PERSPECTIVES IN MEDICAL EDUCATION
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PERSPECTIVES IN MEDICAL EDUCATION
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A REPORT PREPARED FOR
THE INDEPENDENT COMMISSION ON HEALTH IN INDIA
1
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DECEMBER 1995
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SOCIETY FOR COMMUNITY HEALTH AWARENESS
RESEARCH AND ACTION
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BANGALORE - 560 034
INDIA
1
* the evolution and organisation of the Compulsory rotating internship after the
final examination, which includes 3/6 months of community based postings;
are three important and significant reforms, among many others, endorsed and
recommended to medical colleges, towards the goal of producing 'basic doctors'.
4. The populist rhetoric of Doctors for Rural Areas has become an integral part of
policy formulation; political party manifesto; social exhortation at every level; and
media and professional reflection and debate - not showing any decrease in
intensity over 40 years.
5. POLICY GAP
However inspite of
a) clarity in the stated goals of policy;
b) phenomenal quantitative growth in the institutional framework;
c) some efforts to qualitatively reorient the curriculum to match the policy goals;
and
d) the enhanced populist rhetoric;
the situation of medical education in the country has moved towards greater and
greater crisis.
I
i. The majority of the young doctors still opt for urban hospital and urban clinic
practice and the trends towards specialization are high.
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ii. The vacancies in rural and peripheral community based health centres and
hospitals in the government services have reached significant proportions.
VACANCIES IN HEALTH CENTRE
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"The State of Maharashtra which accounts for almost one fifth of
the total national out turn of doctors annually, has about onefourth of the sanctioned post of doctors at PHC's lying vacant as
of 1st January of the current year. Uttar Pradesh with seven
medical colleges has forty percent of similar posts lying vacant
Bajaj, 1994 (13
iii. Professional preoccupation, both at 'practitioner' and 'educator' levels
continue to be with illness care at secondary and tertiary level centres, rather
than with the challenges of care at the primary health / community levels.
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iv. Finally since the late 1970's there has been an emergence of a large number
of
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PERSPECTIVES IN MEDICAL EDUCATION
2. DIAGNOSIS OF THE PROBLEM
An overview of the growth and development of Medical Education in the country,
since Independence is ?
p^-^quisite to understand the dynamics of
change and the complexities of the emerging problems.
2.1. SITUATION ANALYSIS
The country has witnessed a tremendous growth in the infrastructure and
facilities for Medical Education since Independence. A perusal of tables 1 and 5
will highlight the following salient features:
a) There has been a massive, quantitative expansion in Medical college facilities
in the country - from 22 colleges in 1947 admitting 1983 students to 145
colleges admitting approximately 16,200 students annually in 1993. This
represents a 600% expansion in colleges and 800% expansion in admissions.
b) The Male-female ratios in admission and output have increased gradually from
78:22 in 1971 to 60:40 in 1990, with an unusual peak of over 41% admissions of
female in 1977-78 and a corresponding peak of female doctors graduates in
1982-83 (44%). The overall trend has been positive and more female doctors
needed by the country are being catered for.
I
c) The increase was gradual till 1975. Then following the Srivastava Report
there was a plateau till 1985 and then another phase of expansion, till the
Presidential ordinance in 1993.
1
The phase till 1974 was predominantly an increase in government sponsored
colleges, and the phase after 1988 was predominantly the commercialization and
private sector phase of medical college expansion.
d) Till 1985, we were fairly consistent about the number of colleges in the country
- without much variance between government and non-government sources.
Since 1985, even the publically stated estimates have varied from 130 to 170.
The most recent estimate of the new Health Minister is 200(!).
a
2.2. REGIONAL DISTRIBUTION AND DISPARITY; (The BIMAROU dilemma!)
Based on the Mudaliar Committee norm of one college per 50 lakh (5 million)
population, a review of the present regional distribution of colleges in the country
taken against the 1991 census estimates show important trends (see tables 2, 4
and 6).
I
a) Some states like Karnataka, Maharashtra, Tamilnadu and Union Territory of
Delhi show a number far beyond their entitlement and requirement.
5
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TABLE 1
GROWTH Of MEDICAL COLLEGES AND ADMISSIONS SINCE INDEPENDENCE(1947-93
YEAR
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1993
* N.A.
SOURCES :
NO. OF
MEDICAL
COLLEGES
ADMISSIONS
22
30
30
30
31
31
3.1
31
31
52
52
52
52
52
79
79
79
79
79
87
95
98
100
105
105
106
106
106
106
106
106
106
106
106
106
122
125
128
128
128
145
1 ,983
2,811
2,609
2,675
2,489
2,691
2,846
3,087
3,660
3,958
4,083
4,554
4,904
5,874
6,846
7,719
9,697
9,897
10,520
10,620
12,029
12,048
11,772
13,205
11,561
11,281
11,176
11,117
10,658
11,021
11,101
10,749
11,054
10,877
10,610
10,090
11,622
14,166
13,262
11,791
16,200
OUTPUT
959
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
N.A.
10825
11311
11364
11911
11982
11962
13783
12190
13429
12170
12197
15992
10511
10469
11470
12280
12100
12292
N.A.
N.A.
NOT AVAILABLE
1 , 4, 9
pi>-
6
TABLE 2
REBlOWd. DISTRIBUTION WD STATUS AEAINST ENTITLEMNT - 1973
NO. OF
SEATS
cormrs /
OBSERVATIONS
10
1120
8
3
3
9
6
2
365
580
885
1
1
2
9
3
19
65
260
3266
29.10
6
66.20
80.10
13
16
5
6
30
ORISSA
PUNJAB
RAJASTHAN
TAMILNADU • k POOIOER'/
31.70
6
20.30
4
9
3
6
6
321
520
56.70
11
15
1590
16
UTTAR PRADESH
139.10
20
9
1071
ADEQUATE
ADEQUATE
SHORTFALL
ADEQUATE
ADEQUATE
ADEQUATE
ADEQUATE
MISSIVE EXPANSION
CAPITATION / corm
-CIALIZATIOH TREND
ADEQUATE
SHORTFALL
MASSIVE EXPANSION
citation / corm
-CIALIZATION TREND
SHORTFALL
MEQUATE
ADEQUATE
MODERATE EXPANSION
COrmCIALIZATION
TREND INITIATED
SHORTFALL
17
18
19
NEST BENGAL
68.10
9.40
14
2
7
4
755
460
SHORTFALL
EXCESS
9.10
2
1
85
ADEQUATE
1.60
0
0
0
846.40
163
POPULATION
1991 CENSUS
(MILLIONS)
ENT1TLE-
66.50
13
4
17
7
8
.»OFA PRADESH
ASSAM
BIH¥L *
GUJARAT
HfRYPWA
HUWCHAL PRADESH
JArtlJ I KASWIR
KARNATAKA
9
10
11
KERALA
JWm PRADESH
MAHARASHTRA* It GOA
12
13
14
15
STATES
SI.
NO.
1
2
3
4
5
6
2Q
DELHI
NORTH EAST EXCLUDING
ASSAM
OTTER STATES /
UNION TERRITORIES
TOTAL
22.4086.40
ACTUAL
COLLEGES
NENT * *
1993
41.30
16.50
5.20
7.70
45.00
44.00
150
700
720
3004
610
16527 ,
Lxzzzxzzxzxzzszzzxzzzxxzzzzzzzxxzxxxxfczzz:
> ixxzxaxxxxxxxxzxzxxx^'czzzzzzzxzzzzzzzzxzzzzzzzzczzzzx
«n = SSXSSSS = SS8SSSXZll«S = X = = SS
SOURCES :
6, 10, 11
# IFFURMATION (X 0T€ COLLEGE IN TTtSE TTFEE STATES ARE NOT AVAILABLE.
*« NORM: 1 WICAL COLLEGE / 5 MILLION PEOPLE
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to
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>TABLE 3
PATTERN OF GROWTH - NO. OF MEDICAL COLLEGES BY REGIONS
1965 AND 1995
AND STATES
ZONE / STATE
NO. OF MEDICAL
COLLEGES
IAMR - 1965
NO. OF MEDICAL
COLLEGES - DIRECTORY
OF MEDICAL COLLEGES
IN INDIA - 1995
7
6
6
9
3
4
3
5
3
9
1
3
7
8
9
4
10
19
5
9
15
CENTRAL ZONE
MADHYA PRADESH
UTTAR PRADESH
EASTERN ZONE
ASSAM
BIHAR
MANIPUR
ORISSA
WEST BENGAL
I
SOUTHERN ZONE
ANDHRA PRADESH
KARNATAKA
KERALA
TAMILNADU
PONDICHERRY
i
>
WESTERN ZONE
L
I
GUJARAT
MAHARASHTRA b GOA
5
11
6
30
1
3
2
1
6
6
4
NOTHERN ZONE
JAMMU
KASHMIR
HARYANA
HIMACHAL PRADESH
PUNJAB
RAJASTHAN
DELHI
5
5
3
145
88
se = = =: = «i=:«:»: = c = « = = = « =
= = n: = = = = = s: = = = = = = = = =: = = fc
9
SOURCES :
1, 6,
* I AMR
INSTITUTE OF APPLIED MANPOWER RESEARCH
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TABLE 4
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REGIONAL PATTERN OF GROWTH OF MEDICAL COLLEGES IN DECADES
STATES / UNION
TERRITORIES
PRE 1950 1950-59 1960-69 1970-79 1980-89 1990-94
3
ASSAM
1
2
BIHAR
2
3
GUJARAT
2
1
HARYANA
1
HIMACHAL PRADESH
1
KARNATAKA
1
1
KERALA
4
4
1
2
1
GOA
JAMMU U KASHMIR
1
2
1
4
ANDHRA PRADESH
3
5
2
2
MADHYA PRADESH
2
2
2
MAHARASHTRA
4
1
4
1
1
1
8
1
2
10
8
1
MANIPUR
ORISSA
1
1
1
PUNJAB
1
2
1
1
1
1
3
1
1
1
5
RAJASTHAN
TAMIL NADU
3
UTTAR PRADESH
2
WEST BENGAL
4
1
DELHI
1
2
4
1
1
5
1
2
■<
1
PONDICHERRY
TOTAL
CUMULATIVE TOTAL
1
27
27
41
.91
23
50
13
104
27
131
12
143 *
* YEAR ESTABLISHED - NOT GIVEN FOR 2 COLLEGES
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Source 6,10
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TABLE 5
MALE AND FEMALE ADMISSION TRENDS
MALE*
FEMALE*
1971-72
98
78
21.5
1972-73
100
77.6
1973-74
105
1974-75
(
QUALIFIED
ADMISSIONS
NO. OF
MEDICAL
COLLEGES
YEAR
TOTAL
TOTAL
MALE*
FEMALE*
12048
73
26.9
10825
22
11772
74.6
25
11311
79
20.7
13205
76.5
23
11364
105
78
21.8
11561
76
23.8
11911
1975-76
106
77.9
22
11213
77
22.5
11982
1976-77
106
75.5
24
11176
77
22.5
11962
1977-78
106
58
41.8
11117
78
21.8
13783
1978-79
106
72.6
27
10658
79
20.7
12190
1979-80
107
70
29.7
11021
79
20.8
13429
1980-81
109
69
30.8
11101
77
22.7
12170
1981-82
111
67.8
32
10749
74.5
25
12197
1982-83
111
63
36.8
10784
55.9
44
15992
1983-84
111
N.R.
N.R.
10877
71.6
28
10511
1984-85
116
63.6
36
10610
70.7
29
10469
1985-86
122
62.6
37.3
10090
67.3
32.6
11470
1986-87
125
61.5
38
11622
65.6
34
12280
1987-88
128
61
38.9
14166
63.7
36
12100
1988-89
128
60
39.8
13262
62.9
37
12292
1989-90
128
60
39.8
11791
N.R.
N.R.
►
* N.R.
N.R.
NOT RECEIVED
SOURCES : 4 , 9
10
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TABLE 6
DISTRIBUTION OF MEDICAL COLLEGES BY SEATS
SIZE OF COLLEGES (BY SEATS) - 1993
4
NO. OF
SEATS
NO. OF
COLLEGES
TOTAL
CUMULATIVE
TQ-r/"
35
50
60
64
65
70
75
80
85
90
100
102
107
110
1 13
1 15
118
120
125
130
140
150
155
170
175
180
185
195
191
200
210
240
300
328
1
18
5
1
2
2
2
1
1
2
41
1
3
4
1
1
1
6
• 3
6
4
11
1
1
5
3
2
2
1
5
1
1
35
900
300
64
130
140
150
80
85
180
4100
102
321
440
113
115
118
720
375
780
560
1650
155
170
875
540
370
390
191
1000
210
240
600
328
35
935
1235
1299
1429
1569
1719
1799
1884
2064
6164
6266
6587
7027
7140
7255
7373
8093
8468
9248
9808
11458
11613
11783
12658
13198
13368
13958
14149
15149
15359
1557'7
16199
16527
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I
3
I
1
■-
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2
1
I
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E = =?= = E = =E = = E3E = = = = = = = XX = = = = = = = = i = X = = = = = C = EE C =
TOTAL
142
THREE COLLEGES - SEAT TOTALS NOT AVAILABLE
SOURCE : 10
11
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TABLE 7
DISTRIBUTION OF COLLEGES BY SEATS ( REGIONAL PATTERN)
STATES / UNION
TERRITORIES
T
50
60
ANDHRA PRADESH
100
90
110
4
2
2
2
1
4
3
1
1
1
i
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1 (64) - 1
!(85) - 1
I
II
115) - 1
i
1
1
I
I
(75) - 1 '
1!
1
I
I
3
1
3
(35) - 1
(173) - 1 185) - 1
328) - 1
1
2
4
2 <240) - 1
I
2
I
(107) - 3
2!
3
1
2
3
125) - 2
2 (102) - 1 113) - 1
1
5 (70) - 2 (00) - 1 (90) - 2
563) - 2 (73) - 2 (85) - I
(65) - 1
210) - 1
150
2
1
II
1
41 (110) - 4 120) - 6 130) - 6
(107) - 3 115) - 1 125) - 2
(102) - 1 118) - 1
11
1
4
185) - I 191) - 1
755
460
73
1
I
11 (155) - 1 ;
1 [100) - 3 195) - 2 200) - 51210) - 1 300) - 2 1^527
[175) - 5 185) - 2 191) - 1(240) - 1 328) - 1
I
113) - 1
-- L
TOTAL (-3)
19
5
5
3
3
41
8
9
9
4
11
I i
1
8
4
6
2
3
» INFORMATION OF TOTAL SEATS OF THREE COLLEGES IN EACH OF THESE STATES WE NOT AVAILABLE
ticstiiKEiacrzciiiciiiciziiiitiiiiiiittittittccittEiiiitiiiiiiiiiiittiiiiiiiiiutiitiiiiiiiiiiiiitiiitiiiiiiiitiiiiiiiiiiiiiiiitiiiiiiiiiiiitiiniiiniiiiainKtintitniiifn
'W
/
n
65
260
3266
700
720
2934
85
321
520
610
1515
1071
kl73) - 3
I
3 (155) - 1 [
I
(75) - 1
|(50) - 18
(173) - 2
I
i
118) - I
16
Ii
345
500
885
70
I
1
i
TOTAL
300
1120
3
i
250
200
1
t
I
1
I
190
1
I
2
i
100
170
160
150
.1
'(65) - 1
1
1
140
125) - 2
I
1
(35) 1
130
120
6
|(65) - 1
ASSAM
BIHAR (-1) *
GUJARAT
GOA
MRYAM
HIMACHAL PRADESH
JArtlJ 4 KASHMIR
KAPNATAKA
KERALA
MADHYA PRADESH
rmWASHTRA (-1) *
MANIPUR
ORISSA
PUNJAB
RAJASTHAN
TAMIL NADU (-1) *
UTTW PRADESH
WEST BENGAL
DELHI
PONDICHERRY
80
70
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Especially in the first two states mentioned, this trend is further underlined by the
association with the privatization / commercialization trend as well.
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b) Some states like Bihar, Madhya Pradesh, Uttar Pradesh, have colleges far
below their entitlement (nearly 50% less). Orissa, Gujarat, Rajasthan and West
oien hpwe c^mparitively less than their entitlement.
c) At a National level, the overall situation evens out with only a small shortfall.
However the same regional planning distortions, seen in all aspects of Health
Care planning in the country are seen.
d) The Regional disparity are characterized by another feature. Karnataka and
Maharashtra, the commercial belt, also have the largest admission ratios thereby
proving the economy of scale theory - more admission more income and profits!
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2,3, COMMERCIALIZATION - PEYQND PRIVATIZATION
In terms of ownership and governance there has been a gradual increase in the
number of colleges run under the auspices of the Private Sector (Trusts or
Societies) from less than 5% at the time of Independence to 30% in 1993-94
(see table 2).
While 'private sector' support to higher education may not be a negative trend
per se, it is significant that most of the more recent entrants into the private
sector group of medical colleges show the following characteristics:
j
- They belong to the 'capitation fee' charging variety of medical colleges and the
magnitude of this fees has been increasing over the years; (from 1 lakh to 30-35
lakhs per seat!)
1
- They are initiated by trusts and societies often with caste / communal
affiliations;
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- They are initiated by individuals representing specific sectoral interests like
sugar barons in Maharashtra State, or liquor barons and other pressure groups in
Karnataka and Andhra Pradesh, all of whom are not conversant with the
objectives of medical education;
It is quite significant that all the unrecognised medical colleges in the country (26
out of 146 estimated by the Ministry of Health and Family Welfare, Annual
Report 1993-94) are in this group.
These represent a trend of Commercialization of Medical Education which is
significantly different from the issue of privatization of higher education.
r
Further, reports in the media are regularly available of how colleges run on the
capitation fees ethos are also contributing to fall in qualitative standards at the
time of examinations, where money, power and political influence affect results.
13
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The ‘nexus’ between the capitation tees colleges lobby and the political system
bject of media report and
through contribution to party funding is also a subject
debate.
2.4. PROBLEMS OF NORMS AND ESTIMATES : SHORTFALL OR EXCESS?
The growth of medical colleges in the country has resulted from a application of
the Mudaliar Committee norm of 1 Doctor per 3000-3500 populat.on and the
norm of 1 medical college per 5 million population. With a growing population,
these norms have kept up the momentum of expansion.
I
However we would like to emphasise that in our considered opinion the situation
in the country with its present stock of 300,000+ doctors is one of having Too
many doctors, not less. Some important facts that underscore this opinion are:
a) The Shore and Mudaliar Committees used only 'MBBS Graduates' as being
doctors in all their calculations and estimates.
In the Indian situation we have trained practitioners of a range of alternative
systems. At the primary care level all these can be considered to be contributing
to the health care delivery system.
When their numbers - estimated from Government reports are included in
deriving doctor - population ratios then the situation changes remarkably to an
excess rather than the deficiency situation, usually portrayed (see table 11).
b) It is now well documented that majority of the doctors who graduate from the
145 medical colleges (presently established in India) are not motivated to public
health / primary health care and opt for specialization and / or urban practice.
The doctor-population estimates are further skewed by this factor - so we have
an increasing number of the wrong type of doctors in the wrong situation. Hural,
tribal and hilly areas are underserved while urban areas have an excess.
Doctor population ratios also show wide regional disparities.
c) Finally the 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. It
has been now well established 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
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than the health services of the government.
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While factor (a) explodes the myth of the shortage, (b) and (c) underscore that
any increase in the existing type of MBBS doctors is unlikely to make any impact *
on the problem.
It is not at all surprising that as early as 1980, the ICSSR / ICMR Health for all
Study Group(i5) categorically stated that "Two immediate decisions will have to
be taken.
i) There should be no new medical colleges and no increase in the intake of
existing medical colleges.
ii) There is no need at all to set up new and additional institutions to train
additional doctors through short term courses".
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2,5) STUDENT WASTAGE AND BRAIN DRAIN
Successful human power development policies presuppose that efforts or
resources paid for by the tax payer in training should bear returns of fully
qualified personnel, reaching the required positions, to confidently and efficiently
provide service to the community.
Wastage occurs if students discontinue or delay their studies or trained
personnel seek avenues of work other than support to the public services eg:
through brain drain to developed or other countries and so on.
Studies on 'Wastage' and 'Brain drain' have been rather inadequately pursued in
the country. These are particularly important because there is both a urgent
need for trained manpower, especially in situations of disadvantage as well as a
shortage of resources, to facilitate their training.
—1
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*
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The Institute of Applied Manpower Research in collaboration with National
Institute of Health Administration and Education conducted the only known study
on wastage. However, the data was from 7 colleges only, out of the potential 36
in the sample and the period of study 1954-56. Real wastage (not completing
the course) was 6% and time wastage (delays in completing the course) was 912%. Compared to studies done in India and elsewhere these were not very
alarming. However, these were not followed up.
Another area which has not received adequate attention is the attrition rate
among women doctors due to family demands and child bearing. This is
particularly important since there has been an attempt to increase the number of
females at the intake stage, which is welcome (see table 5) .
However large attrition during the course or after graduation would make this
shift counterproductive. This area of study should also help identify ways and
means of support to female doctors to prevent attrition due to family demands
and facilitation of reentry into the profession, with continuing education and other
supports at a later stage as well.
In terms of 'Brain Drain', studies have been done to estimate the magnitude of
15
TABLE 10
DOCTORS RESISTERED WITH STATE FED I CAL COUNCILS (1984-1990)
r
1984
1985
1988
1987
1988
1989
1990
AKDHW PRADESH
15373
15990
16516
17106
17639
18236
18899
ASSM
8279
8640
8912
9145
9428
9746
10099
GUJARAT
16955
17669
18417
19173
19906
20701
21576
BIFW1
21621
22217
22902
23450
24137
24872
25689
JWHJ L KA5TIR
3103
3209
3442
3622
3676
3937
4067
KW^TMCA
23470
24490
25518
26722
39355
BHOPAL <K.P.)
6473
7141
7867
8526
9147
ffVrWIASHTRA
35585
37394
39397
41035
42730
40872 | 42399
I
9852
10542
i
44684 I 46858
ORISSA
8831
9378
9478
9866
10061
10426 | 10746
23096
23632
24128
24615
25130
25598
26178 j
RAJASTHAN
10065
10501
11059
11613
12243
12912
13475
TAH1LNADU
35644
36860
38673
40023
41465
43074
44769
KITTW PRADESH
26613
27584
28514
29376
30348
31336
35986
37005
37751
38738
13644
14208
14900
15568 ! 16455 N.A. *
11091
11504
11780
12153 ! 12469
12805 i
j
13199 *
N.A.
N.A.
256
319 !
437
523
N.A.
2412 j
MME OF STATE
FEDICAL COUNQIL
PUNJAB
I
i
I
teST BENGAL
I
JTRAWWCORE (KERALA) .
I
i
•WDERABAD (A.P.)
i
HARYAW
Imci
N.A.
TOTAL
295829
I
39510
N.A.
794
830
1639
307502
320304
331882
355695
T
t
32369 I
I
I
I
40210 i 40920'
J N.A.
I
I
1
3196 j
352196 I 3650001
I
iisSSZEBSt
X=x==x==x:
SOURCE : 5, 10
« N.A. x NOT AVAILABLE
<
r
16
1
in
I
J
TABLE
11
DOCTOR POPULATION RATIOS - ALLOPATHIC SYSTEM AND
OF ALTERNATIVE SYSTEM OF MEDICINE
YEARS
ALLO
PATHS
HOMEO
PATHS
VEDA
(1)
(2)
(3)
1974
190838
145434
1979
249752
1981
AYUR
INCLUDING PRACTITIONERS
SIDHA
UNAN I
TOTAL
(4)
(5)
(6)
223109
18128
30400
607909
590 1:3091
1 :c 70
112638
225477
18093
25988
631948
660
1:2642
1:1044
268712
115710
233824
18357
28737
665340
683
112541
1:1026
1984
297228
123852
251071
11352
28382
711885
735
1:2472
1:1032
1985
306966
123852
251071
11352
28302
721623
750 1t2443
1i1039
1986
319254
131091
272800
1 1581
28711
763437
767
1S2402
1t1004
1987
331886
N.A.
N. A.
N.A.
N.A.
N.A.
783 112359
N.A.
1988
355695
N.A.
N.A.
N.A.
N.A.
N.A.
BOO
112249
N.A.
1989
352196
N.A.
N.A.
N.A.
N.A.
N.A.
817
1t2319
N.A.
1990
365000
N.A.
N.A.
N.A.
N.A.
N.A.
834
1<2284
N.A.
1991
394068
N.A.
N.A.
N.A.
N.A.
851
1t2159
N.A.
POPULA- DOCTOR POPULATION
TION
(MILLIONS)
(7)
1 :7
6t7
■-
■BBKHaasaedaa
SOURCE
17
:
7,
10
■fa»
TABLE 12
I
F3
ND. tF COLLEGES W© ADMISSIONS OF ALTERNATIVE SYSTEM OF »G)ICI>€S (1991)
1
UNMI
NO. OF I ADMISSION
COLLEGES!
OPACITY
AYIFVEDA / SIDDHA
ADMISSION
CAPACITY
STATES / UNION
TERRITORIES
ND. OF :
COLLEGES!
AKL+FA PRADESH
3
110
ASSM
1
25
2
1
11 (3)« 100
BO
40
HDMEDPATKT
X). OF : ADMISSION
COLLEGES! CAPACITY
TOTAL
«. OF
COLLESES
TOTAL
3
ND. OF YADMISSION I
i
3
125
8
315
5
200
6
225
26 2135 (16)
38
2355
190
12
448
200 J__
3
9
258
4
200
4
HIMACHAL PRADESH
1
50
1
I
50
JNHJ I KASrfllR
1
0
1
I
0
KAR^TAKA
8
195
KERALA
5
170
MADHYA PRADESH
7
187
MWm^TRA
17
795
ORISSA
2
GUJARAT
1
15
I
6
435
15
4
250
9
I
I
420
I
702
25
13
490
21
1
50
24
1221
42
2066
60
3
140
5
200
3
130
3
140
6
270
3
180
9
400
2+1 «
115
URAL PRADESH
9
410
£ST BENGAL
4 120 (2)
DELHI
4
PUNJAB
i
I
RAJASTWK
TM1IL
I
TOTAL
94+1
150
>
4
i
3335
I
i
■
645
1
I
I
3
80(2)
3
140
1
15
1
21
5
151
4
180
16
670
29
1260
10
1236
14
I
1356 IN
1
60
7
260
7453
232
11323
2
16
50
535
120
*Xe£SSZZZS£CZEXS£S?SSZZSSXSZZZZZZSSZSCSSXKSSK*KZSX2£SSZSCSSKZKSBBCZZS EBZZBZ XZXBZZZBZBBXXBKBBZZ BZ-BCXZZZ Z ZZZZ BZXZZB zWz —B— Z B - Z ZZZZ
SOURCE : 2
T
I
i, FIGURES IN 0 BRACKETS INDICATE REPORTING UNITS
h
SIDDHA - 1
18
r
n
---- a-
p
migration and to enumerate 'push' and 'puli' factors. But here again no serious
attempts have been made to identify the economic losses due to the drain. In
more recent years, with the focus on NRI investments in the development
process, the drain of doctors to lucrative practice overseas is often seen as a
'gain' rather than a 'drain', further complicating the issue.
A study of Doctors migrating has shown a steady increase from an annual
average of 810 during the I plan phase to 5304 in 1986-87 (which represents
nearlv 30% of annual output) which is remarkably high.
E
*
f
This is therefore an area of importance for continuous monitoring and study,
because of the broader economic - political - social - cultural context of this
phenomena. For instance, the recent phenomena of NRIs from the US
promoting High technology Diagnostic Centres in the country can be seen as the
MNCs in USA opening new market avenues for high tech gadget, whose sale in
the US 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 a 'market economy process'. In addition there is a
cultural aspect as well - that of the promotion of Western Health Care as being of
higher standard than Indian health care, not withstanding the serious cultural and
economic crisis being faced by the Western Health Care itself!
Much of the so called Continuing Education efforts that has become common in
more recent years, especially linked to NRI supported hospitals and diagnostic
centres is primarily focussed on stimulating the local medical profession to catch
up with the technological gadgetry of the west. The support of the growing
Medical - Industrial complex to this Continuing Education efforts is therefore not
at all surprising.
■
"The training of health services personnel
should be fully oriented to the people their social, cultural and economic
conditions and their health profile"
- ICSSR-IC^m Health for All Report, 1981
19
r*
/
TABLE 9A
RESERVATION IN MEDICAL SEATS - A
STATES / LXIOK
TERRITORIES
sn
sc t
Mm PRADESH
15
6
25
ASSW1
7
15
6 SEATS
14
10
23
GUJfiflAT
7
13
GOA
15
HIFttCHAL PRADESH
13.B
JMU I KASrtllR
8
IX (12 SEATS)
45X (164 SEATS)
SOME X
15X (ALL ItfHA)
10
IX (10 SEATS)
15X (ALL INDIA)
4
s&t x
15X (ALL INDIA)
54X (GEJERAL)
30 (ALL INDIA)
3
3 SEATS
TRIP1RA-3 SEATS
15 (ALL I»IA)
43 (CENTRAL)
7.6
3
21
sat x
sat x
sat x
2
8
KERALA
GE)€RAL
5X (20 SEATS)
736
sat x
K/WWTWA
30
22
BOTH 33.6
HARYANA
GOVT. OF
INDIA
NDMirtE
HOrtDfl
BCX
sort x
15
MADHYA PRADESH
BOTH 15
rWWASHTRA
BOTH 10 SEATS
15 (ALL IW1A)
65 (KERALA STATE H
15 (ALL IM)IA)
sat x
25
<
sort x
sat x
40
35X
MMIPtF
12
8
ORISSA
2
BOTH 25
POU AB
sat x
15 (ALL IM)IA)
STATE 80VT.
NOMIltE - satx
29
15 (ALL INDIA)
8
6
TAMIL NADU
18
1
50
sat x
UTTAR PRADESH
10
2
15
sat x
50 (30 lOtN)
sat x
sat x
sat x
DELHI
15
7.5
15 (ALL IWIA)
X (STATE GOVT.)
15 (ALL IWIA)
POND I DERRY
7
5
NEST BENGAL
31X
12 (OTTER
STATES) *
24
38X
14X (ALL IM)IA)
!3I
2
1 FROM WUMOW. PRADESH, MWWi It NICOBAR ISLANDS, DADAR I NASAR HAVELI
LADM, rWilPlB, rtHWLAYA, MIZORAM, NA6ALAN), SIKKIM AND TRIPURA
23
I
15 (ALL IWIA)
RAJASTHM
j
CAPITATION FEES AS A SELECTION PROCEDURE
Among the more recently opened colleges, donations and capitation fees is a
major factor of selection representing the commercialization of the medical
education sector (16%). The capitation fees range from 10 to 35 lakhs and NRI's
pay upto 100,000 US $ (media reports).
Inspite of official stands, mostly 'lip service' against capitation fees by the
government - (both at centra! and state level) and professional councils and
bodies at all levels, the capitation fees lobby group of medical colleges has been
gaining greater and greater patronage by the active connivance of both
professional and political leadership.
In state like Karnataka - even the cabinet meet to decide on the permissible
levels of capitation fees which are then applied and not surprisingly, exceeded by
irregular and unofficial means.
The Supreme Court Judgement in a special writ petition from Andhra has
established that capitation fees as it is practiced today "violates the right to
education under the constitution;
KI
is wholly arbitrary;
is unconstitutional according to article 14 - equality before lav;
is evil, unreasonable, unfair and unfit
and enables the rich to take admissions whereas the poor have to withdraw due
to financial inability.......... ;
and therefore is not permissible in any form
"
In spite of this, the crisis continues and the growth of such colleges continues
unchecked.
The nexus between the capitation fees lobby
and the Medical Education policy makers and
leadership at state / central levels is therefore
an important area that needs urgent study if the
commercialization of medical education has
to be halted.
KI
J
1
26
I
L
2. 10) COST / FINANCING OF MEDICAL EDUCATION
Costing and financing of Medical Education in the country has been a topic,
greatly neglected by policy makers and researchers. It had been estimated that
the investment on every medical student for the entire phase of training was
anywhere from 80,000 to 1 lakh - the range being because of varying
expenditures being included in different ways by the researchers. However
these estimates are all outdated (mostly 1970's) and have not been updated.
However, the wider question of who finances medical education in India and
how, is still inadequately understood except for some observations from the
preliminary studies of FRCH (1989).
fl ii
F
n
These studies have shown that the Government till more recently has been the
sole investor in Medical education (wholly financed by the public exchequer from
tax revenue collected from the people). More that 70% of doctors trained by
governmental institutions take up private practice. About 30% migrate to other
countries especially the developed countries of the west. Public.resources are
therefore being used for the benefit of the private sector in the area of Medical
Education !
More recently there has been an unbridled growth of capitation fee medical
colleges especially in the states of Kern at aka and Maharashtra. Apart from
being closely linked to a pheonomenal, commercialization of medical education,
the problem is worsened by the abettment of the governments, in not only
providing tacit approval in spite of stated National and state level policies against
such colleges, but also in providing clinical facilities and other benefits to these
colleges, who make no investments in the health services of the state.
The recent Supreme Court judgement suggesting that the government subsidise
the students in private colleges and even provide soft loans to them is further
adding to the earlier mentioned problem of public subsidy for private sector
expansion. The move to re-label this group of institutions with the more
respectable label of ‘self financing institutions', and the confusion caused by the
central government policy initiative to secure private sector support to higher
education efforts by the state, has made the situation more ambigious.
if
-01
It is important to note that with the years, the costs of medical education and
health care are escalating rather than falling and hence greater clarity in
investment in medical education and seeking alternative avenues of support
rather than direct commercialisation through donations / capitation fees will be a
major challenge to the government. The recent move at both Central and State
levels to introduce NRI quotas of the capitation fees variety' in Government
colleges is therefore a most retorgressive step supporting commercialization’
rather than 'responsible privatization1.
While a public - private mix may be unavoidable, costing / financing of medical
education will have to be subject to rigorous policy studies in the next few years,
so that government efforts are primarily directed to produce adequate human
31
i
i
power for state-run services and get over the imbalance and acute short fall in
the situation of production and enrolment of nursing and allied health
professionals.
L
r -
Medical Education has dominated the health human power development efforts
for too long and provided inadequate returns. A time for more rational planning
which is need based and data based is urgently needed. Training of Doctors is
only one of many tasks in health human power development. This sense of
proportion in efforts need to be re-established.
2. 11) CORRUPTION IN MEDICAL EDUCATION
Corruption and graft have become the bane of public and private life in India and
have crept into all sectors of development and human endeavour. Medical
Education is no exception.
&
I
r
While the more obvious 'commercialization' of medical education - the capitation
fees problem has been mentioned in earlier sections there are more insidious
aspects of corruption that have seeped into all aspects of this sector as well.
Influence of money power and power politics in the selection of candidates for
medical college admission; and in the examination results at various levels; are
now becoming commoner.
Misuse of funds for personal aggrandisement or for improperly sanctioned
institutional or departmental development; extraneous influences in promotions
and transfers and the cancerous growth of private practice values in patient care
within government hospitals are all manifestations of the problem.
While at the level of anecdotal and often experiential evidence, there is adequate
data on the problem, it is 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.
The problem is further worsened by the active involvement of medical college
leadership and the seniors in the Medical profession - many of whom by virtue of
being compromised personally, are unable to take a public stand against the
issue, Even if they do so, it is often a blatant double standard.
Media reports and as mentioned earlier, some committed student sponsored
collective action seem to be the only attempts to counter or atleast bring some
public scrutiny and pressure on the system, to tackle this problem.
A major study that is recommended urgently to understand the full implications of
this degeneration of the medical education sector is the in-depth study of the
nexus between
a) the medical - industrial complex; and
b) the 'capitation fees' lobby of medical colleges
32
ir
L
I
r
with the political and professional health leadership and policy makers in the
country. Only then will it be able to fathom a major paradox in the Medical
Education situation in India, in recent years i.e., the mushrooming and totally
unregulated growth of capitation fees colleges and the fall of ethical standards
inspite of central and state governmental level and professional association level'
stated policies against this type of commercialization.
Any Quality control or applications of norms and standards to ensure training of
well oriented and skilled human power including doctors in the country will come
to naught if this major factor for degeneration of professional standards is not
adequately researched and countered through effective legislation and other
control measures.
2. 12. MEDICAL STUDENTS - PROTEST MOVEMENTS
An important phenomena in Medical Education process has been growing
involvement of medical students and junior doctors in collective action - protests
and strikes.
r
On a superficial overview, this may be seen as a sort of trade-union activity at
junior doctor or medical student level to improve their own facilities and their
allowances, etc., but a deeper analysis shows that the student and junior doctor
community have shown a much more vigorous social concern than the 'teacher'
or 'medical' professional community and the issues for which collective
democratic protest action have been initiated have included:
i) Concern and action about privatization and commercialization of medical
education (the whole recent, Supreme Court case against capitation fees
colleges was initiated by student action). The recent Kerala students / medicos
strike has also been on the same theme.
ii) Corruption in medical colleges, especially around selection and
examinations.
iii) Concern about falling standards or inadequate facilities.
iv) Adhoc policy decisions in response to politically strong pressure groups.
v) Against harrassment of students by teachers in examinations and even
generally
Teachers on the other hand have mostly agitated for better pay and sometimes
improved facilities, showing a lack of broader social concern.
I
1
I
While the involvement of students / teachers in democratic protest action that
could affect patient care in teaching hospitals has been a subject of some public
debate, the growing and wider social concern and vitality for action of the
medicos must be noted with appreciation. This should also be harnessed for
promoting changes in the curriculum framework towards greater social
relevance, as well as countering the disturbing trends described earlier.
33
i
1
REFERENCES
1.
2.
J
J
4
Rl
I,
I.A.M.R. (1967)
Development of Modern Medical Education in India
and Student Wastage in Medical Colleges.
Institute of Applied Manpower Research / National
Institute of Health Administration, New Delhi.
Banerji, D. (1985)
Health and Family Planning Services in India - An
Epidemiological, Social-Cultural and Political Analysis
and Perspectives. Lok Paksh, New Delhi.
3.
M.C.I. (1987)
4.
Indian Medical Council (Amendment) Bill, 1987 as
reported by Joint Committee of Parliament.
Indian Medical Council, Nev/ Delhi.
C.B.H.I. (1987)
Health Information of India, 1987.
Central Bureau of Health Intelligence, Directorate
General of Health Services, GOI Press, Delhi.
5.
I.S.H.A. (1989)
Present stock of Health Manpower and Projected
requirements by 2000 and 2020 - A brief report.
Indian Society of Health Administrators, Bangalore.
Goyal Kaushal. (Ed) (1990)
6.
Directory of Medical Colleges in India
Binny Publishing House. Delhi.
F.R.C.H. (1990)
7.
Health Care Services in India
(An extract from a larger report).
Foundation for Research in Community Health,
Bombay.
Mukhopadhyay J.K. (Ed) (1994)
8
Statistical Outline of India - 1994-95
Tata Services Limited. Dept, of Economics and
Statistics. Bombay.
9.
C.B.H.I. (1991)
Health Information of India - 1991
Central Bureau of Health Intelligence/Directgorage
General of Health Services, M.H & F.W, GOI,
New Delhi.
10.
Book hive (1994)
Directory of Medical Colleges in India
COSMOS Book Hive (P) Ltd., New Delhi.
11(a). W.H.O.- SEARo (1988)
Reorientation of Medical Education : The Rationale
and Vision Publication No.18, Booklet No.1
WHO-SEARO. Regional Office, New Delhi.
11(b). WHO-SEARO (1988)
Reorientation of Medical Education - Goals Strategies
and Targets.
WHO-SEARO Regional Office. Publication No.18.
Booklet No2. New Delhi.
12.
*
4
14.
■W
15.
C.B.H.I. (1985)
Compendium of Recommendations of various
Committees on Health and Development (1943-75)
Central Bureau of Health Intelligence. Directorate
General of Health Services, Ministry of Health and
Family Welfare, New Delhi - 110 001.
Bajaj J.S. (1994)
Education in Health Sciences - Relevance and
Excellence. I.J.M.E., Vol.33, No.3, PI2-23.
Bajaj J.S. (1994)
Quality and Equity in Medical Education
I.J.M.E., Vol.33, No.3, Pl-7.
24.
C.H.C. (1988)
25.
Memorandum submitted to Karnataka Government
Committee on Health University.
Narayan, R (1988)
Newsletter of ACHAN, LINK. Vol/ VII, No.1, AprilMay 1988
26.
27.
28.
29.
30.
ICSSR/ICMR. (1981)
Health for All - An Alternative Strategy. ICSSR/ICMR
Study Group report, Indian Institute of Education,
Pune, 1981.
16.
August 1993.
Medical Council of India, New Delhi.
17. M.C.I. (1994)
Recommendations of Workshop on Training
Teachers today for Tomorrow’s Needs , September
1994. Medical Council of India, New Delhi.
18(a). Duggal, Ravi, F.R.C.h. (1989)
Medical Education in India : Who Pays?
Radical Journal of Health, March 1989.
18(b). Ishi.T.K.
Political Economy of International Migration : Indian
Physicians to United States, p 13-25.
Radical Journal of Health, March 1989.
19. Bajaj J.S. (1991)
National Education Policy in Health Sciences
MME, Vol. 29, Nos. 1 & 2. p35-55 (Jan-Aug 1991)
Narayan, R (1977)
20.
Research in the Methodology of Health
Delivery:Training Programme for Community Nurses/
Health Supervisors (The Kottayam Experiment) A
CSI/FPF project report for Family Planning
Foundation of India, New Delhi.
21.
Narayan,R (1991)
Recent initiatives towards an alternative Medical
Education in Medical Education Re-examination (ed.
Dhruv Mankad) Medico Friends Circle/Centre for
Education and Documentation, Bombay.
22.
Narayan, R et al (1993
Strategies for greater community orientation and
social relevance in Medical Education - Building on
the Indian Expenence.
Narayan T. et al (1993)
23.
Curriculum Change : Building on graduate doctor
feedback of peripheral health care experience - an
exploratory survey.
M.C.I. (1993)
31.
32.
Recommendations of Workshop on Need-based
curriculum for Undergraduate Medical Education -
r5
CHAD - C.M.C.-Vellore (1990)
Teaching Undergraduates Community Medicine
through a Problem Solving Community Based
Approach. Mimeographed booklet, Community
Health and Development Dept., CMC-Vellore,
Tamil Nadu.
Medico Friend Circle (1991)
Medical Education Re-examined (Ed.Dhruv Mankad)
medico friend circle/Centre for Education and
Documentation, Bombay.
Miraj Medical Centre (1988)
The Miraj Manifesto: A proposal for the Christian
Institute of Health Sciences.
Miraj Medical Centre, Miraj. .
Consortium of Medical Institutions (1991)
Inquiry Driven Strategies for Innovation in Medical
Education in India (Ed. Kusum Verma, Brian D'Monte,
B.V. Adkoli and Usha Nayar)
(SEARO-WHO Project IND HMD 017.13).
Narayan T. et al (1992)
Seeking the Signs of the Times
A discussion Document, CHAI Golden Jubilee
Evaluation Project, CHAI/CHC, Bangalore.
Supreme Court Judgment on Doctors and Consumer
Protection Act, dated 13-11-1995.
List of Recognised Medical Colleges in India
Medical Council of Indi, 1995
(sent by VHAI-ICHI Secretariat).
F
I
r
LIST OF MEDICAL COLLEGES IN INDIA
(Included in Tables)
4
ANDHRA PRADESH
Gandhi Medical College .Hyderabad.
1.
Osmanla Medical College. Hyderabad.
2.
3.
An dra Medical College. Visakhpatnam.
Guntur Medical College. Guntoor.
4.
5.
Kurnool Medical College.Kurnool.
6.
Sri venkateshwara Medical College. Tlrupathl.
7.
Rangaraya Medical College. Kakinanda.
8.
Kakarltlya Medical College. Warangal.
9.
Siddartha Medical College. Vljaj-awada.
• 10
Deccan College of Medical Sciences. Hydarabad
52.
I
£
KERALA
55.
Medical College. Thlruvananthpuram.
56.
Medical College. Kozlkode.
57.
Medical College, kottayam
58.
T.D.Medical College. Alappuzha.
59.
Medical College.Thlssur.
I
MADHYA PRADESH
60.
Gandhi Medical College. Bhophal
61.
Gajra RiJ Medical College. Gwalior.
62.
Mahatma Gandl Memorial Medical College. Indore.
63.
Government Medical College. Jabalpur.
64
Pt. Jawaharlal Nehru Memorial Medical College.
Ralpur(MP).
65
Shyam Shah Medical College. Rewa.
I
I
ASSAM
11. Assam Medical College. Dlbrugarh
Guwahatl Medical College. Guuahati
12.
13. Silchar Medical College. Sllchar.
BIHAR
14.
15.
16.
17.
18
19.
20.
21.
22.
K
t
Patna Medical College. Patna
Darbhanga Medical College. Darbhanga
Rajendra Medical College, Ranchi
Jawaharlal Nehru Medical College. Bhagalpur
Sri Krishna Medical College, Muzaffarpur
A N Magadh Medical College. Gaya
Nalanda Medical College. Patna
Patllputra Medical College. Dhanbad
M.G M Medical College. Jamshedpur
GUJARATH
23.
B.J. Medical College.Ahm.idabad.
24
Government Medical College.Sur.it
25.
M.P.Shaha Medical College. J.imnagar.
26.
Medical College. Vadod.ua.
27.
Pamukhaswaml Medical College. 1H) Kiiramsad.
28
Smt N.H LManijial Medl< ;d College,Ahmadabad.
GOA
29.
i
I
!
Goa Medical College.BambollnlGo.il.
HARYANA
30.
Maharshl Dayanand University Medical College.
Rohtak.
31.
Maharaja Agrasen Institute of Medical Research and
Education.
HIMACHAL PRADESH
32
t
1
1
Indira Gandhi Medical College. Shlmla.
JAMMU AND KASHMIR
33.
Govemement Medical College..Jammu
34.
Govl. Medical College. Snnag.u.
* 35
Jhelum Valley College of Medical Sciences. Srinagar.
KARNATAKA
36.
Governmeni Medical College. Mysore.
37.
Government Medical College.Ballary.
38.
Karnataka Medical College. Hubll
39.
Bangalore Medical College. Bangalore.
40.
Sri. Devaraj Urs Medical College.Tamaka.Kolar.
41.
Sri. Siddartha Medical College.Tumkur.
42.
St John s Medical Collge. Bangalore.
43.
Al-Ameen Medical College. Bijapur.
44.
B L.D E-assoslatlons Medical College.Bijapur.
45.
Kasturba Medical College.Mang.ilore.
46
AdichunchanagUl Instltue of Medical Sciences
"VLsh wmanava". Bell ur.
47.
J.S.S.Medical College.Mysore.
48.
Kasturba Medical College. Manlpal.
49.
Jawaharalal Nehru Medical College. Belgum
50.
HRE Society's Mahadappa Rimpur Medical College.
Gulbarga.
51. J.J.M.Medical College. Duvanagere.
J
i
I
I?
|
I
III
I
1I
53
54.
M.S.Ramalah Medical College. Gokhul Extention.
Bangalore.
Dr. B.R.Ambedkar Medical College. Bangalore.
Kempegowda Institute of Medical Sciences.
K.R.Road. Bangalore.
MAHARASHTRA
66.
Grant Medical College.Bombay.
67.
B. J.Medical College. Poona.
68.
Government Medical College. Nagpur.
69
Government Medical College. Aurangabad
70
Govt. Medical College. Sangll
71
Dr. V M Medical College. Solapur.
72
Swami Ramanand Tlrth rural Medical College. Seed.
73.
Sri Vasantro Naik Go\i Medic al College. Yavatmal
• 74
K J.Somlya Medical College. Bombay.
75
Mahatma Gandhi Mission's Medical College.
New Bombay.
• 76.
R. A.Education Society's Padmashree
Dr. D.Y.Patil Medical College. Bombay.
• 77.
Tern.) Medical College. Bombay.
78
Government Medical College. Nanded.
* 79.
Maharashtra Institute of Medical Sciences and
Reseiuch. Latur.
* 80.
Mahatma Gandhi Mission's Medical College.
Aurangabad.
81
S. R.T.Rural Medical College. Beed.
• 82
Jawaharalal nehru Medical College. W.udha
83.
Mahatma Gandhi Institute of Medical Sciences.
Wardha.
• 84
N.K.P.Salve Institute of Medical Sciences and
Researc h Centre. Nagpur.
* 85
Jawahar Medic.il Eoundetion. Annasaheb Chudaman
PatU Memorial Medical College-.
Dhule.
86.
Bharathl Vldyapith's Medical College. Pune.
* 87.
N.D.M.V.P. Samaja's Medical College. Nasik.
88.
Rural Medical College. (Parvara- Medical Trust).
Ahmed n.agar.
89.
Shrl Bhausaheb Hire, dhule.
90.
D.Y.PatU Education Society's. Medical College.
Kolhapur
91.
Armed forces Medical College. Pune.
92.
Indira Gandhi Medical College. Nagpur.
93
Dr.PanJabrao Deshmuh Memorial Medical College.
Amravathi.
94.
Krishna Institute ol Medical Siences. Satara.
MANIPUR
95.
N.E.Regional Medical College.ImphaliManlpal(
ORISSA
96. S.C.B.Medical College. Cuttack
97. V.S S.Medical College. Sambalpur
98
M.K.C.G.Medical College, Berhampur.
&
87
1 ’UN JAB
99
Government Medical College. Am.'jts.ir
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