A Cross Sectional and Descriptive Study of the Regional and Population Wise Distribution

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A CROSS SECTIONAL AND DESCRIPTIVE STUDY OF THE REGIONAL AND POPULATION WISE DISTRIBUTION OF GRADUATE MEDICAL COLLEGES AND GRADUATE MEDICAL SEATS (MBBS) IN INDIA

Raghunath Hanumantharaya1, Subhas Babu Puttamaligaiah2, Nagaraja Goud Bhoompuram3.

Assistant Professor, Department of Bio Chemistry, Mandya Institute of Medical Sciences.
Assistant Professor, Department of Community Medicine, Mandya Institute of Medical Sciences.
Assistant Professor/ Statistician, Department of Community Medicine, Mandya Institute of Medical Sciences.

CORRESPONDING AUTHOR:

P. Subhas Babu

Mandya Institute of Medical Sciences,

Mandya.

E-mail:

HOW TO CITE THIS ARTICLE:

Raghunath Hanumantharaya, Subhas Babu Puttamaligaiah, Nagaraja Goud Bhoompuram. “A Cross- Sectional and Descriptive Study of the Regional and Population wise distribution of graduate Medical Colleges and Graduate Medical seats (MBBS) in India”. Journal of Evolution of Medical and Dental Sciences 2013; Vol2, Issue 23, June 10; Page: 4143-4151.

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.3Since 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

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 are the unequal distribution really unequal? If yes, how unequal is it?

OBJECTIVES:

To compare state wise distribution of the medical colleges and their ownership in terms of whether under the government and non government category.
To determine the state wise availability of graduate medical seats under the government and non government category.
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 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)

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* / State / Government
Medical colleges / Graduate seats / Non Government
Medical colleges / Graduate
Seats / Total / Total graduate medical seats
1 / Jammu and Kashmir / 2 / 200 / 2 / 150 / 4 / 350
2 / Himachal Pradesh / 2 / 200 / Nil / 0 / 2 / 200
3 / Punjab / 3 / 350 / 7 / 645 / 10 / 995
4 / Chandigarh* / 1 / 50 / Nil / 0 / 1 / 50
5 / Uttarakhand / 2 / 200 / 2 / 200 / 4 / 400
6 / Haryana / 2 / 300 / 4 / 400 / 6 / 700
7 / NCT of Delhi* / 5 / 730 / 1+1 / 200 / 7 / 930
8 / Rajasthan / 7 / 900 / 3 / 400 / 10 / 1300
9 / Uttar Pradesh / 12 / 1449 / 15 / 1800 / 27 / 3249
10 / Bihar / 7 / 540 / 4 / 360 / 11 / 900
11 / Sikkim / Nil / 0 / 1 / 100 / 1 / 100
14 / Manipur / 1 / 100 / 1 / 100 / 2 / 200
16 / Tripura / 1 / 100 / 1 / 100 / 2 / 200
18 / Assam / 5 / 626 / Nil / 0 / 5 / 626
19 / West Bengal / 13 / 1750 / 2 / 150 / 15 / 1900
20 / Jharkhand / 3 / 250 / Nil / 0 / 3 / 250
21 / Orissa / 3 / 450 / 4 / 300 / 7 / 750
22 / Chhattisgarh / 3 / 200 / Nil / 0 / 3 / 200
23 / Madhya Pradesh / 6 / 660 / 6 / 900 / 12 / 1560
24 / Gujarat / 9 / 1530 / 13 / 1400 / 22 / 2930
27 / Maharashtra / 19 / 2200 / 24 / 2995 / 43 / 5195
28 / Andhra Pradesh / 14 / 2050 / 26 / 3450 / 40 / 5500
29 / Karnataka / 11 / 1350 / 32 / 4655 / 43 / 6005
30 / Goa / 1 / 150 / Nil / 0 / 1 / 150
32 / Kerala / 5 / 900 / 18 / 1950 / 23 / 2850
33 / Tamilnadu / 19 / 2205 / 23 / 2850 / 42 / 5055
34 / Puducherry* / 2 / 225 / 7 / 900 / 9 / 1125
Total / 158 / 19665 / 197 / 24005 / 355 / 43670

*Numbers 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 is 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”.4Also 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)

Table 2. Comparison of the population of each State/ UT* of India, with that of the number of medical colleges (absolute numbers and proportions)

Census
Admn.
Code* / Name of the state/Union territory / Total Population
(2011 Census) / Proportion of Population / Total / Proportion of medical colleges
1 / Jammu and Kashmir / 1,25,48,926 / 1.037% / 4 / 1.127%
2 / Himachal Pradesh / 68,56,509 / 0.567% / 2 / 0.563%
3 / Punjab / 2,77,04,236 / 2.289% / 10 / 2.817%
4 / Chandigarh* / 10,54,686 / 0.087% / 1 / 0.282%
5 / Uttarakhand / 1,01,16,752 / 0.836% / 4 / 1.127%
6 / Haryana / 2,53,53,081 / 2.095% / 6 / 1.690%
7 / Delhi* / 1,67,53,235 / 1.384% / 7 / 1.972%
8 / Rajasthan / 6,86,21,012 / 5.670% / 10 / 2.817%
9 / Uttar Pradesh / 19,95,81,477 / 16.492% / 27 / 7.606%
10 / Bihar / 10,38,04,637 / 8.578% / 11 / 3.099%
11 / Sikkim / 6,07,688 / 0.050% / 1 / 0.282%
14 / Manipur / 27,21,756 / 0.225% / 2 / 0.563%
16 / Tripura / 36,71,032 / 0.303% / 2 / 0.563%
18 / Assam / 3,11,69,272 / 2.576% / 5 / 1.408%
19 / West Bengal / 9,13,47,736 / 7.548% / 15 / 4.225%
20 / Jharkhand / 3,29,66,238 / 2.724% / 3 / 0.845%
21 / Orissa / 4,19,47,358 / 3.466% / 7 / 1.972%
22 / Chhattisgarh / 2,55,40,196 / 2.110% / 3 / 0.845%
23 / Madhya Pradesh / 7,25,97,565 / 5.999% / 12 / 3.380%
24 / Gujarath / 6,03,83,628 / 4.990% / 22 / 6.197%
27 / Maharashtra / 11,23,72,972 / 9.286% / 43 / 12.113%
28 / Andhra Pradesh / 8,46,65,533 / 6.996% / 40 / 11.268%
29 / Karnataka / 6,11,30,704 / 5.051% / 43 / 12.113%
30 / Goa / 14,57,723 / 0.120% / 1 / 0.282%
32 / Kerala / 3,33,87,677 / 2.759% / 23 / 6.479%
33 / Tamilnadu / 7,21,38,958 / 5.961% / 42 / 11.831%
34 / Puducherry* / 12,44,464 / 0.103% / 9 / 2.535%
TOTAL / 1,21,01,93,422 / 100.000% / 355 / 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 non-government (n=168)

Table 3. Decade wise establishment of Medical Colleges

Sl. No / Decade / Number of new medical colleges established / Government
1831 – 1840 / 3 medical colleges / 3
1841 – 1850 / 1 medical college, government / 1
1851 – 1910 / No new medical colleges were established
1911 – 1920 / 3 medical colleges, all government / 3
1921 – 1930 / 4 medical colleges, all government / 4
1931 – 1940 / 1 medical college, Government / 1
1941 – 1950 / 15 medical colleges, 1 trust (non-government) / 14
1951 – 1960 / 34 medical colleges, 31 government / 31
1961 – 1970 / 40 medical colleges, 34 government / 34
1971 – 1980 / 11 medical colleges, 7 government / 7
1981 – 1990 / 32 medical colleges, 5 government / 5
1991 – 2000 / 44 medical colleges, 11 government / 11
2001 – 2010 / 137 medical colleges, 33 government / 33
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.

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 non-government 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 / Decadal
growth rate (%) / Cumulative
Total of
Medical Colleges
1901 / 23,83,96,327 / - / 4
1911 / 25,20,93,390 / 5.75 / 5
1921 / 25,13,21,213 / 0.31 / 7
1931 / 27,89,77,238 / 11 / 11
1941 / 31,86,60,580 / 14.22 / 12
1951 / 36,10,88,090 / 13.31 / 28
1961 / 43,92,34,771 / 21.64 / 66
1971 / 54,81,59,652 / 24.80 / 103
1981 / 68,33,29,097 / 24.66 / 113
1991 / 84,64,21,039 / 23.87 / 147
2001 / 1,02,87,37,436 / 21.54 / 200
2011 / 1,21,01,93,422 / 17.64 / 334*

*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.

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:

Government of India. Census 2011 – Provisional Population Tables and Annexures. progresstables.pdf (accessed 18 August 2012).
Foundation for Advancement of International Medical Education and Research. InternationalMedicalEducationDirectory. (accessed 5th August 2012)
Medical Council of India. List of colleges teaching MBBS. (accessed 1st August 2012)
Government of India. Health Survey and Development (Bhore) Committee Report Volume1. (accessed 24 March 2012)
Government of India. Report of the Health Survey and Planning Committee (The MudaliarCommittee)Volume1 (accessed 21 March 2012)
Government of India. Report of the National Commission on Macroeconomics and Health (accessed 12 July 2012)
Park K. Park’s Textbook of Preventive and Social Medicine. 22nd ed, Jabalpur: M/s Banarasidas Bhanot publishers 2012:pg 516
Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie FoundationfortheAdvancementofTeaching. (accessed 8 July 2011)
The Flexner Report and the Standardization of American Medical EducationAndrew 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

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