JNIMS Paper IV : A roadmap for reform
- Teachers' Association-JNIMS White Paper No. 1 -

Prof (Dr) Ksh Achouba Singh / Dr Pahel M Soibam *

Jawaharlal Nehru Institute of Medical Sciences (JNIMS) in 2017 :: Pix - TSE

This is the fourth and concluding part of TA-JNIMS White Paper No. 1. Part I set out why healthcare must be governed differently; Part II examined the disconnect between health-care workers and adminis- trators, and what the national regulations require; Part III showed what that disconnect has cost JNIMS, the State's biggest Medical College. This concluding part presents the reforms that follow from that argument and that evidence.

From Principles to Policy

Part III laid bare the condition of JNIMS: a premier teaching institution whose employees go without regular salaries and whose wards go without basic consumables, while the system responsible looks elsewhere. That condition is not an accident. It is the predictable product of how healthcare is governed—and it will repeat itself, in institution after institution, until the way healthcare is governed changes.

The forces at work were named in Part II: the disconnect between healthcare workers at ground zero and the administrators above them; the red tape that entangles the simplest necessities; policies framed without the stakeholders who must implement them; and undue external interference in matters that should answer only to science and law.

These are not abstractions of governance. They are killing the careers and the enthusiasm of some of the most talented doctors this State has produced—and, through them, they are costing human lives. The reforms that follow are addressed to those forces, one by one.

Healthcare Policies Should Be Framed with Healthcare Experts

Healthcare policies should not merely be framed for healthcare professionals; they should be framed with healthcare professionals. Those who must implement a policy understand better than anyone the practical realities that determine whether it succeeds or fails, and can identify operational challenges and unintended consequences long before these surface through routine administrative processes.

The case for this is more than procedural courtesy. Analysis of the NHS Staff Survey has identified staff involvement in decision-making as the single most important component of the staff engagement that predicts care quality, retention and, in the acute sector, avoidable patient mortality (West and Dawson, Employee Engagement and NHS Performance, The King's Fund, 2012). Excluding professionals from decisions is therefore not a neutral administrative choice; it degrades a measurable determinant of institutional performance.

TA-JNIMS therefore believes that all major healthcare legislation, service rules, and structural reforms should ordinarily undergo structured stakeholder consultation before finalisation. In this context, the draft Manipur Medical Education Rules, 2026 should be placed in the public domain for at least one month to invite comments, suggestions, and objections from healthcare professionals, Medical College faculty members, pro- fessional associations, and other stakeholders.

Good policy is strengthened—not weakened—by informed consultation. A Government confident of its own proposals loses nothing by placing them before the public. And a proposal that cannot withstand one month of scrutiny by the very professionals who must implement it is not a proposal fit to govern them.

Medical Colleges Need Stability and Institutional Identity

Great institutions are built through continuity. Every Medical College gradually develops its own academic culture, leadership traditions, research priorities, specialised services, and institutional character, and faculty members spend years establishing departments, mentoring younger colleagues, and building clinical services.

TA-JNIMS believes that each Government Medical College should have its own independent cadre. Institution-specific cadres will strengthen faculty retention, institutional accountability, and long-term academic development.

Routine inter- college transferability of faculty is inconsistent with these objectives; where movement becomes genuinely necessary in the larger public interest, transparent mechanisms such as voluntary deputation should ordi- narily be preferred. Institutions are built by people who stay. No Medical College anywhere has been built by faculty merely passing through it.

Medical Education Must Be Led by Medical Educators

The administration of medical education is itself a specialised discipline. Appointments to positions such as Director, Medical Superintendent, Director of Me- dical Education, and Additional Director of Medical Education should therefore be guided by merit, transparency, and Nationally accepted standards.

For the headship of a Medical College, the matter is settled by regulation rather than opinion: as Part II set out, the Medical Institutions (Qualifications of Faculty) Regulations, 2025 define Medical Superintendent, Dean, Director and Principal as the institution's administrative posts and prescribe medical-faculty, teaching and professorial qualifications for them.

The NMC Regulations do not separately prescribe who must serve as a State Director of Medical Education or Additional Director of Medical Education; TA-JNIMS therefore advances its position on those offices as a policy principle grounded in the same logic of domain expertise.

The Association believes that both posts should ordinarily be held by senior Medical College teaching faculty members possessing substantial academic, clinical, research and adminis- trative experience, rather than by bureaucrats or doctors from non-teaching cadres.

This is not a question of hierarchy between services, nor of any disregard for the civil service or for any cadre of doctors. It is a recognition that specialised institutions function best when led by individuals whose professional experience most closely matches their responsibilities— and the responsibilities of these posts are, in their essence, academic.

The management literature describes this as expert leadership: the proposition, now supported across sectors from hospitals to universities to professional sport, that organisations perform better under leaders who possess deep practised knowledge of the organisation's core work (Goodall, IZA Discussion Paper No. 6566, 2012). Part I set out the hospital-specific evidence: measurably higher quality scores under physician leadership, better management practice where a greater proportion of managers are clinically trained, and systematic reviews finding clinician involvement in senior leadership associated with superior organisational performance (Goodall, Social Science & Medicine, 2011; Dorgan et al., Management in Healthcare, McKinsey and LSE, 2010; Clay-Williams et al., BMJ Open, 2017).

The Association states the evidence fairly. Clinical qualification alone is not sufficient: the study spanning nine countries found the strongest results where medical and managerial training were combined (Bloom, Lemos, Sadun and Van Reenen, Review of Economics and Statistics, 2020). The conclusion TA-JNIMS draws is accordingly not that doctors should lead because they are doctors, but that those who lead medical institutions should be drawn from the medical academic stream and then equipped with management capability—the combination the evidence favours.

This position is also consistent with arrangements used in several States, where medical- education directorates and senior academic-administrative posts are commonly filled from the medical academic stream. In Tamil Nadu, the posts of Director and Additional Director of Medical Education have in recent years been held by senior professors and deans drawn from the teaching cadre.

Kerala's Medical Education Service rules provide promotion and seniority path- ways within the Department that link the Principal's post to senior directorate positions.

Andhra Pradesh maintains a dedicated Directorate of Medical Education overseeing its Government Medical Colleges, and its Medical Education Rules require a senior professor with prescribed teaching experience—a requirement invoked by professional bodies when an IAS officer was given additional charge of the post. Uttar Pradesh's Directorate General of Medical Education is likewise led from the medical academic stream.

TA-JNIMS does not present these examples as proof of a single uniform national rule and invites the Govt to verify them. The comparative point is narrower: leadership of medical education through the medical academic stream is an established and workable model in Indian States.

What TA-JNIMS seeks for Manipur is therefore neither novel nor adminis- tratively exotic. It is what the National Medical Commission's own Regulations require for the headship of a Medical College, and it is consistent with a well-established Indian model. The question before the State is not why medical education should be led by medical educators.

It is why anyone would propose otherwise.

Nor should a stop-gap arrangement become a route around the professional character of the office. Whenever the post of Director falls vacant, temporary charge should ordinarily be entrusted to an appropriately qualified senior doctor of the Institute—such as the Medical Superintendent or a senior Professor who meets the applicable requirements—rather than to a bureaucrat holding unrelated portfolios.

A Medical College may need bureaucratic support, but temporary necessity should not become a justification for normalising non-medical control of an academic-medical institution. A teaching hospital cannot pause while Government decides.

Institutions Must Have the Power to Act

Part III described a Director without powers: an institution whose every routine decision must travel by file to the Health Commissioner and wait there. No reform in this White Paper will succeed while that remains the case.

TA-JNIMS therefore urges that JNIMS—and every Government Medical College in Manipur—be granted genuine administrative and financial autonomy: delegated financial powers adequate to its scale, authority over routine establishment and personnel matters, and the power to procure, repair, and appoint within defined limits without referring each decision upward.

This is the direction international evidence points. The World Bank's comparative studies of public hospital reform treat the grant of managerial and financial autonomy—coupled with strengthened accountability and retained public ownership—as a principal instrument for improving publicly run health services (Harding and Preker, The World Bank, 2000; Preker and Harding, The World Bank, 2003), and management-quality research has identified the absence of local autonomy in centralised systems as a substantial cause of poor hospital management scores (Dorgan et al., Management in Healthcare, McKinsey and LSE, 2010).

Accountability must remain absolute, through audit, statutory oversight, and periodic review; indeed the same literature is emphatic that autonomy without accountability fails. But accountability is served by scrutinising how an institution uses its powers, not by denying it powers altogether. A teaching hospital that cannot sanction a repair or fill a vacancy on its own authority is not being supervised; it is being disabled.

Dedicated Institutions Require Dedicated Leadership

Part II described what divided attention costs a teaching hospital: files wait, decisions are deferred, and urgency drains away between meetings. The remedy is not complicated. The posts of Deputy Director (Administration), JNIMS and Deputy Director (Finance), JNIMS should be dedicated exclusively to JNIMS. Healthcare institutions have become too complex to be administered as one responsibility among many. An institution of JNIMS's size and consequence deserves administrators whose entire working day belongs to it—and whose responsiveness, accountability, and results can be judged accordingly.

Every Medical College Must Be Allowed to Dream Big

Every Government Medical College should have the opportunity to realise its full potential as a centre of excellence in medical education, research, and patient care. No institution should be treated as a symbolic establishment or expected to remain permanently small and dependent.

The objective of establishing a Medical College extends far beyond producing MBBS graduates: every institution should aspire to postgraduate programmes, super- speciality departments, advanced research, and nationally recognised academic standards—because strong Medical Colleges inspire talented students, attract committed faculty, expand specialised health-care, and ultimately benefit the entire population.

Quality Before Quantity

The expansion of medical education should always be accompanied by adequate financial, human, and infrastructural support. If financial constraints genuinely limit the Government's ability to support existing Medical Colleges adequately, indiscriminate expansion risks spreading already scarce resources thinner still: new institutions struggle to realise their potential while existing ones face deepening shortages of faculty, equipment, medicines, consumables, research support, and infrastructure.

The staffing evidence cited in Part III reinforces the broader patient-safety principle that sustained frontline understaffing is associated with worse out- comes. Dall'Ora et al. (International Journal of Nursing Studies, 2022) and Griffiths et al. (JAMA Network Open, 2024) concern nursing workforces, not the staffing of Medical Colleges or Junior Resident Doctors in India, and they should not be stretched beyond that evidence.

Their relevance here is contextual: expansion that disperses already scarce clinical personnel across more institutions creates foreseeable risks to the continuity and quality of care, and the policy conclusion must rest primarily on Manipur's own workforce capacity and institutional needs.

The people of Manipur deserve not merely more Medical Colleges but stronger Medical Colleges capable of delivering excellent healthcare and out- standing medical education.

Quality, not announcement, should guide expansion. A Medical College that exists mainly on paper treats no patient and trains no doctor.

Healthcare Must Remain Above External Pressures

Healthcare institutions exist for one purpose above all others—to protect human life and health—and must therefore remain places where scientific evidence, professional ethics, compassion, and reason prevail. TA-JNIMS respectfully calls upon civil society organisations, public representatives, bureau- crats, and every other stakeholder to recognise the specialised nature of healthcare and to respect the professional autonomy of its institutions.

Constructive engagement and democratic participation are essential. However, attempts to influence appointments, acade- mic affairs, faculty administration, clinical decision- making, hospital administration, or healthcare policy through extra-institutional pressure ultimately weaken institutions whose sole purpose is to serve society. Such interference is not a victimless indulgence.

Every hour an institution must spend defending its professional space is an hour taken from patients, and every appointment bent by pressure is a standard lowered at the bedside.

The greatest service any stakeholder can render to healthcare is to strengthen its institutions, respect their autonomy, and allow qualified professionals to discharge their responsibilities independently, transparently, and in accordance with law.

Conclusion

Healthcare belongs to everyone. Govt, administrators, healthcare profe- ssionals, legislators, civil society organisations, profe- ssional bodies, and citizens all have a role in strengthening the health-care system, and the objective should never be institutional competition or sectional advantage.

The purpose of this White Paper is not merely to identify problems but to articulate a vision: healthcare institutions that are professionally led, adequately supported, academically vibrant, administratively responsive, and empowered to realise their full potential.

Every policy should be judged by a simple question: does it strengthen healthcare institutions and improve patient care? If the answer is yes, it deserves support. If the answer is no, it deserves reconsideration.

The future of healthcare in Manipur will not be determined by the number of institutions established, but by the strength of the institutions we build, the integrity with which they are governed, and the collective wisdom to place patients above politics, institutions above personalities, excellence above expediency, and the public interest above all other considerations.

The healthcare professionals of Manipur have held their end of this bargain through every crisis the State has faced. This White Paper asks the system to hold its own. Because, in the end: Strong healthcare institutions save lives. Weak healthcare institutions cost lives.