Mapping the rapid expansion of India's medical education sector: planning for the future

Background: India has witnessed rapid growth in its number of medical schools over the last few decades, particularly in recent years. One dominant feature of this growth has been expansion in the private medical education sector. At this point it is relevant to trace historically and geographically the changing role of public and private sectors in Indian medical education system. Methods: The information on medical schools and sociodemographic indicators at provincial, district and sub-district (taluks) level were retrieved from available online databases. A digital map of medical schools was plotted on a geo-referenced map of India. The growth of medical schools in public and private sectors was tracked over last seven decades using line diagrams and thematic maps. The growth of medical schools in context of geographic distribution and access across the poorer and relatively richer provinces as well as the country's districts and taluks was explored using geographic information system. Finally candidate geographic areas, identified for intervention from equity perspective were plotted on the map of India. Results: The study presents findings of 355 medical schools in India that enrolled 44250 students in 2012. Private sector owned 195 (54.9%) schools and enrolled 24205 (54.7%) students in the same year. The 18 poorly performing provinces (population 620 million, 51.3%) had only 94 (26.5%) medical schools. The presence of the private sector was significantly lower in poorly performing provinces where it owned 38 (40.4%) medical schools as compared to 157 (60.2%) schools in better performing provinces. The distances to medical schools from taluks in poorly performing provinces were longer [median 65.1 kilometres (km)] than from taluks in better performing provinces (median 41.2 km). Taluks farthest from a medical school were, situated in economically poorer districts with poor health indicators, a lower standard of living index and low levels of urbanization. Conclusions: The distribution of medical schools in India is skewed in the favour of areas (provinces, districts and taluks) with better indicators of health, urbanization, standards of living and economic prosperity. This particular distribution was most evident in the case of private sector schools set up in recent decades.