India should stop building airports until it has one medical college per district

From Deesa in Gujarat to Balurghatin in West Bengal, there are airports in India with no flights. Not a single passenger flight has used around 27 such ghost airports. While we bleed money on maintaining these pointless airports, many more are being built.

Many airports in tier-2 cities see very few flights: Jaisalmer, Shimla, Chandigarh and Shillong being such examples.

It’s not just these airports that look forlorn, awaiting travellers, like a man waiting to be loved. Even before the economy was brought to a near halt by COVID-19, you could travel from Delhi to Lucknow in 7 hours on the wondrous Agra Expressway and wonder where the cars and trucks are.

India’s mad rush to build infrastructure has an eye on the long-term. These are the assets that will propel economic growth over the next few decades. In the long run, said Maynard Keynes, we are all dead.

India’s economic growth strategy

Infrastructure has been the centrepiece of India’s economic growth strategy for at least 25 years. India’s economic growth has now been declining quarter after quarter since 2016, for multiple reasons ranging from demonetisation to COVID-19. As we rethink the path ahead, it may be time to slow down the mad infra rush.

Amartya Sen has been saying for years that India is the only country that has been trying to become a superpower without investing heavily in education and health. The economic rise of countries like China, Bangladesh and Turkey has not happened without investing in education and health.

While India has more airports than it needs, we don’t have trained staff to operate the ventilators that reached hospitals across India in the wake of COVID-19. China’s doctor to population ratio is 3 times that of India’s. We don’t have enough nurses, compounders, and pharmacists to meet the needs of 1.3 billion people.

The aggregate data doesn’t look that bad because India’s metropolises are rather well-served with a hospital in virtually every neighbourhood. Take out the big cities and you see vast districts with very poor health coverage.

Shortage of doctors and nurses

Why do we have a shortage of doctors and nurses? Is it because nobody wants to be a doctor? Is it because they all go abroad? Doctors are made in medical colleges. India has 542 medical colleges spread over 718 districts. In other words, we don’t even have one medical college per district.

The government’s apathy over this is such that we might one day have one airport per district before we could have one medical college per district.

India needs to replace its mad infra rush with a mad rush to start medical and nursing colleges. India has anyway missed the mass manufacturing bus. It is time to invest better in human resources: it won’t take much time or money to build 150 new medical colleges. It needs political intent to put the money on the table.

The rules for a private investor to start a medical college in India are so complex that someone who runs a hospital told me, they’re designed for corruption. The need for corruption may also partly be behind the rush to make airports and highways we don’t as yet need: the kickbacks are easy.

Improving public health infrastructure

Ayushmann Bharat, a flagship insurance scheme, gives free insurance to 50 crore Indians. It gives these people the financial power to seek hospital treatment, thus creating a demand for private health care entrepreneurs to fill in.

But Ayushmann Bharat won’t create doctors unless we scale up the medical college seats. The government has to step up and improve public health infrastructure in rural India without waiting for Ayushmann Bharat to do it.

Last year, the central government in its post-COVID budget claimed it was more the doubling the health spend. This was an eyewash achieved by including the expenditure on drinking water, sanitation, nutrition and COVID vaccines. In reality there was very little increase in health spends.

According to the Economic Survey 2020-21, India spends 4.5% of its budget (states and centre combined) on health. Another 10.8% is spent on education. Given the gaps that need to be filled, we need to increase these spends with the same gusto as we have been spending on infrastructure.

Politicians privately complain that voters don’t reward them for education and health. But that’s changing. Now that much of India has rural roads, electricity and cheap rations taken care of, they want better health and education.

In Bihar last year, I met young voters who said they didn’t want the government to worry about jobs. “Just give us good education and we’ll get a job,” said one.

As the data above suggests, spends on education are better than the measly money health gets. The problem with education is one of quality. And skills. These are problems far more difficult than giving out a contract to build a highway. We want our politicians to solve the difficult problems now.