Prime Minister of India - Dr. Manmohan Singh

PM's speech at the marking the Golden Jubilee of the AIIMS

"I am truly delighted to be present at this historic occasion when the All India Institute of Medical Sciences (AIIMS) is commencing its Golden Jubilee Celebrations. I am also honoured to participate in the 34th Convocation of this great national institution and be conferred with the Honorary Fellowship of the Institute.

Golden Jubilees of institutions offer us an occasion to reflect on their accomplishments and plans for future. AIIMS is undoubtedly an institution of excellence in medical education and research and health care, and is rightly regarded as a valuable national asset. It must be our endeavour not only to sustain past performance, but strive day after day to improve upon it so that the next 50 years will be still more productive, still more fruitful in the service of the people of our country.

The establishment of AIIMS in 1956, through an Act of the Indian Parliament, reflected our commitment to achieve self-reliance in key sectors of the economy and human development. It also bore testimony to the value our national leadership placed on the attainment of excellence in all such endeavours. Speaking in Parliament on the Bill on AIIMS, the then Union Health Minister said: "It has been one of my cherished dreams that for post-graduate study and for the maintenance of high standards of medical education in our country, we should have an Institute of this nature in India which would enable our young men and women to have their post-graduate education in their own country". She went on to say, "Medical education must, above all, take into account the special needs of the country from the point of view of affording health protection to the people".

This was also the vision of India's first Prime Minister Pandit Jawahar Lal Nehru, who believed that institutions like AIIMS would be regarded as the temples of modern India. The time has come for us, therefore, to rededicate ourselves to the mission of these visionaries and pioneers.

AIIMS has indeed fulfilled its mandate of establishing high standards of excellence in undergraduate, postgraduate, doctoral and post-doctoral education. It has designed, established and evaluated innovative models of education and assisted in their replication across the country. It has gained a well-earned reputation for providing the highest standards of clinical care in many specialties. This is on par with the best medical centres in the world. It has been the leading contributor to published medical research in India, with scientific output of high impact. Its faculty has assisted national and international agencies in developing policies and programmes for health care. Its alumni have provided leadership to academic departments in India and abroad. The cumulative contributions of AIIMS amply validate its claim to be the premier medical institution in India and among the very best in the world - exactly as our Parliament hoped it would be. The country is truly proud of this great national institution that AIIMS is.

I, on behalf of our nation, salute AIIMS for its glorious accomplishments, and express our nation's collective gratitude to the many individuals who have contributed to its growth over the past 50 years. Shunning greater riches and greener pastures in the private sector, or in other countries, they have worked selflessly to build AIIMS to its present position of pre-eminence. We need to draw our inspiration from them today as we look to the future of AIIMS.

While we all are truly proud of our accomplishments in medical science and technology, we must be aware that the health indicators of our country do not do us proud. While working on the frontiers of science and technology is absolutely necessary, we cannot be mesmerized by technological solutions and fixes. We must realize that health is the result of many factors of which medical care is just one. It is a matter of serious concern that after so many decades of our effort, our health indicators are among the worst in the world. Our infant mortality rates, our maternal mortality rates and the incidence of easily controlled diseases and epidemics are unfortunately among the worst in the world.

This golden jubilee therefore is a time for the entire medical fraternity to reflect on the ways by which we could improve the basic health levels of our population. Kerala, with its world class health indicators, has shown that there is no necessity for high standards of living or high per capita income and high cost medical care to improve the health of our population. I request all those connected with planning of health services in our country, those who are in the Government, those who are health policy planners, AIIMS and the medical fraternity with the task of exploring ways by which we can bring the health status of the rest of the country to the levels prevailing in Kerala in the next one decade. I think that's a challenge which can be met and which should be met and I suggest that AIIMS must take a leadership role in this. It is only when society at large benefits from government investment in high-class medical care that we can truly say that the investments have borne fruit.

In this background, we must ask whether AIIMS continues to imbibe and uphold the values of its founding generation. Have growth and expansion created bureaucracies? Has bureaucratism robbed individuals of initiative? Has the surge of patients reduced time for research? Has the pressure of quantitative growth impacted qualitative development? Has the emergence of for-profit corporate health care created new temptations that attract better talent away from institutions like AIIMS? Has Government interference discouraged professionals and hurt professionalism? How do we strike a balance between the needs of intellectual and functional autonomy while maintaining societal accountability? We must address these questions before we rush to create new institutions. AIIMS can take a lead in nurturing many state institutions to higher standards of medical care so that the patient pressure on it reduces and it can focus on the frontier areas of research.

Just as the mandate of AIIMS 50 years ago was defined in the historical context of our national aspirations then, we now need to redefine that mandate in the context of the current environment. There are new issues, new challenges arising out of the growth of private healthcare, the increasing demand for advanced medical care and the government's own obligations to primary healthcare. I strongly believe that the bulk of the provision of basic health services and medical care, particularly for the poorer sections of society will continue to be in the public domain for many many decades to come. I do believe in liberalisation. I do believe in giving greater play to market forces, but I also recognize that markets serve those who are part of the market system. When millions and millions of people live on the edges of subsistence, market signals can have no meaning for them and therefore, it is the responsibility of society at large, to take care of these disadvantaged and under-privileged sections of our population. The expansion of private health care, which is a happy phenomenon, will address the needs of the affluent and those covered by organized medical care programmes. However, millions of people living below the poverty line and in our rural areas will continue to depend on government as the primary health care provider. Private care cannot be the immediate answer to the needs of those who do not have basic purchasing power.

Therefore, AIIMS and other similar institutions and national policy makers will have to refashion the health care system to meet the needs of this segment of society. We need to adopt a holistic approach to the whole issue of national health care. And when I look at the literature, I am struck by the fatness of the report like the Bhor's committee report, which reported on this vital issue even before India became independent. We have launched a National Rural Health Mission. I hope it will take care of the primary health care issues, but we cannot be satisfied with the status quo. We must look at the mechanisms and changes that we are planning to introduce, whether they really live up to the challenges that our health care system faces. Policies must be framed to meet the hospital care needs also. A balance needs to be struck between government and private initiative in this context.

Investments in health, while essential for economic progress, are not motivated, as I said, cannot be purely by economic considerations alone. We recognize health as an inalienable human right that every individual citizen can justly claim, so that he or she can develop to his or her full potential. So long as wide health inequalities exist in our country and access to essential health care is not universally assured, we would be falling short in both our economic planning and in our moral obligation to all our citizens, particularly those who are at the bottom rung of social and economic ladder.

Science and technology are indeed the fertile fields from where innovative contributions to health can and must emerge. The ability of health professionals to investigate the causes of disease, and to intervene effectively to treat disease, is now greatly enhanced by a range of new technologies that have emerged from biomedical sciences as well as other scientific disciplines. From stem cells to nano-technology, the rapidly expanding frontiers of science have the immense potential for improving our ability to provide better health to our people. I am very happy to learn that AIIMS is operating on the frontiers of all such new technologies.

However, health care for treating health disorders is only one component of health. The legitimate expectations of society and the mandate of our governments must extend to encompass health promotion and disease prevention. These require multi-sectoral actions in several spheres, which influence health. Many of these lie beyond the traditional health sector. Issues like provision of education, nutrition, health care, often require policy initiatives in agriculture, food processing and commerce. Even fiscal measures are needed to ensure the greater availability of essential foods and discourage the consumption of unhealthy ones. Even the control of infectious diseases requires integrated planning for provision of a clean environment.

At the same time, health professionals are beginning to acknowledge that interventions in health cannot be driven by medical sciences alone. For the optimal use of scarce resources, comparative cost-effectiveness of different health interventions has to be evaluated. Whether it is the promotion of responsible sexual behaviour, or avoidance of tobacco, medical sciences will have to form an alliance with social and behavioural sciences to achieve positive outcomes. We are, therefore, witnessing an exciting era of the integration of multiple streams of learning and diverse spheres of activity into a combined effort to enhance the health of our people. Medical scientists have to recognize the value of such new partnerships, even as they ceaselessly strive to advance in their own fields. To enable such constructive and productive collaboration, our government proposes to support the establishment and growth of Schools of Public Health, which can provide the framework for multi-disciplinary partnerships in education, research and health action. AIIMS should rightly play a pivotal role in catalysing such a network of public health institutions.

The Nobel laureate, the Late Gunnar Myrdal aptly observed that 'Health leaps out of science and draws nourishment from the totality of society'. While science provides the tools to identify the causes and cures of disease, we must also strive to create the social conditions that promote and protect health. As health professionals you must therefore, draw upon the strength of science to improve health care, while we as policymakers, should aim to provide the supportive environment for safeguarding health. However, the best results are likely to be achieved when all segments of society work together to positively influence the multiple determinants of health. AIIMS, I suggest, should become a thought leader in promoting this broad understanding of health through trans-disciplinary education. It must also become a catalyst for multi-sectoral applications of such an integrated approach.

We must also recognize and respond to the great need for empowering our people with health related information. Health literacy needs to be enhanced, both through our formal education system and informal means, including the increasing use of mass media. The pattern of health care needs to change from an outmoded paternalistic, prescriptive, provider-driven model to a partnership-based collaborative model. It must bring together patients and communities. You must help not only to create new knowledge, but to also disseminate it among the masses at large.

On behalf of the government and our country, I would like to assure all of you that we will continue to provide full support to this great, national institution of excellence to retain its pre-eminence in our national life. The institute's commitment to the pursuit of excellence in social equity is something, which we need to nourish day in and day out. We will continue to take pride in your achievements and will act promptly to remove the obstacles that threaten to limit your potential.

To the young health professionals and scientists who are receiving their degrees today, I offer my heartiest congratulations. I have only one word of advice. You are now stepping forth from the portals of this great institution, with the promise of a bright future beckoning you. Please remember the contributions of the many who have laid the foundations for your future. Use your own knowledge and skills to prepare an even better future for the generations that will follow you. By all means, pursue your personal career goals, but do also aim to contribute to the greater good of humankind. Please try to translate your own success into gains for our nation. Your own future is best guaranteed when the whole of society moves to a higher level of health and stability.

Neither institutions nor individuals can survive as islands of excellence in an environment of mediocrity. Both ennobling altruism and self-interest should motivate us to improve the environment in which we all have to work. The commitment to excellence and social equity that AIIMS inspires in you should shape the manner in which you function in your own new work environment. You must become, therefore, agents of change wherever you are, improving the knowledge and skills of people around you. As our ancient sages taught us, knowledge is the only wealth that multiplies when shared. Each one of you can and should become a beacon of enlightenment, so that collectively you can illuminate the whole Indian society. I am confident that you will be motivated by such impulses to excel and to care. I wish you the very best in your future pursuits".