Title: A Cross Sectional and Descriptive Study of the Regional and Population wise
Distribution of Graduate Medical Colleges and Graduate Medical Seats (MBBS) in India
Running title: Graduate Medical Colleges in India
Authors: Raghunath H, P Subhas Babu, Nagaraja Goud B
Abstract:
India being the second most populous country in the world is among the countries
with a large number of graduate medical colleges. To know the extent of regional and
population wise distribution of medical colleges, data on the regional population and number
of medical colleges in the corresponding regions as on 1st August 2012, was obtained from
the official websites of census commissioner of India and the Medical Council of India
respectively. So collected information was entered into Excel spreadsheet and analysed using
the same software. With 355 institutions imparting graduate medical education in India, the
average number of colleges corresponds to 10 per state/ UT. But there is great disparity in the
regional distribution of the medical colleges with the difference varying from 43 medical
colleges (Karnataka and Maharashtra) to no (zero) medical colleges in 4 states and 4 union
territories of the country. In terms of ownership of graduate medical colleges, there is a rising
trend in the establishment of non – government graduate medical institutions in India. The
states of Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand, Orissa, Rajasthan, Uttar Pradesh
and Uttarakhand (Empowered Action Group states) with 45.87 % of the India’s population
account for 25.69% of the medical colleges. The southern states of Karnataka, Andhra
Pradesh, Tamil Nadu and Maharashtra which correspond to 27.29 % of the population have
47.32% of the graduate medical institutions. There is regional inequity and mismatch
between the population and the number of graduate medical colleges and seats in India.
Introduction:
India is a union of states with 28 states and 7 union territories (centrally administered
areas). With a population of 1,21,01,93,422 which corresponds to 17% of world’s population,
is also the second most populous country.1 It is among the countries with a large number of
medical colleges.2 For a country with such huge population the health care requirements in
terms of manpower, infrastructure, and facilities are tremendous. The availability of trained
professional manpower is though not a very critical determinant of public health when
compared to basic amenities required for health, it is nevertheless an important one. This in
turn depends on the medical professionals trained through the medical colleges in the country
which itself is decided by the number of medical colleges and number of seats available.
The first Medical College imparting training in modern medicine was established in
1835 in the erstwhile Madras (now Chennai) as the Madras Medical College.3 Since the
beginning of modern medical education in India, the inadequacy of the number of medical
colleges and the graduate medical seats available for the country have been an important
observation of various committee reports.4, 5
Materials and Methods
Need for the study:
This study is felt necessary for the following reasons
-
Though data is available in various government departments of the country on the
availability of medical seats and medical colleges, its utility in equitable establishment
of institutions and upgrading of number of graduate medical seats in states is not
always based on the human resource needs of the state/region.
-
There are articles which comment on the unequal distribution of medical colleges in
the country, but is the unequal distribution really unequal? if yes, how unequal is it?
Objectives:
1. To compare state wise distribution of the medical colleges and their ownership in
terms of whether under the government and non government category.
2. To determine the state wise availability of graduate medical seats under the
government and non government category.
3. To assess the trend in the growth (establishment) of medical colleges and its
comparison with the population growth of India.
Materials and Methods
Type of study: Cross sectional, Descriptive study
Data collection: Secondary data from the websites of Medical Council of India and the
Census of India website. The number of recognized medical colleges imparting graduate
medical education, as on 1st August 2012 along with the number of recognized graduate
medical seats were obtained from the official website of Medical Council of India
www.mciindia.org and considered for data analysis. The provisional census data for the year
2011 was taken from the official website of the Registrar General and Census Commissioner
of India (Government of India) www.censusindia.gov.in
Data entry and analysis – data was entered into MS excel, re-organized according to State/
UT, whether a Government or Non-government institution, tabulated along with the
corresponding regional population and analysed using the same software.
Statistics: Frequencies and Proportions
Results and Discussion:
Table 1. State wise distribution of Medical Colleges and Medical seats in India –
Government and Non – Government.
Census
Admn.
Code*
1
2
3
4
5
6
7
8
9
10
11
14
16
18
19
20
21
22
23
24
27
28
29
30
32
33
34
Total
State
Jammu and Kashmir
Himachal Pradesh
Punjab
Chandigarh*
Uttarakhand
Haryana
NCT of Delhi*
Rajasthan
Uttar Pradesh
Bihar
Sikkim
Manipur
Tripura
Assam
West Bengal
Jharkhand
Orissa
Chattisgarh
Madhya Pradesh
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Goa
Kerala
Tamilnadu
Puducherry*
Government
Medical
colleges
Graduate
seats
Non
Government
Medical
colleges
Graduate
Seats
Total
2
2
3
1
2
2
5
7
12
7
Nil
1
1
5
13
3
3
3
6
9
19
14
11
1
5
19
2
158
200
200
350
50
200
300
730
900
1449
540
0
100
100
626
1750
250
450
200
660
1530
2200
2050
1350
150
900
2205
225
19665
2
Nil
7
Nil
2
4
1+1
3
15
4
1
1
1
Nil
2
Nil
4
Nil
6
13
24
26
32
Nil
18
23
7
197
150
0
645
0
200
400
200
400
1800
360
100
100
100
0
150
0
300
0
900
1400
2995
3450
4655
0
1950
2850
900
24005
4
2
10
1
4
6
7
10
27
11
1
2
2
5
15
3
7
3
12
22
43
40
43
1
23
42
9
355
Total
graduate
medical
seats
350
200
995
50
400
700
930
1300
3249
900
100
200
200
626
1900
250
750
200
1560
2930
5195
5500
6005
150
2850
5055
1125
43670
*Number are Census codes and are not serial numbers of the states.
Arunachal Pradesh, Nagaland, Mizoram, Meghalaya, Daman and Diu, Dadra and Nagar
Haveli, Lakshadweep and Andaman and Nicobar Islands do not have any Medical colleges.
As evident from the above table, the total number of medical colleges in India, as on
1st August 2012 is 355. The total number of medical seats that are available as on August
2012 is 43670. For 35 States and Union territories (28 states and 7 UTs) there are 355
medical colleges with an average of around 10 per state/ UT. (The range being 43 to Zero).
Government owned institutions are 158 (44.51%) and non-government institutions are 197
(55.49%) out of 355 Medical colleges.
The analysis of state wise distribution of medical colleges and medical seats reveals
that the States of Karnataka and Maharashtra have the maximum number of medical colleges
at 43. Sikkim and Goa states have only one medical college (Excluding the states with no
medical colleges). Karnataka state has the maximum number of medical seats (6005) the
least number of medical seats (100) is in the state of Sikkim (excluding States with no
Medical colleges)
Arunachal Pradesh, Meghalaya, Mizoram, Nagaland, Andaman Nicobar, Lakshadweep,
Daman and Diu, Dadra and Nagar Haveli do not have any medical colleges.
The states of Goa & Sikkim and the Union territory of Chandigarh have only one medical
college.
Puducherry being a Union territory has 9 medical colleges (2 being Government and 7 being
non-government)
From the above table it is evident that there are states where there are only
government institutions providing medical education, in some states there is a mix of
government and non-government medical institutions. Furthermore the analysis of the states
with a mix of these institutions reveals in some states the majority of the institutions belong
to government category whereas in the others the number of non-governmental institutions
have outgrown that of the government medical institutions.
Though the responsibility of professional education cannot entirely be attributed to
the state, there has to be at least a balance which should not tilt towards privatization for a
developing country like India. This has been an observation (as responsibility of the State)
even in the important report of Abraham Flexner which changed the course of medical
education in America. In his report on Medical Education in the United States and Canada,
Abraham Flexner has stressed on the important role of the State (government) in imparting
medical education “The right of the state to deal with the entire subject in its own interest can
assuredly not be gainsaid. The physician is a social instrument.”
8
According to Flexner,
promoting educational reform (in medical education) is a public health measure.9
The availability of medical seats (and colleges) or rather the deficiency of it in India,
has been an important observation throughout many decades. Reports of many committees on
Public Health commissioned by the Government of India have observed the geographical/
territorial inequity in distribution of Medical colleges and have also commented on the state
of professional medical education. Prior to India’s independence, the highly acclaimed report
of Sir Joseph Bhore on India’s health status was published where he has observed “there are
in India some 19 medical colleges which include 2 in Indian states (Mysore and Hyderabad)
and a special college at Delhi for women students only. The other colleges are located in the
provinces of Madras, Bombay, Central Provinces and Berar, Bengal, The United Provinces,
Punjab, Bihar and Orissa which is a recent addition. The total number of students admitted to
these colleges each year is about 1200. For a population of 400 million the annual intake of
1200 students for Medical education is definitely low”.4
Also the Health Survey and Planning Committee headed by Dr A L Mudaliar
observed “.....and 46 new medical colleges have come into being; as against 15 colleges
before 1946, the number rose upto 50 in 1958 and the present number is 61. As against 1200
seats in medical colleges in 1946, at present there were available 5900 seats for admission”. 5
Fig 1. Showing State wise distribution of MCI recognized Medical colleges in India: Government and Non-Government (States/ UTs
without Medical colleges have been excluded)
35
Bar diagram showing the statewise distribution of Medical Colleges in India
and its ownership
30
25
20
15
Government
Non-Government
10
5
0
Table 2. Comparison of the population of each State/ UT* of India, with that of the
number of medical colleges (absolute numbers and proportions)
Sl.no
Name of
territory
the
1
2
3
4
5
6
7
8
9
10
11
14
16
18
19
20
21
22
23
24
27
28
29
30
32
33
34
Jammu and Kashmir
Himachal Pradesh
Punjab
Chandigarh*
Uttarakhand
Haryana
Delhi*
Rajasthan
Uttar Pradesh
Bihar
Sikkim
Manipur
Tripura
Assam
West Bengal
Jharkhand
Orissa
Chhattisgarh
Madhya Pradesh
Gujarath
Maharashtra
Andhra Pradesh
Karnataka
Goa
Kerala
Tamilnadu
Puducherry*
TOTAL
state/Union Total
Population
(2011 Census)
1,25,48,926
68,56,509
2,77,04,236
10,54,686
1,01,16,752
2,53,53,081
1,67,53,235
6,86,21,012
19,95,81,477
10,38,04,637
6,07,688
27,21,756
36,71,032
3,11,69,272
9,13,47,736
3,29,66,238
4,19,47,358
2,55,40,196
7,25,97,565
6,03,83,628
11,23,72,972
8,46,65,533
6,11,30,704
14,57,723
3,33,87,677
7,21,38,958
12,44,464
1,21,01,93,422
Proportion
Population
1.037%
0.567%
2.289%
0.087%
0.836%
2.095%
1.384%
5.670%
16.492%
8.578%
0.050%
0.225%
0.303%
2.576%
7.548%
2.724%
3.466%
2.110%
5.999%
4.990%
9.286%
6.996%
5.051%
0.120%
2.759%
5.961%
0.103%
100.000%
of Total
4
2
10
1
4
6
7
10
27
11
1
2
2
5
15
3
7
3
12
22
43
40
43
1
23
42
9
355
Proportion
of medical
colleges
1.127%
0.563%
2.817%
0.282%
1.127%
1.690%
1.972%
2.817%
7.606%
3.099%
0.282%
0.563%
0.563%
1.408%
4.225%
0.845%
1.972%
0.845%
3.380%
6.197%
12.113%
11.268%
12.113%
0.282%
6.479%
11.831%
2.535%
100.000%
*UT – Union Territory
Arunachal Pradesh, Nagaland, Mizoram, Meghalaya, Daman and Diu, Dadra and Nagar
Haveli, Lakshadweep and Andaman and Nicobar Islands totally account for 84,48,371
population which is 0.70% of the total population (2011 census) but do not have any Medical
colleges. Whereas Puducherry accounting for only 0.103% of the total population has 9
medical colleges.
The 8 Empowered Action Group(EAG)7 states of Madhya Pradesh, Chattisgarh,
Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Orissa and Rajasthan together account for
45.87% of India’s population but correspond only to 21.69% (n=355) of the total Medical
Colleges. A significant proportion, 56% of Medical colleges in these states are government
(n=77) Whereas the states of Maharashtra, Karnataka, Andhra Pradesh and Tamil Nadu
which corresponds to 27.29% of India’s population account for 47.32% (n=355) of the total
medical colleges. A significant proportion, 62.5% of medical colleges in these states are nongovernment (n=168)
Table 3. Decade wise establishment of Medical Colleges
Sl. No
Decade
Number of new medical colleges established
Government
1.
1831 – 1840
3 medical colleges
3
2.
1841 – 1850
1 medical college, government
1
3.
1851 – 1910
No new medical colleges were established
4.
1911 – 1920
3 medical colleges, all government
3
5.
1921 – 1930
4 medical colleges, all government
4
6.
1931 – 1940
1 medical college, Government
1
7.
1941 – 1950
15 medical colleges, 1 trust (non-government)
14
8.
1951 – 1960
34 medical colleges, 31 government
31
9.
1961 – 1970
40 medical colleges, 34 government
34
10.
1971 – 1980
11 medical colleges, 7 government
7
11.
1981 – 1990
32 medical colleges, 5 government
5
12.
1991 – 2000
44 medical colleges, 11 government
11
13.
2001 – 2010
137 medical colleges, 33 government
33
14.
2011 onwards
40 medical colleges all non-government
40
A look at the decade wise establishment of graduate medical colleges also reveals an
important trend. A total of 27 medical colleges had been established prior to 1950 before the
1st five year plan of Independent India and only one being a non-government one 3
Fig 2. Showing the number of Medical colleges established in India, each decade since
the year 1840.
160
Decade wise establishment of new Medical Colleges in India
140
Total
137
Government
120
Non-government
100
80
60
40
34
20
0
15
3
1
0
3
4
44
40
32
11
1
Fig 2. shows that there is a steep increase in the number of medical colleges
established after the year 2000 with non-government institutions mainly contributing the
increase in the number of medical colleges established in the country.
Further it is also evident from the Table.3 and Fig.2 that the number of nongovernment medical colleges started to increase 1980 onwards.
Table 4. Comparison of the Decennial population growth in India with the cumulative
number of medical colleges in that decade.
Year
Population
1901
1911
1921
1931
1941
1951
1961
1971
1981
1991
2001
2011
23,83,96,327
25,20,93,390
25,13,21,213
27,89,77,238
31,86,60,580
36,10,88,090
43,92,34,771
54,81,59,652
68,33,29,097
84,64,21,039
1,02,87,37,436
1,21,01,93,422
Cumulative
Total of
Medical Colleges
4
5
7
11
12
28
66
103
113
147
200
334*
Decadal
growth rate (%)
5.75
0.31
11
14.22
13.31
21.64
24.80
24.66
23.87
21.54
17.64
*Indicates the total number of medical colleges as on 2011, the number has risen
to 355 after 2011.
Fig 3. Line diagram showing the growth in the number of Medical colleges each decade,
vis a vis the growth in Indian population.
1400
1,210
1200
1,028
1000
846
800
683
600
0
Total Population(in millions)
548
439
400
200
Total Medical Colleges
278
238 252 251
4
5
7
11
318
12
361
28
334
66
103 113
147
200
Table 4. and Fig 3. Shows that the number of medical colleges, being established each decade
has been increasing but still has to catch up with the population growth of the country.
The dearth in the number of medical colleges in some states has been recognized and
remedial measures have been suggested. As per the observations of the Commission on
Macroeconomics and Health, “…..there are extensive distributional inequities in the
availability of doctors……. and to ensure distributional equity across States, it has been
proposed to establish 60 new medical colleges in states with a shortage — UP, Bihar, MP,
Orissa, West Bengal and Rajasthan.” 6
Conclusion
The number of medical institutions imparting graduate medical education is
increasing overall at a national level, though at a slower pace. The growth is not uniform,
with inequalities in terms of region wise (State and Union territory) distribution.
Significant proportion of medical colleges is concentrated in a few states and union
territories. The rate of growth of non-government institutions is higher compared to that of
government medical colleges which is evident from 1980 onwards. As the number of
Graduate Medical Colleges directly determine the number of graduate medical seats
available for the country it calls for more equitable establishment of graduate medical
colleges and based on the regional population needs.
References:
1.
Government of India. Census 2011 – Provisional Population Tables and
Annexures.http://censusindia.gov.in/2011-prov
results/data_files/india/Final_PPT_2011_progresstables.pdf
(accessed
18
August 2012).
2.
Foundation for Advancement of International Medical Education and Research.
International
Medical
Education
Directory.
https://imed.faimer.org/results.asp?country=495&school=&currpage=1&cname
=INDIA&city=&region=AS&rname=Asia&psize=25 (accessed 5th August
2012)
3.
Medical
Council
of
India.
List
of
colleges
teaching
MBBS.
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5.
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(The
Mudaliar
Committee)
Volume
1
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mis.nic.in/ui/who/PDF/A%20Lakshmanaswami%20Mudaliar%20committee%
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Health
http://www.who.int/macrohealth/action/Report%20of%20the%20National%20
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Park K. Park’s Textbook of Preventive and Social Medicine. 22nd ed, Jabalpur:
M/s Banarasidas Bhanot publishers 2013:pg
8.
Flexner A. Medical Education in the United States and Canada: A Report to
the
Carnegie
Foundation
for
the
Advancement
of
Teaching.
http://www.carnegiefoundation.org/sites/default/files/elibrary/Carnegie_Flexne
r_Report.pdf (accessed 8 July 2011)
9.
The Flexner Report and the Standardization of American Medical Education
Andrew H. Beck, Brown Medical School, Providence, RI (Reprinted) JAMA, May 5,
2004—Vol 291, No. 17 2139 Downloaded from jama.ama-assn.org by guest on July
8, 2011
Conflict of interest: None
Annexure: None
Acknowledgement : The authors wish to acknowledge the support of the Department of
Community Medicine, Mandya Institute of Medical Sciences for their support. We also wish
to thank Dr Ragini Ranganthan (PG student, MD Community Medicine) for proof reading the
references.