What The Yogi Adityanath Government Has Done To Improve Access To Healthcare In Uttar Pradesh

Uttar Pradesh Chief Minister Yogi Adityanath had to face his first crisis only months after taking office in March 2017. It was a medical crisis — hundreds of children were dying of acute encephalitis syndrome (AES) in Gorakhpur and other parts of eastern Uttar Pradesh every month. The problem had been festering for years, if not decades, and successive governments of the Samajwadi Party and the Bahujan Samaj Party had largely ignored it.

On 13 August 2017, at a hurriedly convened press conference during his visit to Gorakhpur's Baba Raghav Das Medical College, the epicentre of the crisis, Adityanath broke down talking about the situation — at least 64 children had died of AES in the last six days.

"Hum log ab ye nahi hone denge (We will not let this happen now)," the Chief Minister said at the presser, assuring action on the issue.

Next year, the cases of AES came down to less than half of those reported in 2017, and the number of deaths linked to AES fell by 66 per cent. A sustained campaign of immunisation, awareness and capacity building helped fight AES, and the battle is now in the last stage.

Work on healthcare hasn't slowed down since.

With the inauguration of nine new medical colleges in Uttar Pradesh by Prime Minister Narendra Modi from Sidharthnagar today (25 October), the Adityanath government has operationalised 16 new government medical colleges in the state since it took office in 2017, which is more than any other government in the past in a single term.

Some of Uttar Pradesh's most backward districts — Deoria, Etah, Fatehpur, Ghazipur, Hardoi, Jaunpur, Mirzapur, Pratapgarh and Siddhartha Nagar — now have medical colleges, considered a luxury until recently.

Alok Kumar, who serves as Principal Secretary of Medical Education, told Swarajya that the nine medical colleges to be inaugurated by the Prime Minister today had already received permission from the National Medical Commission (NMC) to start admissions for the next academic session. All arrangements for hospital, hostel and staff have been completed at these nine medical colleges and faculty has been appointed.

"All of these are new medical colleges. They have two parts, one is the academic part and the other is the hospital part. Hospitals are brownfield; eight of them are upgradations of district hospitals, while all academic facilities are new. The medical college in Jaunpur is a totally greenfield one," Kumar said, adding that each of the nine medical colleges will add 100 new Bachelor of Medicine, Bachelor of Surgery or MBBS seats.

The addition of 900 new MBBS seats will take the total number of seats in government-run medical colleges in the state to around 3,900.

The physical infrastructure required for a new medical college is the least of government's worries. Recruiting of faculty members and getting all the requisite permissions, including from the NMC, takes years.

"The operationalisation of a medical college involves much more than the construction of physical infrastructure for education and training, which is the easiest part of the job. Finding faculty, both doctors and technicians, who are willing to work in remote areas, is the toughest part. Getting permission from the NMC is also a time consuming process. Starting 16 medical colleges in a little over four years is an achievement," a doctor at a government-run hospital in Lucknow, who did not want to be named, said.

Permission from the NMC comes in three stages, Kumar said.

"The first is the LoP (letter of permission) stage, which requires a 330 bed functional hospital running for the last two years and 90 per cent of the faculty in place. Then there are some minimum building requirements, including two lecture theatres and pre-clinical blocks. The first inspection takes place before the start of teaching, the second after two years and the third one after another three years, when the first batch passes out," the principal secretary for medical education told Swarajya.

"The first part is to upgrade the district hospital. Where there is a 200 bed district hospital, we add beds as the minimum number of beds required is 330 beds. We add more faculty, nurses and technicians. The second part is to construct the academic block and the campus. The hospital doesn't itself have any academic campus. Usually it is in a different plot of land but we try to make it as close to the hospital as possible," he said.

The Adityanath government is also in the process of setting up the Atal Bihari Vajpayee Medical University, a state collegiate university that will affiliate the medical colleges being built in the state. The government had allocated Rs 100 crore for the university in its 2021-22 budget.

"A health university, which will be an affiliating university for all medical colleges, just like the Uttar Pradesh Technical University, which affiliates all engineering colleges in the state, will be set up by the government," the Principal Secretary for medical education said.

Apart from affiliating the new medical colleges coming up in Uttar Pradesh, the Atal Bihari Vajpayee Medical University will also regulate and streamline the process of admission and examination.

‘One District, One Medical College’ scheme

Under the 'One District, One Medical College' scheme, the Adityanath government is addressing the issue of geographical disparity in the healthcare sector by building at least one private or government medical college in each of the 75 districts of the state.

For this, at least 14 more medical colleges have been approved by the state government and are currently under construction, Kumar confirmed. The districts where these medical colleges will come up include Kanpur Dehat, Kaushambi, Chandauli, Bulandshahr, Jalaun, Kushinagar, Gonda, Pilibhit, Bijnor, Lakhimpur Kheri, Sultanpur, Lalitpur, Sonbhadra and Amethi.

The Medical Education Department plans to operationalise these medical colleges from 2022. The colleges will add around 1,400 MBBS seats to the nearly 3,900 seats that are now available in Uttar Pradesh.

After the construction of these 14 medical colleges, 16 districts in Uttar Pradesh will be without a medical college. For these 16 districts, the government is looking at the public-private partnership (PPP) model and has invited expression of interest from interested parties.

"After these 14, there will be only 16 districts which will not have a medical college, either government or private. 59 districts will have either a public medical college or a private one or both. For the remaining 16 districts, we are trying to go through the public-private partnership route. Once we are done with it, every district in the state will have one medical college," the principal secretary told Swarajya in Lucknow.

For the construction of medical colleges in 16 unserved districts of Uttar Pradesh, the Adityanath government has invited expression of interest from private entities. It has set 5 November as the deadline for receiving applications from the interested parties.

"The policy [for unserved districts] has been announced and the expression of interest has been called for. November 5 is the last date for submission of expression of interest," Kumar said.

The districts that are likely to benefit from this include Baghpat, Ballia, Bhadohi, Chitrakoot, Hamirpur, Hathras, Kasganj, Maharajganj, Mahoba, Mainpuri, Mau, Rampur, Sambhal, Sant Kabir Nagar, Shamli and Shravasti.

The policy document on the construction of medical colleges in the unserved 16 districts suggests two different models for private sector participation and offers multiple incentives for private entities.

"The private sector may be involved through the investment policy route or through facilitation from the Viability Gap Funding scheme of the Government of India," the document reads.

Private entities can open medical colleges either on their own land or on government land leased from the state government.

The incentives to be provided by the state government to the private sector include interest subsidy of 5 per cent, assistance of up to 2 lakh per seat per year in MBBS course and reimbursement of Rs 100 per outpatient department consultation and related diagnostics, among others.

The augmentation of capacity in the medical education sector will yield benefits in the healthcare sector in a few years from now, when the students enrolling in the new medical colleges graduate, an official in UP's Medical Education Department said, adding that many of the new doctors will start private clinics or join government hospitals.

By spreading out medical colleges throughout the state instead of building them in education hubs like Noida and Lucknow, the government is trying to create sustainable healthcare infrastructure in every part of the state, another official noted, adding that the programme is also leading to the modernisation of district hospitals across the state.

Also Read: UP’s Battle Against Encephalitis: Two Years On, Data And Ground Check Reveal An Encouraging Story