The department-related parliamentary standing committee of the ‘Ministry of Health & Family Welfare’ recently submitted a report on the ‘Review of Progress of all AIIMS’ in the Lok Sabha. Among other things, the committee highlighted delays, under-utilization of funds, shortage of faculty in the new AIIMS.
During the Winter Session of the Parliament, the department-related parliamentary standing committee of the ‘Ministry of Health & Family Welfare’ submitted a report on ‘Review of Progress of all AIIMS’ in the Lok Sabha. The committee, chaired by Lok Sabha MP Girish Bhalchandra Bapat, looked at multiple issues such as the progress in construction and operation of 22 AIIMS in the country, how these are different from AIIMS (New Delhi), reasons for the delay in setting up these AIIMS, streamlining the process of setting up of new AIIMS, budgetary allocations, recruitment process, and encouraging research activities. Furthermore, the committee made a slew of recommendations on various issues.
22 AIIMS have been approved under PMSSY since 2003
Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was announced in 2003 for expanding tertiary healthcare facilities across the country by setting up of new All India Institute of Medical Sciences (AIIMS) and up-gradation of existing Government Medical Colleges (GMCs) in various States. Under the scheme, a total of 22 new AIIMS have been approved, of which six AIIMS at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur, and Rishikesh are fully operational. These six AIIMS were approved in Phase I of the scheme. The remaining 16 AIIMS are at different stages of construction. According to the PMSSY dashboard, the construction is in progress for 10 AIIMS, while the appointment of executing agency is ongoing for 2 AIIMS. While MBBS classes have commenced in three new AIIMS, MBBS classes and OPD services have begun in another four of them. The remaining six are at the initial stages, according to the dashboard.
Years of delay in completion of new AIIMS
The committee noted that the delay in the completion of new AIIMS ranges from 2 to 12 years. The expected date of completion of the 16 AIIMS as per the Ministry’s response to the parliamentary committee clearly shows that there is a delay in the progress of all these AIIMS. The period of delay is as high as 1 year 7 months for AIIMS (Rae Bareli) as of December 2021 when the report was published. The AIIMS (Mangalgiri) and AIIMS (Kalyani) are staring at a delay of more than one year, as per the report. Among those AIIMS in the initial stages of construction, the encumbrance-free land is yet to be handed over by the State Government in the case of AIIMS (Manethi) that was approved by the Cabinet in February 2019. The Cabinet approved date of completion is February 2023 for this AIIMS.
The reasons behind delays as cited in the report include delay in the approval of the scheme, delay by the State Government in providing the encumbrance free land for AIIMS (Dharbanga & Manethi), non-availability of sand for construction work AIIMS (Mangalgiri), delay in completion of activities to be undertaken by the State Government such as the arrangement of water supply, stormwater disposal drain, the main approach road to campus and shifting of existing NDRF Campus and COVID -19 pandemic, and delay in filling up of vacancies and other administrative reasons.
Fund allocation for setting up AIIMS is not as per the AIIMS Act
With respect to the funds for setting up AIIMS, the allocation is made for all the projects together under the PMSSY Division. This allocation is a combined allocation and not institute-wise. This is despite the provision in AIIMS Act to make an allocation to every institute in each financial year.
Unlike others, AIIMS (Madurai) would be set up with a loan from an international agency (Japan International Cooperative Agency – JICA). First, the amount will be spent from the combined allocation following which the reimbursement would be claimed from the agency (JICA).
Underutilization of funds observed across different AIIMS
The committee further noted a gap between projected requirements and allocations at the budget estimates (BE) stage between 2016-17 and 2021-22. In 2016-17, the projected requirement was Rs.4,362.1 crores while the BE was Rs. 2,450 crores. In the same year, the revised estimates (RE) were Rs.1,953.24 crores while the expenditure was Rs.1,953.15 crores. Except in 2018-19 and 2019-20, the allocation at the RE stage was less than at the BE stage. During the year 2021-22 against the proposed allocation of Rs. 8,965.14 crores, the allocation at BE stage is Rs.7,000 crores. The expenditure was Rs. 3,903.41 crores till 22 October 2021.
The Committee also observed that the expenditure is less than the effective release for various AIIMS. For instance, between 2018-19 to 2021-22, AIIMS (Bhopal) incurred an expenditure of Rs. 980.83 crores while the effective release was Rs. 1357.07 crores, giving a percentage expenditure of 72.3%. Likewise, the percentage expenditure for AIIMS (Bhubaneshwar) was 88.3%, 59.9% for AIIMS (Mangalgiri), 32.4% for AIIMS (Kalyani), and 27.8% for AIIMS (Guwahati).
All new AIIMS should be treated on par with AIIMS (New Delhi)
The committee noted that there should not be any difference between AIIMS (New Delhi) & other AIIMS, with respect to the delegation of financial and administrative powers for procurement of equipment, having specialties & super specialties teaching, since all the new AIIMS are being governed by the AIIMS Act, 1956 as amended in the year 2012. All AIIMS must be treated on par with AIIMS (New Delhi).
While AIIMS (New Delhi) is headed by a Director (with an age limit of 65 years), the new 16 AIIMS are being headed by an Executive Director (with an age limit of 70 years). The committee called for strict adherence to the AIIMS Act for the appointment of the Director as head in each new AIIMS instead of the Executive Director. It is also recommended against the appointment of any person above 65 years of age as the head.
AIIMS like institutes must be set up in all states
Furthermore, the committee noted the underutilization of scarce budgetary resources, unavailability of required beds and specialists and super specialists, and the slow progress in opening centres in various AIIMS and asked the Ministry to take measures to achieve physical and financial targets, as well as ensure the availability of sanctioned beds, specialties, and super specialties. The committee also recommended that the Ministry take necessary steps to set up AIIMS like institutes in all states in a time-bound manner and include it in the 15th Finance Commission Report.
Timelines need to be fixed to ensure effective monitoring of progress
The Committee expressed that timelines were required for each action point in the guidelines for setting up of new AIIMS so that the progress can be monitored effectively. The committee advised the Ministry to fix timelines and take efforts to ensure that these are followed.
Even in the past, committees have recommended that the process of effective operationalization of all the essential medical services and tertiary level health care facilities at new AIIMS should be completed within the stipulated timeframe. The recent report recommended the constitution of a project review panel for each AIIMS to evaluate both the physical targets of construction of buildings as well as setting up of medical facilities. The panel is supposed to review every quarter and report laxities to the Ministry.
Further, to address the delay caused by the State Governments such as getting land clearance, the committee recommended that the Ministry should bring it to the notice of the concerned Member of Parliament (MP) for taking up the matter with the respective State Government. Observing that most AIIMS are in the outskirts of the main cities, the Committee highlighted the issue of road connectivity and urged the Ministry to actively monitor road conditions to meet four-lane connectivity at each AIIMS project.
Issue of Human Resources also highlighted in the report
Noting that only 43% to 72% of the faculty posts have been filled up in the six new functional AIIMS, the committee asked the Ministry to take up urgent measures to fill up the vacancies in time so that medical education and services do not suffer due to shortage of faculty posts. A policy for appointment of regular and contractual posts with clear-cut bifurcation, keeping contractual appointment minimum, has been recommended by the committee.
Further, it also asked the ministry to explore the possibility of enlarging the ambit of ‘visiting faculty’ at each new AIIMS till the time regular posts are filled up. The committee has also asked the Ministry to study the feasibility of having rotation/transfer of faculties from one AIIMS to another, to ensure that the quality of education and services in all the new AIIMS are at par with AIIMS (New Delhi). It also asked the Ministry to come up with a mechanism to ensure a uniform syllabus for the MBBS courses in all AIIMS, uniform rules and regulations for completing the course, conducting examination and a robust evaluation process. The committee also advised the ministry to issue guidelines to all AIIMS to put in place a comprehensive module for online medical education at AIIMS, like the SARAL platform of AIIMS (New Delhi).
Separate allocation for research recommended
For planning the future requirements of each AIIMS, the committee called for earmarking an assured fund to each AIIMS in each financial year, as per the AIIMS Act. It also added that the additional allocations as per requirement for each AIIMS be taken up with the Ministry of Finance at the highest level and that the Ministry must ensure full utilization of allocation. The committee also recommended a separate allocation for research activities.
Featured Image: Parliamentary Standing Committee on new AIIMS