AIIMS Madurai: Elusive medical institution mired in delays and disappointment

The much-awaited hospital has already enrolled three batches of students, but they struggle in temporary facilities as construction crawls.

In 2019, Prime Minister Narendra Modi laid the foundation stone at the construction site in Thoppur. | Photo Credit: Samson Ronald K.

“We have no hopes of seeing our college campus before we graduate,” said Srinivas, a third-year MBBS student from the All India Institute of Medical Sciences (AIIMS) college, Madurai. Standing in one of the classrooms on the fifth floor of Government Ramanathapuram Medical College (GRMC), where three MBBS batches are currently accommodated, he told Frontline that he and his classmates were “disappointed” about not receiving the “AIIMS college experience” they were expecting.

By experience, he meant the state-of-the-art infrastructure, high-standard medical education, etc. that AIIMS institutions are widely known for. Nearly 150-strong, the first three batches enrolled at AIIMS College, Madurai, have been at GRMC’s campus since 2022, a temporary measure until the construction of the college and hospital in Thoppur town (roughly 15 km from Madurai) is completed. The Tamil Nadu government facilitated this arrangement.

In February 2015, the then Finance Minister Arun Jaitley announced in the Union Budget that an AIIMS college and hospital would be established in Tamil Nadu. Nearly four years later, on January 27, 2019, Prime Minister Narendra Modi laid the foundation stone at the construction site in Thoppur. Following this, 222 acres of allotted land were transferred to the Central government by the State in February 2020, according to a report in The Hindu. Since then, work has progressed at snail’s pace.

Responding to criticism, the Central government cited the COVID-19 pandemic as well as other procedural delays as reasons for the sluggish progress. In March this year, Dr. M Hanumantha Rao, Executive Director of AIIMS Madurai, issued an official release stating that Larsen & Toubro (L&T), a leading global construction company, had been awarded the Letter of Acceptance by the Ministry of Health and Family Welfare (MoHFW) for the construction of the project. Once construction began, the project would be completed in 33 months, the release said.

 Dr. M Hanumantha Rao, Executive Director of AIIMS, Madurai. | Photo Credit: Samson Ronald K.

According to the L&T website, the project envisages a 720-bed hospital, a 150-bed infectious diseases block, a 30-bed block, a 150-seat medical college, a nursing college, a 750-seat auditorium, a hostel, and residential facilities— a total built-up area of 2.1 million square feet. When Frontline visited the construction site, roughly 450 labourers were working on the 13 buildings under construction. The wide expanse of land was overrun with excavators, bulldozers, loaders, compactors, and trenchers. “We have workers in day and night shifts,” A. Sivaraj, one of the planning managers, told Frontline. “This is where the college building will come up,” he said, pointing to a patch of excavated land where the foundation’s shuttering was taking place.

Victims of strained relations

Parties ranged against the BJP in Tamil Nadu never miss a chance to criticise the Union government for the inordinate delay in the completion of the college and hospital. During the election campaign for the 2021 Assembly election, Udhayanidhi Stalin, the son of Chief Minister M.K. Stalin and now the Minister for Youth Welfare and Sports Development, held a single brick in the air and quipped that it was all that the Centre and the then AIADMK-led State government could show for AIIMS.

The AIIMS project, driven primarily by the Union government, suffered due to “imbalance of power” R. Mani, a former journalist and now a political analyst, tells Frontline. “When the project was announced in 2015, J. Jayalalithaa-led AIADMK government was in the saddle. Her demise in December of the following year resulted in the AIADMK losing bargaining power with the Centre. This impacted many projects, AIIMS included.” The students—nearly 150 future doctors—are victims of “political animosity” between the Centre and State, he adds.

AIIMS is a group of autonomous government public medical universities of higher education under the jurisdiction of the Ministry of Health and Family Welfare. In 1956, the All India Institute of Medical Sciences Act was passed in Parliament to “provide for the establishment” of the first branch in New Delhi, and subsequently more branches in different States.

As per the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), a scheme launched in 2003 by the then Union Health Ministry, every State should have one AIIMS institution. There is a few major medical institutions in the southern districts of Tamil Nadu, Rao told Frontline, “These are only available in Chennai.”

Roping in JICA

While the Centre has funded all the other AIIMS institutes, it announced in April 2021 that it had signed a loan agreement with the Japanese government for the Japan International Cooperation Agency (JICA), Japan’s sole governmental agency responsible for implementing official development assistance and the world’s largest bilateral donor agency, to fund the Madurai project.

Students in AIIMS, Madurai, find it difficult to do practical assignments because of poor infrastructure. | Photo Credit: Samson Ronald K.

In December 2020, Mansukh Mandaviya, Union Minister of Health, said in Lok Sabha that the loan agreement was signed on March 26 after the preparation of the inception report, campus master plan, facility planning, hospital design concept, and equipment planning. The Union Minister also announced that the project’s total estimated cost was ₹1,978 crore, of which ₹1,621 crore would be covered by JICA loans and the remaining would come from Central budgetary support. Notably, the Union Budget 2024-25 did not mention the AIIMS project in Madurai.

Rao said that the funding had been shifted to JICA since the agency has already funded several ongoing projects in the State such as the Chennai Peripheral Ring Road Project, the Chennai Metro Rail Project, and the Tamil Nadu Urban Health Care Project, etc. But Dr. Ravindranath, member of the Doctors Association for Social Equality, took a different view, attributing the decision to Centre-State relations. He noted the Centre’s “partiality to BJP-ruled States”. “I don’t believe the amount is a very big one for the Union government. Over the past few years, they have opened five to six medical colleges across India,” he said. 

The construction would take place in two phases, said Thamizhvanan. K, Deputy General Manager, speaking from one of L&T’s temporary offices on the construction site. Phase one began on May 21 and is slated to be completed in 18 months. According to him, the college, hostels (girls and boys), nursing college, lecture hall, In-patient department (IPD), Out-patient department (OPD), emergency block, and other essential services will be completed in this phase.

Rao told Frontline that the plan was to shift the students to the campus by November 2025. Phase 2 would begin thereafter and continue for 15 months. “We have plans to send the clinical batches to Government Rajaji Hospital, Madurai and Government Tuberculosis Hospital, Thoppur to undertake clinical training twice a month,” said Rao. They now go to Government Hospital, Ramanathapuram, for clinical training.

Despite being under construction, AIIMS opened admissions for MBBS students over two years ago. With roughly 50 students per batch, three batches have been admitted so far, with students from across India. Students complained of poor facilities and infrastructure in their temporary campus and hostel when they first arrived, such as power shortages, mosquitoes, and no Wifi. Most of these were set right after the students protested. The first batch did not receive proper medical equipment until the end of their first year. In April 2024, The Hindu reported that students complained of difficulties in doing practical assignments because of poor infrastructure.

Students of AIIMS, Madurai, sitting in a classroom at Government Ramanathapuram Medical College (GRMC). | Photo Credit: Samson Ronald K.

A former dean of a prominent Madurai-based government medical college told Frontline that GRMC is not equipped to accommodate nearly 150 additional students. Terming the arrangement a vertical bifurcation, he explained, “The cadavers they use for anatomy dissection are given to them after GRMC students have finished using them. This hinders the teaching and learning process.” Dr. Ravindranath told Frontline that these initial batches are bound to receive sub-standard medical training. “The Centre took a wrong call on this,” he said. According to the students, the teachers and the management were doing their best under the given circumstances, but the problem areas were clinical training, where their timings clash with the GRMC students, and the shared equipment and material.

When AIIMS was first established in 1956, the objective was to establish a major central institute for postgraduate medical education and research. Nearly 70 years later, the present government is on a mission to set up AIIMS in every State, but the once sought-after institution has since fallen from grace, with the institutions outside New Delhi facing serious shortcomings, analysts told Frontline.

Mani said that he did not foresee AIIMS Madurai being a major contributor to the medical education system in Tamil Nadu. “We already have excellent medical colleges such as Madras Medical College, Stanley Medical College, etc. that have existed for decades.”

Sumanth Raman, a Chennai-based general physician and political analyst, told Frontline that accommodating a budding hospital in temporary facilities is a common practice but it “usually lasted only for one year”. He added that all AIIMS branches outside New Delhi face several problems. “Moreover,” he said, “the quality of the faculty is not dramatically better than those of other colleges in Madurai.” Ravindranath too questioned the need for an AIIMS in the State, pointing out that the existing government hospitals were more than equipped to meet the State’s needs.

According to data shared in February by the Minister of State for Health and Family Welfare, Tamil Nadu has 74 private and government medical colleges, the highest in the country. According to the TNHealth & Family Welfare Department, the State has established a dense network of 8,706 sub-health centres, 1,421 primary health centres, 235 sub-district hospitals, 29 district hospitals, 15 medical college hospitals, and various other facilities under the Directorate of Medical Education and Directorate of Medical Services. Further, Tamil Nadu has the second-highest number of doctors in the country, with 1,49,399 registered with the Tamil Nadu Medical Council, according to data from the National Medical Commission. The doctor-population ratio is 1:253, which exceeds the World Health Organization recommended norm of 1:1000.

There are at present 25 AIIMS institutions in India; 20 functional and five under development. While a completion date has been set for AIIMS Madurai, the present batch of third-year students is likely to spend its entire course time at the GRMC campus. Srinivas, the third-year student, told Frontline that he and his classmates faced the worst obstacles as they were the very first batch. “We were prepared to face challenges, but the reality has been far worse. We hope things will get better.”