INDIA: Medical education gets international flavour

India's medical education is acquiring an international flavor, even before the country prepares to open the sector to foreign medical institutions wanting to set up to meet India's huge demand for doctors.

India's own medical institutions are not only tying up with foreign universities to enhance opportunities in medical education and research, they are also exploring opportunities to set up campuses abroad and increase their international presence.

With 330 medical colleges and an intake of 35,200 undergraduate medical students studying for the MBBS degree, India's medical education sector is one of the largest in the world. But with a dire need for more doctors, the sector is expected to expand dramatically.

Even with 730,000 doctors and 930,000 nursing personnel on the rolls, the country estimates that it needs another 800,000 doctors and, according to the health ministry, as many as 500 more medical schools in the next few years.

"Medical education and research in India is poised to grow. We need to build capacity, expand our knowledge base and create expertise," said Ranjit Roy Choudhury, a member of the Medical Council of India (MCI) governing body.

"Everyone will be interested in getting a slice of the pie. While we need global collaborations and partnerships, we also need to build a strong regulatory framework that will ensure quality, which has been our biggest challenge so far," Choudhury said.

The MCI, the apex regulatory body for medical education, is currently formulating the National Commission for Human Resources for Health Bill 2011, to allow the setting up of foreign medical universities in India. Earlier, it had distanced itself from the Foreign Educational Institutions Bill backed by the education ministry, which will allow in foreign universities for all but medical education and training.

"We want foreign medical colleges to come to India. The best international universities will raise the standards of our medical colleges and benefit medical students. But the norms have to be set by the MCI and not the education ministry. We are still working on the regulations," said Choudhury.

Medical research tie-ups

While it is not yet clear what the MCI-backed bill might include, some overseas institutions are not waiting for legislation that will allow them to set up medical schools, but are laying the foundation for further collaboration through tie-ups on medical research which does not come under the regulations being considered by parliament.

For many, the time is ripe for a move into India and they hope to build on less tightly regulated research collaboration. Others are offering sub-medical degrees and hospital administration qualifications.

For example, Delhi's Institute of Clinical Research India (ICRI) recently tied up with the Medical University of South Carolina in the US to offer a masters in global health administration.

"This is a step to strengthen the presence of ICRI globally and groom professionals in healthcare administration in India. The tie-up will provide an international framework for structured education and also bring global expertise to the country," said Shiv Raman Dugal, chairman of the ICRI board of directors.

"The Indian healthcare industry is seen to be growing at a rapid pace and is expected to become a US$280 billion industry by 2022. There is a need for a skilled team of hospital administrators," Dugal said.

Stanford Medical Centre is studying collaboration possibilities for medical training in an agreement signed in March with Jaslok Hospital and Research Centre in Mumbai, beginning with medical courses delivered by e-learning. The first courses are scheduled to start this month.

And earlier this year Duke University in the US finalised several agreements with Medanta, a conglomeration of multi-specialty medical institutes in India. The joint venture known as Medanta Duke Research Institute (MDRI) will be a world-class early phase clinical research facility located just outside Delhi.

"As we expand our ability to impact [on] heathcare around the world, India is critically important to us. The shift in demographic, the evolving human capital and the increasing investment by the government in healthcare and medical education makes India a natural partner," said Krishna Udayakumar, Director of Duke Medicine Global.

Increasing capacity

With a shortage of doctors, particularly in rural areas, the health ministry wants to increase the number undergraduate medical seats within the next two to three to 50,000 compared to 35,250 now, and postgraduate seats to 25,000 from 20,000 now.

Some in the ministry believe allowing in foreign medical institutions will enable a swift expansion of quality medical education. But there is also apprehension that better pay packages and incentives offered by foreign counterparts could wean away large numbers of medical teaching staff and doctors from Indian medical facilities.

There is already a major faculty shortage across medical colleges in India, estimated at 3,000 to 4,000 vacancies.

One way to bridge the gap has been to allow private hospitals to enter the medical education sector.

According to the Investment Commission of India under the ministry of finance, the healthcare sector has experienced phenomenal growth of 12% per annum since 2006. A report by Yes Bank and the Associated Chambers of Commerce and Industry of India, said the country's healthcare industry is projected to reach US$77 billion by 2012.

Addressing a recent seminar at the Symbiosis International University in Lavale, in western India, Minister of Health Ghulam Navi Azad said: "We are willing to promote private-public partnerships in areas where there is an urgent need for more medical institutions. More medical colleges will create more medical seats. This will churn out more medical personnel and enable us to offset the acute shortage of manpower."

India's largest corporate hospital chains - Apollo Hospitals, Fortis Healthcare and Max Healthcare - are exploring international collaborations. Max Heathcare, already involved in medical education through its DNB programmes (an equivalent of the MD), has said it is exploring tie-ups with established players overseas.

Apollo has set up Medvarsity, India's first medical e-learning venture, which offers paramedical courses in collaboration with organisations such as the Royal College of General Practitioners in the UK.

Opening campuses abroad

Although the MCI is still working on the regulations for foreign institutions to enter India, it has given its consent to private Indian medical colleges to open campuses abroad.

Melaka Manipal Medical College, jointly operated by Manipal Education, a private Indian provider, has received accreditation in Malaysia. Indian institutions are also setting up in Gulf countries and in Mauritius.

The Padmashree Dr DY Patil Medical College, established in Mauritius, began operating in 2009 and works closely with the college and hospital of the same name in Kolhapur in central India.

"There is a huge population of students who cannot come to India for medical education. By attracting foreign universities to open new campuses in Mauritius, the government plans to increase enrolment in tertiary education within the country as well as attract foreign students," said a spokesperson for the college.

However the MCI does not recognise any medical degree earned outside the country, even if it is awarded by an institution with headquarters in India, giving such degrees the same status as foreign medical degrees.

New regulations to formally allow private medical institutions to open campuses abroad and recognise their medical degrees at home are being planned by the health ministry in the wake of legal challenges by several medical institutions whose proposals to set up foreign campuses were rejected.

Institutes that offer courses other than medical degrees, such as engineering and management, are allowed to set up campuses abroad based on the rules and regulations of the education ministry.

While the regulatory environment for medical education is still evolving in India, it has become clear that the country is set to become a major player in international medical education.

Related links

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All articles in the Special Report: The Internationalisation of Medical Education

GLOBAL: Internationalisation and medical education
ASIA: World-class medicine pursuit drives collaboration
MIDDLE EAST: Medical cities seek foreign academics
INDIA: Medical education gets international flavour
CARIBBEAN: Medical schools battle to retain US access
SOUTH AFRICA: Cuba helps to train rural doctors
AUSTRALIA: Overseas doctors fill large gaps
FRANCE: Medical reform aims to fight 'human wastage'