the development of the
region,
Orness of similar .acuities and the possible contribution
to education, health care and econom.c and soc.al
region.
42-
the
I
Feasibility may be based on the possibility of building and
■■
>
taining a quality institution in a desirable location and the strength of
SUStf ament that proposes to set it up. The management should have
manaq9round and experience, adequate financial strength and a time
Mund programme tor implementation ot the project.
The yardstick
b°"uid bo whether the project is achievable in a given time.
These
general guidelines have to be applied to individual cases after assessing
each case on merit.
With the short time at its disposal, the committee would not be
able to quantify the above factors and test its assumptions on empirical
Nevertheless, if a decision
decision to
to open
open fresh colleges is taken the
data.
following
principles
b
beP
may
adooted
adopted
to
to
determine
location
and
desirability.
RE COM MEDATIONS
1
From 1946 to 1987 in various expert committee reports the
doctor population ratio of 1:3000 is stated as a target/norm.
has been prepared or suggested by the Govt, of India.
No target
Therefore, it is
not possible to draw any firm conclusions on what should be the target
for the next decade for the State.
Further to quantify unemployment
amongst doctors is not feasible, because - a) the employment exchange
registration is not reliable as many doctors do not register and many
doctors do not find job placement through employment exchange: and
b) self employment opportunities available for doctors are difficult to
asses.
In view of these if a decision to open new colleges is taken it
2.
should be necessary to have a cell or a committee at State level that
would
obtain
employment
data
on
the
number
of
doctors,
their
profiles
in
& such other related economic indicators (essentially
4s
f
information system for medical practitioners) on a continuing basis so
that the exercise would provide inputs for future decisions that may
modify the policy in the best interest of health care and economy in the
State.
In view of what has been said earlier and in view of the
3.
uncertainty of data available for employment status, it is. difficult to
recommend precise intake for the State.
the
However, taking into account
demand and other factors mentioned earlier, it appears reasonable
the admission level for the State as 3000 (excluding MAKE &
to keep
St.John's) this would give a doctor: population ratio of 1:1528 by 2006.
4.
It is evident from the report of the committee that visited the
medical colleges, that establishment of medical colleges has helped in
improving the economy and health care of the area.
This strengthens
the case for fresh medical colleges in areas where there are no medical
colleges at present. Therefore it is desirable not to have a fresh college
in Bangalore city and not to encourage new medical colleges in areas
already having medical colleges.
5. While giving recommendations
intake or a fresh college, Government
for feasibility for additional
should rigidly adhere to MCI
norms.
*
• ;
V
44
■
I- ■ ■
EXISTING MEDICAL COLLEGES IN THE STATE
I?"
r....
excIuding Mahe & St. Johns Medical College
Intake: 5
:1996 ~97
2
3
4
■
I
150
245
Kempegowda Inst, of Medical Science
120
120
Ambedkar Medical College
120
120
MSR Medical College
150
150
BANGALORE
Bangalore Medical College
I" ■
■
1995-95
5
BELLARY
Govt. Medical College
100
140
6
BELGAUM
JN Medical College
200
195
7
BIJAPUR
Al Ameen Medical College
100
130
BLDEA Medical College
150
180
245
328
8
9
DAVANGERE JJM Medical College
10.
HUBLI
Karnataka Medical College
50
147
11.
GULBARGA
MR Medical College,
100
185
12.
KOLAR
Devarak Urs Medical College
150
150
13
MYSORE
Mysore Medical College
100
205
JSS Medical College,
100
200
•C
14.
15.
BELLUR
AIMA.
100
195
16
TUMKUR
Siddartha Medical College
130
195
17
MAHE (Mangalore) seats given to state quota
63
63
2128
2948
TOTAL
■ t
I*
J
i
u.
n
'r
Appendix - 5
A Submission to
The Sub Commit tee on Medical Education
Of the
Parliamentary Standing Commit tee ON
Human Resource Development
At
Bangalore
On 1 4th November 1998
By
The Society for Community Health Awareness, Research and Action
367, ‘Srinivasa Nilaya’ Jakkasandra 1st Main,
1st Block, Koramangala,
Bangalore-560 034
Phone : (080) 553 15 18 & 552 53 72
Fax : (080) 55 333 58 (mark Attn : CHC)
Email: sochara@blr.vsnl.net. in
Introduction
♦ The Society for Community Health Awareness, Research and Action is a
multidisciplinary resource centre consisting of professionals interested in making
health care services, medical and health personnel education, and health research
activities in the country
more responsive to the needs of all our people, especially the poor and
marginalised;
more relevant to rural, urban poor and tribal communities; and
more sensitive to disadvantaged groups.
♦ Many members of our Society have worked in medical colleges and teaching
institution in various senior capacities.
Among our many activities has been a longstanding and continued interest in the
Reorientation of Medical Education towards greater Social Relevance and
Community Orientation.
In this connection, we have undertaken the following in recent years:
i)
A detailed study of Recommendation on Medical Education from the Bhore
Committee (1946) upto the MCI Curriculum Recommendations (1997).
ii)
A study of Social Relevance and Community Orientation in Medical
Education in the country.
We studied initiatives of around 25 medical
colleges.
iii) A study of feedback on the curriculum from young doctors (medical
graduates) who have had work experience in peripheral health care
institutions in the early 1990s.
iv) A study of innovative Community Health Training Experiments in the
country.
v)
A policy study on “Perspectives in Medical Education” for inclusion in the
Report of the Independent Commission on Health in India - recently
submitted to the Prime Minister.
vi) A continuing dialogue with a host of medical colleges in the country and in
neighbouring countries of Nepal and Bangladesh on evolving mechanisms to
operationalise strategies of change.
Based on these studies and reviews we make a submission to the Sub-Committee on
Medical Education (Parliamentary Standing Committee on Human Resource
Development).
A. CONCERNS
The following disturbing trends and developments in Medical Education in India
are a cause for grave concern.
1. Commercialisation of Medical Education
Growth of‘Capitation fee’ colleges in Maharashtra, Karnataka and Tamil
Nadu.
Mushrooming of institutions based on caste and communal affiliations
often sponsored by trusts and lobby groups with little previous credibility
or commitment to higher education.
*
Commercial growth of high technology secondary and tertiary medical
care at the cost of primary health care.
Increasing involvement of full time medical college teachers in private
practice.
*
Increasing problem of ‘money power’ and political interference in
selections, examinations, appointments and transfers even in government
health services and medical colleges.
2. Overall Fall in Standards of Medical Colleges
4:-
Inability of increasing number of medical colleges in the country to
maintain even the minimum requirements for undergraduate and
postgraduate medical education as laid down by Medical Council of India
especially with regard to:
Teaching staff
Hospital beds
- Pedagogical norms.
*
Growing dissonance between present selection procedures of medical
students and the type of doctors the country needs.
3. The Increasing Erosion of Norms of Medical Ethics
Increase in medical mal-practice and negligence.
Growth in doctor-drug producer axis.
Growth in powerful medical industrial complexes.
* Inadequate response of the medical profession to the societal needs.
■£
Inadequate Social and Community Orientation
4. -Inadequate social and community reorientation of Medical Education of all
faculties inspite of MCI guidelines, expert committee recommendations and
innovative experimentation by pace-setting medical colleges in the country.
48
AGENDA FOR ACTION
In the report to the Independent Commission on Health in India, which submitted its
report to the Prime Minister in May 1998 (recently forwarded by us with some
modifications to the sub-committee on Medical Education), we suggest the following
agenda for action, reform and governmental initiative:
1. Control of Commercialization Education in Medicine
a)
Setting up Health Human power Development Commission consisting of
representation of all the professional councils such as MCI, DCI, NCI, etc.,
professional resource groups and knowledgeable other persons, to plan
Health Human power Development including undergraduate and postgraduate
medical education on need based and evidence based planning.
b)
Review of Financing of Medical Education under both government and
private ownership to identify the problems, options and prospects and
approaches that are rational, legal and do not allow merit and social justice to
be compromised. This should include a review of the concept of Capitation
Fee colleges, ‘self financing’ colleges, free and paying seats, NRI and
management quotas and the recently recommended differential fee structure
for various categories by MCI, so that the options are decided by people’s
needs and not market forces.
2. Quality Control and Irtiprovement of Standards
*
Ensuring that all the existing medical colleges have adequate infrastructure,
teaching faculty, clinical facilities and pedagogical standards and banning
quantitative expansion of medical education.
*
Strengthening of MCI and Directorates of Medical Education at State level, to
ensure quality control and monitoring of standards.
*
Evolving mechanisms to include wider societal representation in decision
making to ensure greater social relevance.
3. Introduction of short courses in Medical Colleges to improve ethical
standards and broaden the horizons.
Ethical standards
Medical Ethics (Recently introduced by Rajiv Gandhi University of Health
Sciences - Ordinance 1998)
Rational Drug Use and Essential Drugs concept.
Broaden horizons
Introduce Mental Health Care; Integration of Medical Systems; Management;
and Gender sensitivity in Medicine/Health
4. Continued Reorientation of Medical Education to enhance Social Relevance
and Community Orientation
Universal acceptance and promotion of recent MCI 1997, Regulation on
Graduate Medical Education especially institutional goals; skill development,
orientation, new internship guidelines, (which have substantial changes since
the 1982 guidelines).
Proper faculty selection and reorientation
objectives of medical education, of all faculty.
*
towards
social/community
Provision for creative autonomy for a few selected pace setter colleges to
experiment with Alternative Track Medical Education - geared more
specifically towards Primary Health Care / Family Medicine / General Practice
(cf. Kakkar Report to MCI, 1995).
We request the Chairman and Members of the Sub-Committee on Medical Education
to consider these recommendations and include them in their report for necessary
actions. We would be happy to provide further information, data and resource
materials on these and other concerns.
Thank you.
Dr. Ravi Narayan
Dr. C.Tvl. Francis
Dr. Thelma Narayan
On behalf of
Society for Community Health Awareness, Research and Action,
Bangalore.
Dated : 14th November, 1998
SO
IsCiv'L approves oroa/ PO
medical colleges
By S.Rajendran
BANGALORE, Sept. 3.
The State Government, after a gap of about
10 years, has granted approval for the setting up
of over 20 medical colleges in the belief that the
Union Government would give its final sanction
to at least seven medical colleges, thus ensuring
that there is at least one medical college in each
district.
Under the rules of the Medical Council of In
dia, amended in 1992, the State governments
have been deprived of the powers to give out• right permission for the establishment of med
ical colleges. The States, based on the
applications received and the necessity for new
colleges, may issue an “essentiality certificate”.
Thereafter, the applicants have to approach the
Medical Council of India, which gives a recom
mendation to the Union Government. The Gov
ernment decides whether to accept the
recommendation or not.
The Chief Minister, Mr. J.H.Patel, now on a
fortnight- long official trip to Europe, reportedly
accorded permission to the Medical Education
Ministry to issue essentiality certificates to 20 of
the 60 applicants, according to official sources.
While the applications of some of the influential
applicants such as the Dayanandasagar group
of educational institutions (which had moved
the court and obtained a directive), the NWJ
Institutions and the Sringeri Math have been
kept on hold, those of some little known educa
tional institutions have been approved.
State Government will open another college in
the premises of the Bowring and Lady Curzon
Hospital, the Indian Air Force, which runs a
major hospital for the personnel of the IAF and
their kith and kin. has also received the essen
tiality certificate. The third college proposed to
be established in Bangalore will be managed by
members of the Adi Jambhava community.
to the respective managements and the non
Karnataka quota, nearly 500 additional scats
will be available for the local candidates. The
intake of the medical colleges will thus increase
to around 2,500 from 1,900.
Most of the applicants for medical colleges
have claimed that they are ready with the in
frastructure, including a building and hospital.
As per information available with the Govern
ment. at least six of the applicants are willing to
face an inspection by the MCI. The State Govern
ment itself will have to get into top gear to pre
pare the Bowring Hospital for the MCI team s
visit.
The Savadatti Committee, which went into
the need for new medical and engineering col
leges two years ago. had recommended that
there was a need for at least 3,000 MBBS seats
in the State. The Government thereafter consti
tuted a Cabinet sub-committee under the chair
manship of the Minister for Law. Mr.
M.C.Nanaiah, to study the matter and scrutinise
the applications. In 1990-91. late Veerendra Pa
til put a halt to new medical colleges and said
they would not be allowed for five years. Succes
sive Governments have conformed to the policy
in the last eight years.
In the view of Dr. Shankarnaik. the objective
of giving approval for starting new colleges is to
neutralise the sudden drop in the intake of med
ical colleges following the Medical Council of
India deciding to go by the rule book and the
Union Government strictly following the recom
mendations of the MCI irrespective of the over
riding powers vested in it. The four Government
medical colleges in the State have been worst hit
with their intake reduced from 1.585 to 790.
The intake of private colleges has come down. A
few years ago. the intake of Davangere college
was reduced to 150 from 345. The J.S.S. College
at Mysore is perhaps the only college the intake
of which has been enhanced.
The State Government is hopeful that the MCI
would approve an intake of at least 700 seats in
the new colleges. Even if 30 per cent of these go
The Minister of State for Medical Education,
Dr. M.Shankarnaik, told The Hindu here today
that he would not like to go into the details of
how approval was granted since the Cabinet
had. at a recent meeting, authorised the Chief
Minister to take a final decision on the matter. “I
stand by the Chief Minister’s decision since it is
in the interest of the State. The State Govern
ment is confident of securing the final approval
for at least seven medical colleges and this
should suffice for the present,” he said.
The districts where medical colleges arc pro
posed to be established for the first time are Raichur. Bidar, Bangalore Rural, Hassan and
Bagalkot. Bangalore City, which already has five
medical colleges including the St. John’s Medical
College (a minority institution and consequently
out of the purview of the State Government),
will have three more medical colleges. While the
Appendix - 6
Newspaper Reports on new Medical Colleges
dv-v- 2516m
>•: ■
-■?
LETTER^
______________
s
J
Opening of new medical
colleges: To what end?
Sir, This has reference to
Karnataka’s Minister of State
for Medical Education M Shan
kar Naik about the Govern
ment’s proposal to start six
more medical colleges in the
State (DH, June 19). The Gov
ernment will definitely have an
ultimate say in the governance
and policy making. But in the
changing trends of our democ
racy, where in the governments
and ministers keep changing in
months or years, floating halfbaked policies for their con
venience may have long term
harm also.
The ministers will not be in
power to share the good and
bad results of their actions. The
governments cannot tailormake such policies to suit their
convenience and tenure.
Karnataka has 17 medical col
leges in Bangalore, Belgaum,
Bellary, Bijapur, Gulbarga,
Davangere,
Hubll,
Kolar,
Manipal, Mangalore and My
sore. Twelve medical colleges
are under constant scrutiny by
the Medical Council of India
(MCI) for reasons like inad
equate staff and poor facilities.
Nearly 80 per cent courses of
fered are not recognised by the
I
c
a
A
B:
fr
ir
Y.
nt
re
P<
MCI. Thousands of medical
graduates are without proper
job and the Government has no
plans to employ them. The posi
tion of Government medical col
leges are still worse.
There is a need to collect
exact figures from all the col
leges, analyse them realistically ti
and arrive at an information di
base. This should be followed by rr
a debate. Such formed opinions v:
only shall be the guiding prin tf
ciples for such policy making ti
and not the desire of those In
power
who
feel
no th.
accountability for the future of
M
the State.
cc
The Issues in question are: it
Has the Government worked ai
out the future needs of medical
doctors? Can’t the present medi
cal colleges be improved Instead
of starting newer ones? How
can the Government take up
such issues for short-term
gains? Is the Government SI
bypassing the MCI leaving the ai
institutions and graduates high ft
and dry for future years?
y
DR H R VIVEKANANDA si
Medical Superintendent p
Karnataka Institute of ti
Medical Health h
DHARWAD
5
1
It has become necessary for the
people themselves to find out the
quality of milk being supplied to
them.
Can’t
some
enthusiastic
entreprenuers come forward to
manufacture lactometers to exam
ine the density of milk supplied to
them? This will go a long way in
assisting the public to check the
quality of milk.
SSUNDARA '
Bangalore
PH
~
Make it need-based
The Karnataka Government’s decision on Thursday to for
ward the list of 20 new medical colleges to the Medical Council
of India (MCI) for approval should be seen in the context of
the former’s professed intentions to ensure at least one medi
cal college in each district. In fact, the Minister of State for
Medical Education, Mr Shankar Naik, had hinted in July that
the Government was thinking of sanctioning six new medical
colleges in the unrepresented and newly-carved out districts.
However, before recommending the need for 20 new medical
colleges, it is not clear whether the State Cabinet had ascer
tained the professional requirement in the existing colleges.
Whatever the Government’s intentions, one cannot overlook
the fact that the very policy on sanctioning new medical col
leges should be genuinely need-based, related to doctor-patient
ratio and other such functional norms, and not based on caste
or other considerations.
Even though the State Government will issue “essen
tiality certificates” to the 20 new colleges, the MCI will take a
final decision on the matter and recommend the same to the
Union Government for approval. Thus, the MCI needs to play
a responsible role in this regard. Before according approval,
it has to make a realistic assessment of the potential for
infrastructural facilities, quality of equipment, condition of
laboratories and the teaching staff in the new institutions in
the offing so that they fulfill the statutory norms prescribed
by it. The rural areas in the State continue to face a dearth
of doctors in government hospitals because of the doctors’
reluctance to serve in these areas. To that extent, the prolifer
ation of medical colleges and increase in medical manpower
will continue to be a paradox. Most modern-day doctors
seem reluctant to go to rural areas. This attitude should
change for the better if the rural health care system should
be strengthened.
n. a.
--------------------------- ----
--------------------
‘More medical colleges needed’
..If
„loo is brought Qns
*If violfltinn
violation nf
of rrules
to our notice, we will write to ical colleges had infrastruct
Gulbarga, Sept 12: Medical the MCI to derecognise the col
ure as per the MCI norms.
Education Minister Shankar lege,” he said.
Nayak
said it was for the MCI
Nayak has said that Karnataka
Nayak justified the
issuance
_ __ xaciui
to
ascertain
such
factors. He
needs more medical colleges as of essential certificates by the said the government
had
thousands of students from the State Government for starting ived about
60
applications
for
State are deprived of medical 20 medical colleges. He said alt
starting medical colleges and’
education.
hough the State Government ___ thorough screening, the
Speaking to reporters, the had recommended the starting after
State had recommended only
minister said only 1,900 stude of colleges, the decision rested
20
applications.
nts from Karnataka could now with the Medical Council of In
He
pointed out that although
get admission to medical colle dia (MCI). He hoped that the
ges while the Savadatti Comm MCI may approve about half a the Andhra Pradesh Governm
ent had recommended opening
ittee had observed that 3,000 dozen medical colleges.
of 17 medical colleges the MCI
students could afford it. Based
He denied that the State Gov
on the Savadatti Conunittee re ernment had arbitraily and in approved only two.
The minister said most of
commendations, the State Gov discriminately issued essent
the
applicants would use gove
ernment felt the need for reco ial certificates to proposed
mmending more medical colle medical colleges although he rnment hospitals for teaching
facilities.
ges, Nayak said.
agreed that caste and commun
He said the government had
He said the government in’ factors of the promoters of
no
objection for allowing priv
would not allow any medical the institutions were conside
ate medical colleges to use gov
college to admit students in ex red in some cases.
ernment hospitals as it could
cess of the prescribed quota.
Asked whether the instituti- charge clinical fee.
Express News Serv.ce
<
mt ui
new medical colleges
DH News Service
BANGALORE, Sept 3
The Government has finalised the
list of 20 new medical colleges to
be set up and sent the list to Medi
cal Council of India for its appro
val. Chief Minister J H Patel is
learnt to have cleared the new col
leges before leaving on his foreign
tour last week.
Two colleges to be opened by the
Government and one by The
Malnad College of Medical Science
and Research Education Trust of
Shimoga headed by Mr Patel him
self also figures in the list.
The cabinet sub-committee rec
ommendations came before the
Cabinet meeting on Friday. How
ever, the Cabinet is learnt to have
authorised the chief minister to
take the appropriate decision.
The other educational institu
tions whose proposals have been
cleared, are: Nitte Educational
Trust, Mangalore; • Siddaganga
Educational Trust, Tumkur;
Mahasamsthaana
Kaginele
Kanaka Gurupeetha Educational
Institution,
Chikmagalur;
Jagadguru
Murugarajendra
Vidyapeetha, Chitradurga; Islamic
Academy of Education, Manga
lore; Dharmasthala Educational
Trust, Dharwad; Father Muller’s
Institute of Education and Re
search Institute, Mangalore; H D
Deve Gowda Medical College (Adi
Chunchanagiri Educational Trust,
Belur); KVG Medical College,
Sullia; Karnataka Adi Jambava
Social and Educational Trust,
Nelamangala;
Shantivardhaka
Education Society, Bhalki; Khaja
Hajarat Bandenawaz Education
Society,
Gulbarga;
Basavalingamma
Sanganatha
Subedar Trust, Raichur; Govern
ment Medical College, Bowring
Hospital,
Bangalore; Armed
Forces
' Medical
Institute,
Bangalore; Vijayanagar Education
Trust, Bangalore Rural District;
Navodaya Education Trust,
Raichur; Sanchara Charitable
Trust, KGF; and Basaveswara
Vidyavardhaka
Sangha,
Bagalkote.
MCI unlikely to grant new colleges for State
Express News Service
Bangalore, Sept 4: The Medi
cal Council of India (MCI) is
unlikely to grant any new med
ical college to Karnataka.
Indications to this effect
were available from the MCI
headquarters in Delhi on Fri
day. The stand follows the Kar
nataka Government’s reported
decision to give ‘essentiality’
certificates to 20 new colleges.
These include - two to be set
up by the Government, one
named after former Prime Min
ister H D Deve Gowda and one
headed by Chief Minister J H
Patel.
The MCI officials told Thein-
dian Express that a surprise in
spection of the existing 17 med
ical colleges in Karnataka
would lead to many of them be
ing disqualified. Most of them
lack in clinical facilities and
teaching staff. “No new medi
cal college can manage the req
uired teaching staff overnight.
They invariably woo teachers
from existing medical colleges
causing deficiency there,’’ the
officials said.
MCI president Ketan Desai
speaking from Gandhinagar in.
Gujrat said: “The State Govern
ment can only give ‘desirabil
ity’ certificate, and recomm
end the applications to the Uni
on Health Ministry. The
Health Department will in
turn refer the applications to
the Medical Council. If the app
lications are in order, the Cou
ncil will send teams to the new
colleges for inspection and la
ter take a decision based on
their opinion”.
The State Government is bel
ieved to have cleared the appli
cations of the following colle
ges, and decided to recommend
them to the Centre.
The Malnad College of Medical Science and Research Education Trust at Shimoga hea
ded by J H Patel; Nitte Educati
onal Trust, Mangalore; Siddaganga
Educational
Trust,
Tumkur; Kaginele Mahasamst-
mma Sanganatha Subedar
Trust, Raichur; Government j
, Medical College, Bowring Hos-1
pital,-Bangalore; Armed Force»
Medical Institute, Bangalore;!
Vijayanagar Education Trust,)
Bangalore rural district; Navo- j
daya Education Trust, Raic-|
hur; Sanchara Charitable j
Trust, KGF and Basaveshwara;
Vidyavardhaka Sangha, Bagal- >
kot.
»
Meanwhile,
Bangalore- J
based Rajiv Gandhi University [
of Health Sciences has already i
cleared the applications of Kur-1
unji Venkatramana Gowda j
Medical College, Sullia and |
Yenepoya Medical College, i
Mangalore.
i
i
hana Kanaka Gurupeetha Edu
cational Institution, Chikmaglur; Jagadguru Murugharajendra Vidyapeetha, Chitradurga;
Islamic Academy of Educa
tion, Mangalore; Dharmasthala Educational Trust, Dharwad; Father Muller’s Institute
of Education and Research Ins
titute, Mangalore; H D Deve
Gowda Medical College (Adichunchanagiri
Educational
Trust, Bellur); KVG Medical
College, Sullia; Karnataka Adi
Jambhava Social and Educati
onal Trust, Nelamangala; Shanthivardhaka Educational Soc
iety, Bhalki; Khaja Hajarat
Dandenawaz Education Soci
ety, Gulbarga; Basavalinga-
Minister wants MCFs wings clipped
Express News Service
Gulbarga, Sept 13: Medical
Education Minister Shankar
Nayak has made a strong plea
for clipping the wings of the
Medical Council of India (MCI)
and restoring the power of san
ctioning medical colleges to
State and Central Govermnents.
Inaugurating the XII Karnat
aka State Obstetics and Gynae
cological Societies Conference
organised jointly by the M R
Medical College and Gulbarga
Obstretrics and Gynaecologi
cal Society, Nayak criticised proper to accept whatever MCI
the MCI for its “dictatorial” does and says?” He urged the
Government
to
and “authoritarian” behavi Central
our in sanctioning new medi withdraw these powers from
cal colleges, a power vested in the MCI.
Shankar Nayak, who has tak
it by the Supreme Court.
“MCI should only be a reco en an active role in issuing ess
mmendatory body and should ential certificates for 20 medi
not be given powers to overr cal colleges, said he hoped the
ide the decisions of Governme MCI would clear at least half a
dozen.
nts.”
There was a shortage of doct
Nayak said the Supreme
Court had vested the powers ors particularly lady doctors
with the MCI but went on with , in rural Government hos
a volley of rhetorical questi pitals. Despite facilities, doct
ons: “To whom is the MCI acc ors are unwilling to work in
ountable? Is it a dictator? Is it rural areas.
“.Doctors want to make fast . Chancellor fe*'tyluniyamma,
money. However, they should who released the souvenir,
realise their social responsibil urged the medical community
to organise camps in rural
ity.
“Doctors should develop the areas to bring about awaren
tendency to serve the poor and ess on health and hygiene, par
the needy to make their profes ticularly among women.
Hyderabad Karnataka Educ
sion meaningful,” Nayak said.
ation
Society president BasavWithout adequate health
care facilities in rural areas, it arj Bhimalli presided over the
would not be possible to achi function.
The three-day conference
eve the goal of “health for all
was attended by about 500 dele
by the year 2000.”
Director of Medical Educat gates coming from across the
ion Shivaratna Savadi inaugur length and breadth of Karnat
aka as well as neighbouring
ated the scientific session.
Gulbarga University Vice- states.
MCI does a volte-face on nod for new colleges
adeauate
adequate financial
financial Qlinnort
support
would be given permission.
Bangalore, Oct 7: In a compl
The State Cabinet had, last
ete turn around from its earl month, given essentiality certi
ier stand, the Medical Council ficates to 21 medical colleges
! of India, (MCI), has said it and had forwarded the propos
would accord permission to al to the MCI. Dr Desai had,
new colleges only if they met however, reacted by saying
the regulations stipulated by that the MCI would not permit
them.
any new colleges from coming
Talking to media persons on up in the State.
Wednesday, MCI president Dr
Justifying the present stand,
Ketan Desai said those institu Dr Desai said if these instituti
tions which owned 25 acres of ons followed the legalities,
land, a 300-bedded hospital and there was no way he could
Express News Service
_
deny fknm
them permission. tt
He,
however said, the MCI had not
received any such proposal
from the State Government.
The MCI would also consi
der the requirements of doct
ors in the State before giving
permission to medical col
leges, he said.
When asked about the ratio
nale behind granting.any new
institutions to the State even
as the existing ones lacked inf
rastructure facilities and other
requirements, Dr Desai said it
danir
___
r-
was for the State Government
to take a decision on the issue.
Commenting on the recent
statements of Medical Educat
ion Minister Dr M Shankar
Naik against the powers of the
MCI, Dr Desai said the body
was constituted by an Act of
Parliament. “If the Minister
has any problems, he should
take it up with the Centre.
There is no need to issue such
statements.
The Supreme
Court verdict has also upheld
the powers of the MCI”, he
said. Earlier, the MCI presid
ent said opening of new colleges would only lead to deterior
ation in the standards of medi
cal education.
"Doctors will then use their
bargaining powers as they
would be tempted to work in
those colleges which offer
more salaries. This situation
will only lead to a fall in medi
cal standards and ethics”, he
said.
Desai regretted that there
was a "rat race” in Karnataka
to open new colleges, either
medical or dental. Drawing a
comparison between Karnat
aka and Gujarat, he said while
Gujarat had just two dental col
leges, Karnataka had the dist
inction of having 40 dental col
leges.
Dr Desai said opening new
colleges would not solve the
problems if quality teachers
were not produced. He urged
academicians to indulge in int
rospection to improve the qua
lity of medical education.
Basavarejeshwari set up Bellary Rural Engineering College
at Bellary last year.
Former Sericulture Minister
and Congress member G Para
meshwar is looking after Siddartha Institute of Technology in
Tumkur. His brother looks
after Siddartha Medical Coll
ege there. Last year, former
Congress MLA Shafi Ahmed’s
HMS education trust started
an engineering college in
Tumkur. In all, Tumkur City
has three engineering colleges.
Congress-turned-Dal -tumed-Congress leader R L Jalappa
heads the Devaraj Urs Medical
College in Kolar. Davanagere’s
Congress MP Shamanur Shivashankarappa is also a 'leading
educationist' running Bapuji
College of Engineering, Bapuji
Dental College and other coll
eges at Davanagere.
Shanti Vardhaka Education
Society at Bhalki in Bidar dist
rict involves former Transport
Minister and Congress MLC
Bheemanna Kliandre on its
management.
A trust headed by Mysore’s
former mayor Vasu runs
Vidya Vikas Institute of Engin
eering and Technology, Mys
ore. Former JD MLA P M Chikkaboraiah started the Vidyavardhaka College of Engineering
at Gokulam in Mysore.
n Why are politicians, inclu
ding uneducated ones, profo
undly interested in educat
ion? Read all about it tomor
row.
Politicians control professional
alasubramanyam
i Byy K R Balasubramanyam
i Bangalore, Oct 7; At least 45
| professional colleges in Karnat
Kamat-
aka are run with active
artivo involvinvdv.
' ement of politicians.
, Of the 20 applications recen
tly floated by the Government,
8 have politicians including
Chief Minister J H Patel on the
management.
Karnataka has 17 medical
colleges, 40 dental colleges and
90 engineering colleges. Of th
ese, only four medical colleges,
one dental college an no engin
eering college are run by the
Government.
A rough estimate shows that
the Congress party has tacit
control over 1tl’yee medical,
'
seven dental and 14 engineer-•
ing colleges. The Janata Dal
has its members in one medical and three engineering coll-----at least one'
The Bjp has
medical, two dental and three
engineering colleges.
That’s not all. Bhanumathi
Tambidurai, wife of Union
Law Minister M Thambidurai
is one of the three trustees of
the Bangalore College of Engin
eering and Technology at Malur in Kolar district. An And
hra Pradesh politician too has
set up an engineering college
in Bangalore. Evidently Karn
ataka has some special attrac
tion to those who run education as business.
Patel Jieads the proposed’
Malnad CoUege of Medical Science and Research Education
---------------------
EOWIOH AS COMI
Trust in Shimoga. In the same
district, former Chief Minister
S Bangarappa’s son, Kumar
Bangarappa, looks after Sharavathi Dental College.
In Hassan, Malnad College of
Engineering is headed by seni
or Congress member Hamahally Ramaswamy. Hassan may
soon get a medical college
named after H D Deve Gowda.
In Bangalore, former Minis
ter for Information C M Ibra
him of the Janata Dal adminis
ters Khwaja Khuthubuddin
Bakthiar Kaki College of Engineering while Adult°Education
Minister R Krishnappa is with
Revanasiddeshwara Institute
of Technology. One of the old
engineering colleges in the
City, named after Dayananda
Sagar is being run by former
Congress Minister Premachandra Sagar.
Two Ministers have got two
medical colleges cleared for
Raichur district. Textiles Mini
ster M S Patil and the other Rel
igious Endowments Minister
Muniyappa Muddappa. Intere
stingly, some political groups
in Raichur have opposed med
ical colleges with the involve
ment of Ministers. They want
a Government college.
Former Union Minister and
senior Congress member M
Govt, seeks more powers
on medical admissions
/ 'lA/.Sf-C- J
By Our Special Correspondent
The Minister said the applications for 20 new '
BANGALORE, Nov. 28
medical colleges, which were cleared by the
The State Government, unhappy with what it State Govefnment a few months ago, were pend- i
calls “the dominant role played by the Medical ing with the Centre. It was for the MCI to send i
Council of India in the functioning of medical ??inspection team and the Centre to act on the
£ -’1
-.
. .
ivii i
— 1:
x
colleges»»”, i has urged* the Union Health-Minister.
MCI
recommendations. The applicant-manageMr.
have,1three
Vears meet the condi-Mr. Dalit'
Dalit Ezhimalai
Ezhimalai. "to
to vest
vest "powers
powers * with
with lhe
the ^entVw°
v8uId
u*dhave
threeyearstomeetthecondi
r
____ —1_ xt_
»x-.r
State Government in the management
of. private rmne
tlons loin
,.ld down by the AJ/T
MCI 4.1though
the »MCI
,
- J Government-run medical colleges.
generally gave its assent only to the colleges I
and
Barring the issue of Essentiality Certificate to which had an attached teaching hospital. Of the
managements seeking to set up medical colleg 20 applicants, five had attached hospitals. The :
es. the State Governments, under the amended State Government is an applicant and has
MCI Act, have been deprived of any control over sought to establish a medical college at the I
Bowring Hospital here.
admissions. The Union Government, however,
nas been
oeen vested
vested with
witn adequate
adequate powers
powers to
to over^0Yer^nlontalso urged for increashas
rulc the MCI recommendations and has the final .n8 int£}ke in the Bollary,, Hub i and Mysore med
ical colleges. For the Hubli college, it has sought
say with regard to professional colleges.
75 seats as against 50 now and for the Mysore '
The Minister for Medical Education. Dr. M. and Bellary colleges 150 as against 100 now. As
Shankar Naik, told presspersons here today that per the MCI rules, the intake for the undergrad
he had met the Union Health Minister recently uate course (MBBS) could not be more than
and requested that the Centre be more assertive 150. Thus, the Intake of the Bangalore Medical f
and not be carried away by the recommenda College was reduced from 245 to 150 seats.
tions of the MCI, which at times, in the view of
The Governmentt was \
yet ito--------decide on “the
the State Government, were questionable. The
r" re- '
Sate Henlth M'
oi State Health Ministers to discuss the issue. Il tals. Collecting outpatient charges would ensure
need be, the Centre would amend the MCI Act, that the patients concerned preserved their out
patient card. It would help in the easy location
the Union Minister had said.
of the case-sheet of the patient concerned.
Dr. Shankar Naik said the States should at
Most of the Government teaching hospitals,
least have powers to increase the admission in
he said, suffered from poor upkeep and shortage
take into the undergraduate and postgraduate
courses in medical colleges and the Union Gov of drinking water. The sinking of five borewells
in each hospital had put an end to the water
ernment and the MCI could have powers to ap shortage. The Government had ordered that
prove new medical colleges. With the orders of
the High Courts and the Supreme Court, the contractors be involved in the upkeep of the in
stitutions and this was found to pay better divi- State Governments were now virtually deprived dends.
The recruitment of class four employees '
of any power.
in the Government hospitals has been suspend
On the status of the Government medical col ed for several years and the present employees
leges in the State, he said the four medical col would be retained until their superannuation. '
leges and their attached hospitals had been The Government had issued directions to all
given Rs. five crores each. The funds would be hospitals w
to 1OOUC
issue ltcc
free ulcuJCiIlcs
medicines LU
to in
the< inpatients
used for upgrading the facilities including equip- in the —
general wards.
-------- rPrescriptions
---- 3 should be
ment and buildings. It had however, been esti- issued only to tthe
’liV Faiacuu>
patients U1
in U1C
the special waras>
wards.
mated that the four colleges
put together
The bed
charges for the special «vuiuo
wards 11QO
has UCC11
been
—
;
«-•
------------------ O--•
required Rs. 30 crores rr.
— lor installing the raised
•
more
from -Rs. 10 to Rs 20 per day. The charges
latest medical equipment.
had
’
had been
been revised
revised for
for the
the first
first time
time in
in 30
30 year
years.
Admission to Q HiCGlCal col leges banned
1
The Times of India News Service
BANGALORE:The Karnataka government on
Thursday notified the provisional seat matrix
for first year medical and dental courses in gov
ernment and private medical colleges.
The matrix contains 2,245 medical seats, 345
more than last year and 1,520 dental seats, 700
less than last year as eight dental colleges have
not been permitted to admit students bv the
Dental Council of India (DCI).
In a notification, the government invited ob
jections from the public and educational institu
tions, if any, within 15 days. A final matrix will be
issued after that.
The government has banned admission of stu
dents to Father Muller's Medical College, Man
galore and Yenepoya Medical College. Manga
lore as per Medical Council of India (MCI) di
rections. As for dental colleges, KVG dental
College. Sullia, Yenepoya Dental College, Man
galore, K.G.E Dental College, KGF, Oxford
Dental College, Bangalore, R.V. Dental College,
Bangalore, Siddhartha Dental College, Thmkur,
Krishnadevaraya Dental College, Bangalore
and Sharavathi Dental College, Shimoga, have
not been permitted to admit students for this
academic year as the DCI has not fixed their in
take.M.S. Ramaiah Medical College has surren-
1®
1
I
--------- FRIDAY, MAY 19, 2000
MBBS exams
BANGALORE: The MBBS examinations
of Bangalore University, scheduled to be
held from May 22 have been postponed to
June 1, according to a university release.
The detailed time-table for each year and
subject can be had from the college's con
cerned.
dered nine management quota seats for making
18 excess admissions last year and the A.B. Shctty Dental College, Mangalore, has surrendered
four management seats for making excess ad
missions previously.
The intake for first year MBBS course in gov
ernment medical colleges has been fixed at 150
for Bangalore Medical College, 100 for Mysore
Medical College 50 for Karnataka Institute of
Medical Sciences, Hubli and 100 for the Vijayanagar Institute of Medical Sciences, Bellary.
Among the private medical colleges, JJM med
ical college, Davanagere 245, IN. Medical Col
lege, Belgaum 150, M.S. Ramaiah Medical Col
lege, Bangalore 150, Devaraj Urs Medical Col
lege, Kolar 150, JSS medical college, Mysore 150,
B.M. Patil Medical College, Bijanur 150, Siddartha Medical College,Tumkur 130, KIMS, Ban
galore 120, Adi Chunchanagiri Institute of Med-, •
ical Sciences, Bellur 100, Dr B.R. Ambedkari •
Medical CoUege, Bangalore 100, M.R. Medical
College, Gulbarga 100, K.S. Hegde Medical acad
emy, Mangalore 100 and Khaja Banda Nawaz In
stitute of Medical Sciences, Gulbarga 100. ;
The other colleges are: Government Dental
College, Bangalore 60. (Private): Bapuji Dental
College, Davanagere 100, College of Dental Sci
ences, Davanagere 100, KLE Dental College,
Belgaum 100, Dr Ambedkar Dental College’
Bangalore 1CX), P.M. Nadagouda Dental College^
Bagalkot 100, JSS dental college, Mysore 60,
Rajiv Gandhi College of Dental Sciences, Ban
galore 60, SJM dental college, Chitradurga 60,
V.S. Dental College, Bangalore 60, HKE Dental
College, Humnabad, Dr Shyamala Reddy Den
tal College, Bangalore, HKDET’S Dental Col-'
lege Humnabad, KLE Dental College, Banga
lore, Bangalore Institute of Dental Sciences,
Bangalore, Dayanandasagar Dental College,
Bangalore, Nijalingappa (Hasanamba) Dental
College, Hassan, M.S. Ramaiah Dental College
Bangalore, S.B. Patil Dental College, Bidar and
AME Dental College, Raichur at 40 each.
► CET results before PU results, page 5
GOVERFi’lECT OF
karuataka
Government Secretariat,
Karnataua
UO.HFW 219 MPS 913
M.S.Building,
Bangalore, dated:
20-03-99
F r om
. .
to Govt (MB)
The Secretary
Family Iel^J..TieP *
Health & - — , Bangalore i
M.S.Building
The Secretp"^p^ith & Family Welfsre,
Nirnan
'
on
.fic,te for increase
the ?romosed t)ew
Assent :.al i t>
100 to
Suhs Ivst3
.a.-ii Jambha^n
.
from
5
’
3
to
5
* C.f incake
atakr Bengclore.
college by Knrn
Ilc^icol and Educational Tr i’ t
Social
{)irected
tinned above, I am
under
the subject men
ei mce to
5, as cons tituted
Expert Committee
Chancellor to
1 members
ViceProf.M.I.Savadathi, Betirec
state that
end the need
to ■
collag e s
of
. chairmanship
o£ existing professional
the
the St a to•
intake
consider the
professional colleges m
t e nev
to start
Committee opined
pined that;^
College has to be
Medical
the development
2. The
or
..rr-je resirability_t f|°
r account location, - facilities and
into
(I)
«Vng- Se ne rness o£ sinil^fto education,
colleqe
development of
or
o£ the
ociel
po3Sible c
economic and s
■health care and
• £ ' unemployment
, „
... to quantify
the region •
a) 3mploypAent
observed
’‘’^ble, because
many
doctors
The Committee
__ 5 isnot fe^ reliabie as
U) 'anongst Doctors
Eind placement ■
egistration is
ors do not
emoloyment
e- change
\and many a
Sel£
do not register
Ciificult to
t exchange and
Ibtele tor eoc«'= -re
through emplo
opportunities ave.
Sir,
assess".
(3)
and other
account*- the de ma nd -sonable to\
taking in^lleo“it appears.
state
’ci- ned earlitr,
factors . raen
' admission
level for
keep the St.Johns) this would givtMAKE an<
Cf 1:1528 by 2006"•
««
as =3000(excluding
ctorxPopulation-
Students in
Karnataka
for
Government
1998.99 the intake
including
the
year
bur inc;
St.J ohns 9 but
(excluding MAKE S:
M.B.B.S Seats
1405.
College) comes to
Medical ’---...2/-
ratio t'
.
.
sx ■
2
Therefore, I am directed to convey the concurrence of
the Govern ment of Karn; taka for issue of Essentiality Certi
ficate f r li.B.B.S Course v/ith an increase of intake from
50 to 100 in resoect of proposed Karnataka Adi Jarnbhava Social
and Educational Trust, Bangalore subject to condition to
ootaininu affilietion
Sciences, Bangalore
from Rajivgandhi University of Health
vfrom the Academic Year 1999-2000.
Y our 3 f c?4 i thf u 11 y,
(N.V.PALSKA?.)
Under Secretary to Govt.
Health & Family Welfare Dept.
(Medical Education)
To:
1.
The Director, Medical Education, Government of India,
Ministry of Health & Family Welfare, Niroian Bhavan,
New Delhi,
2. The Secretory, Medical Council of India, Kotla Road,
Nev/ Delhi,
3.
The Registrar, Rajiv Gandhi University of Health Sciences,
4th T Block, Jaynagar, Bangalore,
4. The Director, Medical Education, Bangalore,
5. The Director: Secretary, Karnataka Zidi jarnbhava Social &
Education?! Trust, No. 14/3, 4th K Block, Rajajinacar,
Bengal jre-560 010.
6. The SGF/Spare copies.
1
I
i
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