Medical Education in India: A Synopsis

This is a compilation of the most up to date data on Medical education in India:

1. Medical Education(Doctors) Summary:This document contains the number of seats available in each Indian State in all systems of medicine: Allopathy (MBBS and BDS) and AYUSH(Ayurveda, Unani, Siddha and Homepathy).

2.Pharmacy Education Summary: This document contains the number of seats available per State in colleges that award Degrees and Diploma in Pharmacy as also those that only conduct the courses that lead to a Degree or Diploma.

3. Nursing Education Summary: This document contains the number of seats in BSc Nursing and Post Basic Nursing programs per State.

4. Medical Education Summary: This document contains the summary of the above data along with references.

The data has been collected from respective governing bodies homepages and appropriate references are provided. Related and similar data is available on Ministry of Health and Family Welfare but that is not complete from the point of view of available educational opportunities in Medical Sector. The references in document point to complete List of respective colleges along-with their contacts and addresses.

Some Observations:

1. There is huge inequality in availability of opportunities for Students across States as exhibited by following graphs:

The first image shows the number of Seats in Medical Stream per thousand students in Standard 1 presently. This captures, the inequality with respect to overall population of a State irrespective of the learning environment and outcomes that make a Student eligible to lay claim to these opportunities.

The second image shows the number of Seats available per thousand Students passing out of 12th Class. This can be a reflection on better opportunities available in some states as also poor Graduation Candidate Ratio in other states. In Karnataka both are extreme and hence disproportionately higher number of opportunities available for Karnataka Students. If we contrast the two images, we get an idea that increasing retention at the Secondary level puts pressure on the availability of higher education opportunities even in Backward States like Madhya Pradesh, Odisha and Rajasthan.

These extreme inequalities also indicate that their is no such concept called India as far as Medical Education is concerned with some big states like Assam, Bihar, Jharkhand, Uttar Pradesh and West Bengal along-with North Eastern States barely visible on the first graph. Just 4 States: Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu constituting just about 20% of India's population account for about 1.3 lakh out of about 2.4 lakh Seats across India.

2. The educational opportunities in Medical sector (predictably) has a high correlation with health infrastructure as well. In absence of adequate data on number of beds or doctors or Clinical establishment per State, we can probably use Blood banks as a proxy. The 5 States of Andhra, Kerala, Karnataka, Maharashtra and Tamil Nadu have 1085 out of total 2347 Blood banks in the country. If we look at Eye Banks, these 5 States again come up trumps with 306 of the 586 Eye Banks in the country present in these States.

3. Looking at Mental health, the top states again dominate with 1364 out of 2294 psychiatrists. Contrast this with just 12 in Madhya Pradesh, 15 in Chattisgarh, 19 in Odisha and 28 in Bihar. True, in most states,including top 5, number of psychiatrists available is less than half required in case of most of the rest it is not even 10%. The number of Psychiatrists, Clinical Psychologists and Psychiatric Social workers that we need are 10261, 14057 and 20194 respectively while the availability is 2294, 355 and 294 respectively.

4. Though it is Kerala which is famous for its Kerala Ayurveda, number of Seats in Ayurveda for Kerala is just 896 which is less than a third of those in neighboring Karnataka and less than a fourth of those in Maharashtra.However Kerala if famous for good reason, notwithstanding number of students admitted, Kerala leads with 124 Ayurvedic Hospitals and 740 dispensaries in contrast to Karnataka's 130+561 and Maharashtra's 55+469 Hospitals+Dispensaries.

5. Bihar accompanies Madhya Pradesh as the only States where number of Seats in Homeopathy is more than those in MBBS. The former is 830 and 1755 respectively while latter number is 660 for Bihar and 1070 for MP. It is Maharashtra though which has the highest number of Homeopathy colleges(49) admitting 3596 students which is close to its 41 MBBS colleges admitting 4570 students.

6.Just 3 States: Andhra, Karnataka and Maharashtra account for half of the Diploma/Degree Seats in Pharmacy i.e. 38680 out of 77195.

7. Karnataka churns out 1/4th of all Indian nurses with 18958 seats out of all India 74356. In contrast, the 19 States from bottom have less than half that number of total Seats.

8.Uttar Pradesh tops the number of Seats in the Unani System of medicine with 220 out of 620 Seats across India.

School Education in India:An Integrated picture

Despite the well recognized challenge and payoffs of Human Development and education attainment, it is hard to find a single report or data source that gives an overall picture of educational attainment for India. If at all, the data is available with a time lag of 3 years by which time Indian economy might grow 30% rendering it obsolete. This blog had earlier looked at state level data about Engineering education. Continuing further, this article and the associated document describes the overall Statewise education scenario for India from enrollments in Class 1 upto statistics about number of students passing out of Class 12th. The data source is primarily DISE and the newspaper reports about the results of different State and Central Examination boards. The document also contain the enrollment and qualification data by gender by using the

Gender based Exam results publications. The latest available enrollment data for upper primary is for Year 2007-08 and hence compatible and comparable with the Matriculation results of current year 2009-10. But the data for Intermediate classes cannot be strictly compared to that for matriculation due to 2 year lag and hence can only be indicative of broad picture.

Here are some interesting observations:

1. Karnataka, home state of the knowledge capital of India, Bangalore has a GCR(Graduation Candidature ratio) of 17.83 just marginally less worse than the most backward state Madhya Pradesh in this regard which has a GCR of 17.96. This means only 1 out of 10 students in his age group attains the eligibility to apply for admission to a college. Delhi is the best state on this count with a GCR of 64.4 with Tamil Nadu a distant 2nd at 55.79 and Himachal 3rd with GCR of 48.26
2. Gujarat,an otherwise economically advanced state has a shockingly low GER of 54% at upper primary level resulting in a poor GCR of 23.30%. Only States that have a worst Upper primary GER than Gujarat are UP and Bihar. In terms of GCR, Gujarat is 6th worst among all States.
3. At all India level there were 1.64 Crore students in upper primary and surprisingly 1.66Crore students in Matric level.This partly indicates inaccuracy in DISE numbers and partly a high number of repeaters and overaged students.Noteable high ratio of Upper Primary to matric are UP-1.61 and Jharkhand-1.24. This means that for every 10 matric students, there were 6 students in 8th Class in UP and 8 students in Jharkhand. Given that both of these states have passing rate of about 70%, even if we accept all 30% who failed are repeating where are the extra 30% in UP coming from?Certainly,UP did not experience any population boom induced by some astrologically auspicious phenomenon or any immigration shock.
4. There were total 96.6 lakh students in 12th Class out of which 77.5 lakhs passed.Since there are about 8.6 Lakh engineering seats,every 9th Graduation candidate can opt for engineering.
5. The overall pass percentage hides the poor pass percentage in constiuent disciplines in some States. For example, in case of Jharkhand, Science pass percentage was is 30.33 though overall pass percentage is 50.39.
6. The matriculation pass percentage of Jharkhand has dropped from 87% in 2008 to 74.3% in 2010. Jharkhand is probably the only state to witness so much deterioration in Education attainment while most of the States have improved theirs. Chief Minister Shibu Soren was perhaps the only Chief Minister to personally release the result.
7. Similar to Gujarat, West Bengal has a low ratio of students reaching potential graduation stage at 22.51 inconsistent with its image of an intellectuals' state.
8. The national capital seems to have the best educational infrastructure what with 64.44% students attaining graduation candidature but this is tempered by the fact that there is only 1 engineering seat per 30 students passing out of 12th class as against the national average of 1:9
9. Kerala is at the top in terms of gender parity with 72% of 12th students being girls whereas the ratio is almost inverted for the state on the other end of spectrum Rajasthan with 35% of students being girls.
10. In Punjab,a state with a very low sex ratio, 56% of the students in 10th class are girls whereas the last state on this count is Gujrat with only 37% girl students in 10th class.
11. Leadership of Tamilnadu in education is exhibited by 115% GER in upper primary, 80% of them transitioning to matric, pass percentage of both 10th and 12th standard being in 80s and 2nd highest number of Engineering seats among all States.
12. Some of the north eastern states like Tripura and Manipur have a greater number of graduation candidates than better known Goa.
13. The number of children in 8th standard is only about half of the number in 1st standard despite an upper primary GER of 75% for All India.
14. In case of Jharkhand there are 5 students in 1st standard for every student in Class 8th and Jharkhand only has a GER of 57 for upper primary.
15. A happy thing to note is that there are at least 9 states where number of students in 1st standard is lesser than those currently in 8th and there are 3 others where this gap is less than 10%. Hence,the next generation in these States is likely to get better educational facilities. BIMARU states are still not out of the woods and need to invest more in primary education going forward given the high ratio of number of students currently entering the School system to those in upper primary.

Total Engineering Seats in India & some conjectures about IT

This document contains the total number of engineering seats in each of the major states of India. Some of the southern states have a huge number of seats relative to the demand and hence some seats are going vacant. This 'some' is about 50000 seats in case of Tamil Nadu. Recently, this has been observed in Northern States like Haryana as well. An interesting thing to note here is that the number of Engineering seats in the city of Pune is greater than the combined total of 7 States. Overall, there are 7.3 lakh engineering seats in India.

These numbers partly explain why IT companies are setting up shop in Bhubneshwar, Jaipur, Indore,Ahmedabad and Lucknow but not in Patna, Jamshedpur, Ranchi, Shimla, Guwahati and Panaji.Neither are they likely to do so despite the fact that some of these states do send students to other states in large numbers and despite the fact that quality of life in some of the latter group of cities is comparable to the former and might be better in some. When the new private engineering colleges come up, their students are below employable standards for some years. These students are employed for low wages by small IT companies mostly focused on domestic IT market. Here, they polish their skills or learn the new ones in 2 to 3 years and move into bigger and more professionally managed companies. Due to this continuous poaching, the smaller companies would vanish if there was no availability of large number of fresh Engineers willing to work for them. Gradually, quality of newly setup Engineering colleges and hence the quality of students improves thus boosting the supply of good local talent. Also ,some of the small IT companies may grow bigger and better and start attracting talented people who left their home state/region to join bigger companies. Due to this competition for talent, apart from a desire to lower operational costs, the big companies might set up shop in the small city thus improving the Eco-system further. This is not possible in States who only have a couple of thousand Engineering seats.

The economics of an autorickshaw in Delhi

Happened to talk to an auto rickshawallah in Delhi recently. Some interesting insights though not verified. Since they are coming directly from the horse's mouth,should be generally true:
1.There are 90k auto rickshaw permits in Delhi and new ones are not being issued.
2.One auto rickshaw driver who owns the auto-rickshaw,earns on an average Rs25k per month.
3. Some auto rickshaw drivers rent out theirs for night shift @250 per night + 50%of cost of maintenance.
4.An auto rickshaw from outside Delhi is fined Rs 5k as soon as he enters Delhi. Vice versa is not true.
5. The permit can be sold for upwards of Rs 3lakhs which together with the cost of vehicle at about Rs 1.25 lakh results in on road price of about Rs 4.25 lakhs.
6. The permit regime for Cars is liberal making it practically cheaper to have a Car on road than rickshaw.
7. The per km fare of rickshaw is Rs 4.5 and the auto rickshaw unions will shortly stage a strike to demand an increase. An average Car gives a mileage of 12km per liter and a liter of Petrol costs about Rs 50. So running cost per km are about Rs 4. But Car can accommodate 4-5 people, hence at maximum utilisation auto rickshaw is about 50% more expensive.
8. Due to the latest fare policy, per which public transport costs Rs 1-2 per Km, some people are reverting to use of auto rickshaws when travelling in groups. These people might eventually shift to personal vehicles. The expanded network of Delhi Metro may reverse some of that but cannot decisively arrest this trend.

Blessed thus by Delhi government, Cabs services in Delhi are going to grow a lot. After all ,Delhi has to become a 'global' city. Tata Nano, the new Rs 1 lakh car can only make the matters more interesting. Tatas were once asked to take over Delhi transport corporation. This might as well be the route they agreed to.

RBI gives 'Freedom' to open Branches

RBI recently gave Freedom to Banks to open branches in Centers with population less than 50,000 as per the report of a group constituted by it. This blog had earlier tried to analyse RBI's branch 'expansion' policy.

• The Branch 'Expansion' policy was originally a branch restriction policy to regulate indiscriminate growth of branches witnessed during 2nd World War.The relevant Act was named Banking Companies (Restriction of Branches) Act, 1946. The policy has been successful in restricting the number of branches in urban areas and thus preventing financial deepening,ensuring lack of competition and fat NIMs(Net Interest Margins) that are one of the highest in the world.

• RBI has become progressively aggressive in restricting the branch expansions in urban areas.One would presume,prior to 1946 there was no restriction on opening branches. In 1962, Banks were allowed to open 2 branches in an area of their choice for every branch opened in an nonviable/unprofitable area. This ratio became 1:1 in 1968. In 1970 this ratio was made 1:2 for Banks with 60% branches in rural or semi urban areas and 1:3 for rest. In 1977 this was changed to 1:4 plus 1 branch in a metro.

• In 1990, RBI considered the then prevailing 60000 branches to be adequate to meet Banking requirements. 1 Branch per 15-20 villages or average population per Branch(APPB) of 17000 was also considered adequate then. In 1990 RBI decided to leave it to the judgement of the individual banks to assess the need for additional branches taking into account factors such as business potential and financial viability.

• Despite this decision and 'achievements',for some strange reasons(inertia might be one) policy remained unchanged till 2005 when RBI bettered 1962 with a ratio of 3:1 by mandating 25% of the new branches to be in rural areas.

• Importantly,agriculture's share in GDP declined from 58% in 1950 to 38% in 1980 and about 18% currently.So as RBI became more and more adamant on rural branches,their relative attractiveness kept on declining.

• Apart from the existing category of underbanked districts,the group has created a new category of financially excluded districts numbering 256. A financially excluded district is one in which average population per branch is 19272 and has a credit gap of more than 95%. One may wonder what is special about 19272.This is our national APPB.There are two implications,1)since about half of the districts will always be below average,the policy can continue in perpetuity. 2)Despite the success of Branch 'expansion' policy, our APPB has actually declined from the time RBI declared success in 1990.

• The financially excluded include state capitals and industrial cities such as these: Ahmedabad, Patna, Jaipur, Raipur, Hisar, Panipat, Ranchi, Kolhapur, Allahbad, Gautam Buddha Nagar ,Lucknow, Meerut.This list might make some bankers happy but a clause governing underbanked districts is likely to apply to financially excluded districts as well.The clause states that centers falling within municipal limits of State Capital, a Metropolitan Centre or a District Headquarters or 100kms from 4 metro cities will be excluded from the relaxation.

• A category of underbanked states has been created which is also defined as those with APPB below national average. Since some states will always be below average, this list too shall also exist in perpetuity and consists of undivided Bimaru states(except Uttaranchal)+NE+Orissa and West Bengal.

• The group states that most of the emerging economies require licensing for Bank branches but does not spell out how liberal these countries are in allowing new branches and what are the criterion used. The group also notes that none of the developed countries require licensing for new branches.Should we follow emerging economies or developed?

• The recommendations do not apply to Foreign banks.

Besides some obvious benefits of scrapping the policy, the group does offer some rationale for continuing with the policy:

• The present Policy allows RBI to exercise its judgement or (opaque discretion).
• The present Policy allows RBI to meet with CEOs of the banks and discuss with them critical regulatory matters.In absence of the policy, the CEOs might not want to meet RBI.Brilliant.
• There can be systemic implications of having too many branches as exhibited by current crisis and the policy is a good substitute for enforcing prudential norms though other means. what are the systemic implications implied?How does the current crisis exhibit that?Did the current crisis come about because there are just too many bank branches in cities like New York and London?

Some counter-factual questions: Could we have had our own Rabo bank if our regulators did not have such good intentions?
Could we have had 100% financial inclusion in urban areas similar to 100% teledensity that we achieved recently in Metros if RBI did not insist of Branch expansion as per its directions?
Will more competition in urban areas force banks to mediate larger number of financial instruments like Mutual Funds,Insurance and Pension?

Economic return of investing in Excellence in Education

ISB Hyderabad's first class started on July 1, 2001 and it was established at a budget of Rs 200 crores and a new campus is being setup at Mohali with a budget of Rs 300 crores. ISB is scheduled to enhance its intake to 600 for the academic year 2010.Even in the current difficult economic environment, ISB had a good placement record adding an average of Rs8lakh to the existing CTC per student. Given that this was about 25% lower than the previous year owing to the recession,one can safely assume that ISB will continue to add Rs 10lakh to the existing CTC per student in perpetuity.By their very nature, the capabilities of a knowledge institution only improve with time and hence would likely add more value per student going forward.

Thus,ISB is contributing a minimum economic value of Rs 60crore(600 X 10lakh) per year.If we assume a life of 100 years(though good Institutions are known to last many centuries) for this Institution, a fixed investment of Rs 200 crore gave a return of Rs 6000 crore,an astounding 300 times. Can any venture capital fund gives this much assured return? Government of India, although did not contribute in this endeavour, by way of financing, will get Rs2000 crore as Income Tax only.What other asset class gives this much assured return?
And these are just monetary returns.The value added like executive education, manament development programs, research, conferences and incubation of startups cannot be quantified. The returns that society get from the intellectual capital added and the leadership role these invididuals will play are immeasurable.Is there any better public service other than promoting excellence in education?
ISB, here, is just a template and can be replaced with any institute of excellence be it IISc for Science, IITs for technology or AIIMS for Medicine.Despite the benefits that excellence in education entails,such endeavours continue to face delays such as this.

A related link describes GoIs intended investment in Institutes of Excellence. But this is not enough. Private sector needs to pitch in a big way. What we should have at the very least is to give 100% Income Tax exemption to any contribution to any Institute that meets the crietrion of excellence.

Bonus Shares:Whiten money,lighten tax bag

A little more details further to the previous post.As is clear from the previous post, the bonus shares do create capital loss for the purpose of tax calculation while no actual capital loss may have occur ed.This must not have been a big issue when our capital markets were small and ratio of Market Cap to GDP was low.Due to the fact that Reliance is the biggest publicly listed company in India,the government can potentially lose out on more than Rs20k crore of taxes due to the artificial capital losses generated by this bonus issue.To put things in perspective,this amount is about 20% of the total personal income tax receipts last year. If all the 30 sensex companies were to undertake the same exercise with their current free float market cap at 12 lakh crore rupees,this would create fake capital losses of 6lakh crore rupees which will be about twice the total direct tax collections made last year.Its bewildering to understand how Indian money in Swiss accounts gets so much attention while such big loopholes stare us. Ironically, the bonus issue is being greeted with great joy and welcomed as a gift and token of value creation.

That said,lets return to the alchemical world of converting black into white.Apart from the capital gains that are legitimate being set off against fake capital gains,one can create fake capital gains and set off them against fake capital losses. Some examples:

1. Ram's friend Teja has accounted income in form of say salaries but unaccounted expenditure for example on foreign trips,luxury,art etc. Ram can transfer the black money in cash to Teja and Teja can buy Ram's land at inflated price thus creating fake capital gains.
2. Ram can transfer the money abroad via Hawala or other routes which Teja can borrow, say through FIIs, to buy Ram's land.Also an NRI can also buy Ram's land through the transferred money.
3. Ram's money need not be in India in the first place. It might already be resting in some Swiss account.A foreign entity can buy Ram's land using this money.

The possibilities are too many and time is ripe. In a reset world, returns on investment on white money are much more than black. The Noose is tightening on Swiss banks. Very many politicians/bureaucrats and other benign souls would be thanking Mr ambani for this opportunity.

Some friends have asked how can there be short terms gains taxed at 15%. Wont they get squared against the short term losses. The answer is that the bonus exercise may get stretched upto December.One can book the short term capital losses in this financial year,hedge for remaining months of this financial year and book short term capital gains in next financial year. Yes, there will be additional transaction costs besides those mentioned previously including stamp duty on land which is about 5% and brokerage costs involved in hedging which are relatively miniscule.

One does not know when and why this loophole arose in our taxation strucure but the earlier we get rid of this, the better.

PS: A related article in Business Standard by Kanu Doshi,a CA , explains that law was amended to plug this hole for mutual funds and not for stocks. The law in that case requires the units be either purchased 3 months prior to record date or be held for 9 months after the record date. Why cant law be amended to treat bonus shares at par with stock split for capital gains purposes?