The move to grant autonomy to JIPMER raises fears that the poor will no longer benefit from the Institute's services.
S. VISWANATHAN in PuducherryTHE Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), the pride of Puducherry, is at the centre of a controversy following an announcement on September 7 that the Union Cabinet had approved a proposal to alter the status and administrative set-up of the Institute, the oldest, and possibly one of the best, of its kind in the country. The proposal, which intends to convert JIPMER into "an autonomous institution through an Act of Parliament" with a view to bringing it "on a par with similarly placed institutions" such as the All India Institute of Medical Sciences (AIIMS) in New Delhi and the Post-Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh, drew immediate responses. The employees protested against the move at an urgent meeting and announced their decision to go on an indefinite strike. The next day, nearly 2,000 of the 2,500 employees launched an agitation. While the nurses participated in full strength, the doctors kept off the strike.
"The employees' protest was spontaneous," observed JIPMER Staff Struggle Committee (JSSC) general secretary R. Arochiam Kalaimathi. The convener of the JIPMER Anti-Conversion People's Committee (JACPC), representing a number of political parties and public organisations in the Union Territory, T. Murugan, also announced a series of agitations, which would culminate in a dawn-to-dusk bandh on September 26.
Both Kalaimathi and Murugan assailed the government for attempting to rush through the proposal, without caring to consult the employees or members of the public, for whom it would have far-reaching implications. On September 20, the 13th day of the strike, the police arrested the striking employees, including Kalaimathi and Murugan.
Critics of the move say it would not only rob JIPMER employees of their present status as Central government staff, but also deprive large sections of people of the free and efficient health care provided by the JIPMER hospital. (This is in contrast to the practice in the AIIMS and the PGIMER, which charge services by issuing Outpatient Ward entry tokens.) Besides the people of the Union Territory, the beneficiaries include poor patients who come to the hospital from Villupuram, Thiruvannamalai, Kanchipuram and Cuddalore districts in Tamil Nadu. Super speciality departments in the hospital attract patients even from Karnataka and Kerala.
Critics of the proposal also say that autonomous status would lead to political intervention in the day-to-day administration of the Institute. They fear that JIPMER, which now provides quality medical education at affordable charges, may have to go in for steep fee hikes once it is forced to fend for itself. "Our boys and girls now get quality medical education paying a total fee of less than Rs.20,000 for the entire five-year course. Puducherry candidates also have a quota in the all-India merit-based selection by JIPMER," said Murugan, who is also a member of the Tamil Nadu State Committee of the Communist Party of India (Marxist). Some fear that even the quota for Puducherry may suffer. The Bharatiya Janata Party, the Viduthalai Chiruthaigal Katchi and the Revolutionary Socialist Party are among the parties supporting the agitation.
The move has been in the air for about eight years now. Interestingly, two Union Health Ministers, both from the Paattali Makkal Katchi (PMK), Dalit Ezhilmalai (1998-99) and N.T. Shanmugam (1999-2000), in the two coalition governments headed by Atal Bihari Vajpayee, had shown an interest in the proposal. But it did not reach any definite stage during their terms in office. (Incidentally, Villupuram district, which is under the sphere of influence of PMK founder-president S. Ramadoss, is close to the border of the Union Territory.)
Health Minister Anbumani Ramadoss also of the PMK, took up the initiative once again in March 2005 and has now succeeded in getting Cabinet approval for the plan. When Anbumani sought the support of political parties at an all-party meeting he convened at the Puducherry Secretariat, the Congress, the ruling party in the Union Territory, and the Dravida Munnetra Kazagham, the principal Opposition party, and the two Left parties reportedly opposed the move. The Minister announced that he would continue his efforts towards a consensus. During the 2006 Assembly elections, Chief Minister N. Rangasamy insisted that no decision should be taken without consulting the people of Puducherry. He has not come out with any statement on the latest initiative.
The origin of JIPMER can be traced to 1823, when the French rulers of Pondicherry (Puducherry) established a medical school named "Ecole de Medicine". In November 1956, the Government of India took over the school following the de facto transfer of Pondicherry. In July 1964, the college was upgraded as a regional centre and named Jawaharlal Institute of Postgraduate Medical Education and Research. JIPMER includes a tertiary care referral hospital with a bed strength of 1,200. On an average, 4,000 patients call at the Outpatient Ward every day.
The September 7 press release on the Cabinet meeting simply said that the Union government would "soon" bring a Bill in Parliament and did not give any indication of the new administrative structure of the institution. Explaining the need for a change, it said that JIPMER, which is at present "an attached and subordinate office of the Director-General of Health Services [DGHS]", lacked, "in view of its status", financial power under the rules of the government. "The rules also do not provide for further delegation of powers. Therefore, for every major work - be it a construction/expansion of hospital buildings or residential quarters, renovation of wards, creation and filling up of Group "A" and "B" posts, the prior sanction and approval of the DGHS is required," the press release said.
It asserted that autonomy would enable JIPMER to create an environment conducive to high standards of medical education. It would allow JIPMER to formulate its own policy for recruitment. "JIPMER will thereafter be able to create its own standards of medical education and research as is being done by AIIMS and PGIMER," the release said, adding: "An Act of Parliament will enable JIPMER to get the status of a University and not a deemed University. It will give more freedom and benefits to the institution in terms of better fund mobilisation and organisational development initiatives."
The thrust of the proposal, therefore, is that the status of JIPMER will be elevated "on a par with the AIIMS and PGIMER" so that it is able to mobilise funds better after it is freed from government control. An academic said that the government seems to have proceeded on certain assumptions, such as that JIPMER's functioning needs to be toned up; that the institution must mobilise its own funds; and that the AIIMS, with its autonomous status, can serve as the role model. "That JIPMER needs elevation is indisputable, but the other assumptions are flawed," he said.
The irony is that AIIMS is being projected as the role model for JIPMER at a time when the Delhi-based institute's reputation has reached its nadir. The havoc wrought by political interference in its functioning in the past three years is there for all to see. The strained relations between Ramadoss and AIIMS Director P. Venugopal (whose summary removal from service was stayed by the Delhi High Court) have only brought centre-stage the erosion of the AIIMS' autonomy over the years.
There have been several instances to show that autonomy is only a tool used by the political establishment and the bureaucracy to protect and promote their own interests (Frontline, July 28). About 25 eminent Professors have reportedly left the AIIMS during the last three years. "Going by precedents," said a strike leader, "our fears that the Centre's move would only lead to frequent political interferences and reduce JIPMER to a centre of political power play are not ill-founded." "It is to be noted," said an academic, "that at no point of time had the faculty or, for that matter, anybody interested in the development of JIPMER, demanded autonomy for the institution." Even within the existing arrangement, the government could provide funds to improve its infrastructure and fill the 600-odd vacancies, he said.
Viduthalai Chiruthaigal Katchi member of the Tamil Nadu Assembly, D. Ravikumar, said any harm done to JIPMER would harm the poor and marginalised people in Tamil Nadu. He appealed to Tamil Nadu Chief Minister M. Karunanidhi to protect JIPMER.
