Darbhanga: No land, no building, no doctor, no MBBS student and no patient. But in eight years, AIIMS Darbhanga in Bihar has managed to get an executive director – Dr Madhabananda Kar.
When Kar arrived in August 2022, the Darbhanga district administration provided him with a computer operator, two clerks, an office assistant and a room in the official circuit house. The divisional commissioner’s office was converted into Kar’s office. The DIG nameplate now is the AIIMS Director’s.
This is the story-so-far, a pitiful testament to the political race to announce a new AIIMS in district towns to attract voters, but without preparing the ground, policy consensus or feasibility audits. In many ways, it isn’t unlike the rush to announce new trains in far-flung areas for political dividends. Both are examples of political response to rising regional aspirations but little follow-through.
“Some people wanted AIIMS in DMCH, some wanted it somewhere else. The lack of clarity on AIIMS Darbhanga project turned into a mountain,” Dr Ajay Kumar, a member of Indian Medical Association, Bihar branch, said.
AIIMS Darbhanga isn’t alone.
Haryana Chief Minister Manohar Lal Khattar too announced an AIIMS in Rewari during a rally in 2015, after which a wave of joy swept through the region. But what followed were protests, endless rounds of meetings, delays, and no objection certificates (NOCs). Seven years later, Haryana is yet to hand over the required land for what was to be the state’s first and country’s 22nd AIIMS.
A Centre-state cat-and-mouse game has also been on in West Bengal. In 2013-14, former Prime Minister Manmohan Singh wanted to establish an AIIMS in Raiganj district as there was scarcity of medical facilities in north Bengal. But CM Mamta Benarjee was keen on Kalyani.
“There was a lot of correspondence between the state and the Centre, and in the end, we had to agree with the state’s choice. But Kalyani is close to the state capital, and also has a good district hospital. North Bengal needed it (AIIMS) more,” a retired union health ministry bureaucrat shared with ThePrint.
AIIMS, votes, politics
In the quiet lanes of Darbhanga town, AIIMS isn’t just a hospital. It’s a sentiment and a status symbol for both residents and politicians.
“Nitish Kumar knows that the inauguration will be done only by PM Modi and the credit will go to him. That is why he has created this land issue to ensure that the big hospital doesn’t come up,” BJP’s Darbhanga MLA Sanjay Saraoagi said, blaming “politics” for the delay.
On 28 February 2015, then-union finance minister Arun Jaitley announced in his Budget speech that the government is going to set up five new AIIMS — one each in Jammu and Kashmir, Punjab, Tamil Nadu, Himachal Pradesh, and Assam.
“Keeping in view the need to augment medical services in Bihar, I propose to set up another AIIMS-like institution in the state,” he had said. Bihar’s first AIIMS, in Patna, had come up in 2012, eight years after its foundation stone was laid by then-vice-president Bhairon Singh Shekhawat.
The news of another AIIMS-like institution in Bihar, a state with only 1.19 lakh doctors for a population of 12 crore, spread like wildfire.
“Another Delhi AIIMS is coming to our state, it is no less than an injection when you have high fever,” Rakesh Paswan, 40, a resident of Bakhtiarpur town in Patna district, said.
Bihar was to go to assembly election at the end of 2015. Elections were also scheduled in Assam, Punjab, and Himachal Pradesh over the next two years – all these states were allotted a new AIIMS. The conversations around AIIMS, politics and votes coalesced. It made its way to the speeches of even local booth workers.
“This is one of the things that we were constantly reminded of during the assembly election in 2020. If the BJP is voted to power, there will be a double engine sarkar and the AIIMS project can really take off,” Paswan said.
“One chief minister demands an AIIMS and you announce it. You go to the next state, another MP demands, and you announce it. But the chief minister doesn’t want it. In a way, you have opened a window where any constituency can sit in protest and demand an AIIMS,” a professor posted in Delhi AIIMS said, adding that he believes the announcements of new AIIMS are more to do with politics than policy.
Also read: AIIMS Jodhpur has changed healthcare in Rajasthan. But now it’s cracking under patient load
You do it. No, you do it
An announcement, though, is just a small part of the promise game. What follows is the rigmarole of finding land, establishing roles and working out funds-related modalities. The list of things to set up the huge infrastructure is long.
Three months after announcing an AIIMS in Darbhanga, Delhi wrote to Patna in June 2015 asking the latter to identify three-four suitable 200-acre land with a four-lane road connectivity, water supply and electricity within a month—without the Centre having to incur any cost for land.
RTI replies received by India Today‘s Ashok Upadhyay on the correspondence between the state and the Centre tell a story of what appears to be deliberate political foot-dragging.
Patna kept the proposal on table for months. Delhi sent a reminder in December 2015 and another in May 2016.
“The matter is closely monitored by the PMO,” the letter from the Centre showed an urgency.
When Bihar finally responded in August, it asked the Centre to identify the land on its own.
Four months later, the Centre sent another letter to Bihar: “As you are aware that identification of land for setting up new AIIMS is the primary responsibility of the state government.”
Bihar took another three months to reply to this reminder. It maintained its earlier stand that the Centre must identify the land. Delhi wrote again in April 2017 asking the state to adhere to its responsibility.
Delhi’s final warning in February 2018, sent to Bihar’s then-chief secretary and CM Nitish Kumar’s favourite bureaucrat Anjani Kumar Singh, made it clear: “If no reply is received within 15 days, the proposal for setting up a second AIIMS-like institute in Bihar may not be considered.”
The Bihar government found the land but it was just the start of the AIIMS Darbhanga saga.
Official seal
In December 2018, a meeting of top bureaucrats of the Bihar government was called in.
“Good news: Bihar’s Darbhanga to get the state’s second AIIMS,” announced an article in Apna Bihar. It added that the 227 acres belonging to Darbhanga Medical College and Hospital (DMCH) could finally be chosen for transformation into AIIMS and put Darbhanga on the national map of healthcare.
The project received a final stamp at a 2019 public event attended by top BJP leaders and Bihar Chief Minister. Nitish Kumar asked J.P. Nadda — then-union health minister—to either open an AIIMS in each of Bihar’s 38 districts or upgrade the DMCH into an AIIMS.
For officials at the Centre, this looked like an end to a long drawn-out battle of wits. But it wasn’t over.
In 2020, the union health ministry sought clarifications from Bihar on whether DMCH was a heritage building. In the middle of all this, Nadda was replaced by Harsh Vardhan as the union health minister. New chief secretaries and health secretaries joined. A new election amid a Covid wave was looming in Bihar.
A new development sprung up. The Union Cabinet in September 2020 approved setting up AIIMS in Darbhanga at a cost of Rs 1,264 crore with 15-20 super speciality departments and 750 hospital beds. The last decision had been upended. But the deadline was tight — the project had to be completed within 48 months. Bihar was asked to hand over 75 acres of land from DMCH campus within six months. It was also supposed to connect the upcoming medical college to NH-57 and construct an overbridge since the main campus is divided by a railway track.
In November 2021, Bihar gave its approval for transfer of DMCH’s 200 acres of land but a month later, during his visit to Darbhanga, Nitish Kumar declared only 150 acres would be allotted for AIIMS — the remaining 77 acres would be retained to upgrade and expand facilities for DMCH.
Also read: One woman’s fight to pull AIIMS-Rishikesh out of a decade of raids, scams, lies
New hurdle
Just when things seemed to be falling in place, the AIIMS Darbhanga project saw a new turn. BJP MP Gopal Jee Thakur raised an alarm in January 2022, barely a month after Bihar’s approval of land transfer, that DMCH should have 300 acres in its possession — and not 227 acres as claimed by records. He cited a response from parliament library service (LAARDIS) to claim that the erstwhile Maharaja of Darbhanga, Rameshwar Singh, “had donated Rs 6 lakh and 300 acres of land” for the medical college, which was established in 1946. He argued that 73 acres had been lost to encroachment.
The MP’s contention was that the Bihar government could easily transfer 200 acres if it could sort out the encroachment as that would leave DMCH with 100 acres.
This started a slugfest. Bihar health minister Mangal Pandey refuted the claim in the state assembly in March, saying DMCH only had 227 acres in its possession as per the revisional survey. “Land records show 227 acres in the name of DMCH and it is under its possession. The settlement of the 227 acres is also in the name of DMCH,” he said.
The project came to a standstill and then picked up when, in September 2022, Bihar officially transferred 81 acres of DMCH land as part of the first phase of the AIIMS project. It spent Rs 13 crore on the land-filling process, and demolished the anatomy department, a lecture hall and a bank branch. Biochemistry and physiology departments were in the process of shifting.
Kar, the AIIMS director camping out of circuit house, was hopeful that the second and third phases will see the transfer of 20 acres and 57 acres of DMCH land.
Patna AIIMS, which is going to mentor the upcoming Darbhanga AIIMS, was informed that the first batch of 50 MBBS students will begin attending classes in 2023. The batch would be given their first three-semester training in the Bela Palace in Darbhanga.
More meetings, more confusion
But all this didn’t go down well with the DMCH administration and doctors. They were apprehensive that once the AIIMS project starts, DMCH will be closed. Meetings were sought with the chief minister.
“This will be a disaster. DMCH caters to a population of 2.5 crore people and they have nowhere to go. It will take a minimum of four to five years to demolish the existing infrastructure, construct the new building and start the OPD,” one of the key members of the Indian Medical Association (IMA) and a DMCH functionary told ThePrint on the condition of anonymity.
“The CM was not convinced earlier. In fact he said the idea to upgrade the DMCH into an AIIMS came from his experience of transforming Bihar College of Engineering into NIT Patna,” the IMA member said.
A group of DMCH representatives met the CM and explained to him that teaching institutes are different from hospitals that deal with patient care and so the same rule for transformation can’t be applied.
Also read: India needs to innovate in filling vacant hospital posts. Building new AIIMS alone won’t cut it
In search of a new land
Things took a turn again.
During his Samadhan Yatra in January 2023 where Nitish Kumar visited districts and reviewed various schemes, he announced before mediapersons that DMCH will not be upgraded as an AIIMS and will be shifted to a new location. While Nitish didn’t give any details, senior RJD leader and former MLA Bhola Yadav had said in December 2022 that the government plans to shift the AIIMS project to 400-acre Ashok Paper Mills in Hayaghat, 12 km from Darbhanga, which now lies defunct.
This created a huge uproar because the Mithilanchal region have had enough with the various issues causing the delay. Top state BJP leaders including MP, MLA and former BJP Minister flocked to Darbhanga to protest.
(The common citizens always wanted an AIIMS. They never had any say in whether to convert the existing DMCH into an AIIMS or construct a new one. But when the state government decided to transform DMCH into an AIIMS, it was welcomed by everyone. However, over the last years, the politics on land acquisition kept taking different turns. That is when the public lost its patience and many sat on protests.
As of now, BJP politicians blame Nitish for the long delay. JDU, which is in alliance with RJD, is hopeful that the projects will make some progress soon.
“Nitish is no longer Vikash Purush. He is a weak administrator now,” Darbhanga MP Thakur, who participated in a two-and-a-half kilometre padyatra said. He claimed that the new proposal from Patna has come to the district headquarters.
But a new concern has now arisen.
“The new land that they have identified is in a flood-affected area,” he claimed.
But contrary to the political views, the district administration says that they are in the process of handing over a new location for the AIIMS project and it has nothing to do with floods.
“The location is 3-4 kilometres away from NH-57 and there is a bypass nearby. The area is called Shobhan. Some part of the required land belongs to the government, and we are doing inter-departmental transfer (from revenue to health department). The rest of the land will be acquired as per the law acquisition rules.” a top administration official told ThePrint.
“Land is never the issue, politics around it is,” he added.
This article is part of a series on the state of regional AIIMS hospitals. Read all articles here.
(Edited by Prashant)