Fixing Legacy Issues: How Yogi Government Seeks To Improve UP's Abysmal Nurse Count

For its nearly 23 crore population, the most populous Indian state, Uttar Pradesh, has a pitiable nurses-to-population ratio. 

The state has only 1.38 lakh nurses, which makes the figure a mere 0.6 nurses per thousand population even as the World Health Organization recommends having three nurses for the same. The national average lags at 1.7, but UP is particularly concerning. Kerala tops the states with 8.96 nurses per thousand population. 

Realising the dire state of affairs, UP upped its game in recent years when it increased the number of nursing posts in health facilities. This prompted medical colleges and other institutes to begin nursing courses - both for midwifery and graduate degrees. 

After the Yogi government came to power in 2017, 17 new nursing colleges have started in the state, a government official told Swarajya. Before that, the state had such courses running in only six institutes, producing just about 400 trained nurses. 

As per a report prepared by the Uttar Pradesh Technical Support Unit in 2021, which was formed in 2013 to assist the state government, UP needs about 70,000 nursing posts. 

That’s what triggered the need for Mission Nirayama, started by CM Yogi last year to ensure both the quantity and the quality of trained nurses for its health facilities.

The state’s ambition to fix its nurses-to-population received a major boost in this year’s Central budget allocation when it received an allocation of Rs 270 crore to set up 27 government nursing colleges.

History of medical education in Uttar Pradesh

The medical history of Uttar Pradesh began with the establishment of the state’s first medical institute (King George’s Medical College — now university) in 1905. Between 1950 and 1970, six more colleges were established.

"Around 2010, the state woke up from a long slumber to realise that the world has caught up with its time, and that Uttar Pradesh is trailing behind", says Alok Kumar, Principal Secretary, Medical Education, Government of Uttar Pradesh.

In 2021, when Alok Kumar joined the department, they had 35 government-run medical colleges and only six nursing colleges in the state. The World Health Organization (WHO) recommends having three nurses per doctor. Here, it is less than one-and-a-half.

“As of 2021 we had 7,860 seats for BSc Nursing in the private sector while the intake capacity in the government colleges for the same course was 620. For MSc the numbers stand at 804 for the private institutes while for the government the intake capacity was 50, 2 percent was ANM,GNM, BSc and MSc all combined together”, Kumar told Swarajya.

Since the Yogi administration took the oath in 2017, the state has managed to double the amount of medical colleges. In the next two years, they plan on tripling it. 

The main problems

In neighbouring states like Bihar, students finding the most absurd ways to cheat in examinations is a regular sight. This corruption, while being a bane to many, is also a boon to a few who are lethargic to pursue their degree through honest means.

This system encourages students from Uttar Pradesh to attend colleges in Bihar, where one can easily cheat their way through and obtain a degree in nursing. 

This becomes highly problematic since the quality of education and the integrity of graduates entering the medical profession is highly questionable. This culture, says Sangita Prakash, Director of Lucknow’s Dr. Anchal Singh Nursing College was rampant when she joined the institution in 2013. 

She recalls her students issuing open threats to tear up the question papers during the exams because the newly-established college did not allow an ‘open-book examination’. One more issue is that of ‘non-attending’ students who miss their physical classes and still manage to obtain their degrees. 

Additionally, there were issues related to the quality of infrastructure. Colleges did not have labs that could impart clinical knowledge and skills to students. Those colleges which mushroomed solely for the sake of making money did not bother upgrading themselves to a better standard. 

Mentoring ecosystem for colleges

As of 2023, the Uttar Pradesh State Medical Faculty (UPSMF) have identified a dozen institutes under the first phase of the mentorship programme.

These institutes have signed a Memorandum of Understanding to mentor colleges to uplift the quality of education. Institutions are evaluated on the basis of their infrastructure, students’ attendance and behaviour, quality of teaching, pedagogy to name a few. 

Two members of the faculty from each mentor institute will receive relevant training on clinical and teaching skills as mandated by the UPSMF as a part of a five day residential training programme.

Upon completion of their training, the faculty members will work towards improving the quality of education in their own institution and the mentee institute. Ultimately, the quality will be evaluated by the Quality Control of India. 

These 12 mentor institutions are spread across seven divisions in Uttar Pradesh. The government’s goal is to identify one such mentor institute in every division of the state. Will this not be a potential threat to their business, we asked.

To this, Dr Archana Chouhan, Principal, Baba College of Nursing, stated that even the best institutes struggle to find quality teaching staff. Usually, they are put through a year or two of training and then integrated with the rest of the staff. This incurs cost.

So, it is in the best interest of everybody that the same level of excellence be achieved across every institution. 

To add to the efforts, biometric examinations were carried out across 246 randomly selected institutions in the state, of which, 161 of them had less than mandated faculty. Among these, 20 institutions had serious shortages and action was taken against them. 

Make nursing great again

In order to be able to show a bump in the numbers, the government realised that there is an inherent need to make the profession desirable for students.

To create more awareness, around 300 government and government-aided school principals were trained to become ‘master trainers’.

These principals had one task — inspire students from classes 11 and 12 to consider nursing and paramedical fields as a choice of occupation. To this day, more than four lakh students have been counselled across 2,000 schools in Uttar Pradesh. 

On the lines of NEET, a Common Nursing Entrance Test (CNET) has been introduced in the state to curb corruption and cheating. Students pursuing different degrees of study are eligible to take up the test.

This includes students who are applying for admission to Bachelor of Science (BSc), Master of Science (MSc), post-basic BSc. 

CNET was introduced in 2021. Those institutions affiliated to Atal Bihari Vajpayee Medical University had to mandatorily conduct these exams.

However, the government has given an option to all deemed-to-be universities and private institutions the option to come under the ambit of CNET. For CNET 2022, 31,000 applications were filed, of which, 26,000 appeared for the examination. Among these, 21,000 made it through the 30 percentile cut-off mark. 

Tasiya Katiyar, a student at the College of Nursing, SGPGIMS, told Swarajya that there are positives to the profession. Unlike the popular perception, graduating from a good nursing institution can secure the students a good pay package at government (and private) institutions.

While the obvious challenges exist, there are perks that come along with it too. For instance, families of nurses and paramedical forces receive health insurance coverage which proves to be of great help to families, she says.

Her friends who visit SGPGIMS apparently tell her that her college offers a lot more than theirs do. 

Vikas Kumar, a student at Lucknow’s Sanjay Gandhi Institute of Medical Sciences, took up nursing despite it being a profession dominated by women (and considered to be a taboo for men to pursue it).

Enrolled in the Bachelor of Science (BSc) degree in SGIMS’ College of Nursing, he said he saw opportunity with the state expanding its medical facilities.
Successes and failures that reports on Mission Nirmaya highlight so far are, at best, preliminary, given the fact that the mission is less than a year old.

More than 700 institutes have been evaluated for quality, more than a thousand applications for affiliations have received clearance, 800 plus CCTV cameras have been installed to discourage cheating in examination centres and 20 institutes have been penalised for defaulting.