The expansion of AIIMS under PMSSY seeks to address regional disparities in tertiary healthcare. Critically examine its progress and the gap between approval and operationalisation.

The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was announced in 2003 as a fully Centre-funded Central Sector Scheme. Its aim was to correct regional imbalances in tertiary care and improve medical education [4]. Of the 22 new AIIMS approved, 18 are fully functional [1]. Access has clearly widened, but the scheme has moved slowly from sanction to service.

Progress in reducing regional disparity

• Wider spread: the Phase I AIIMS at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh brought super-specialty care to states that had little of it [2].
• Use, not just existence: the new AIIMS have handled about 6.01 crore OPD consultations since 2021-22. Annual OPD rose from 50.03 lakh to 144.96 lakh (2025-26), which points to unmet local demand [1].
• Three-in-one model: each institute combines patient care, UG/PG/nursing education and research, so it builds health workforce as well as buildings [1].
• Second track: 75 projects upgrade existing Government Medical Colleges/Institutions (GMCIs) [3].

The gap between approval and operationalisation

• Slow commissioning: only 6 of 22 AIIMS were functional in 2021 [2], and 4 are still not fully functional [1].
• Cost overrun: the estimated cost of each Phase I AIIMS rose from ₹332 crore to ₹820 crore (145%) because of delay and weak planning [5].
• Buildings before doctors: 55–83% of faculty posts and 77–97% of non-faculty posts were vacant [5]. The causes were late recruitment rules, court cases and too few eligible candidates [6].
• Idle assets: only about 47% of the equipment ordered (by value) was in use, and bed shortages ranged from 43% to 84% [5].
• Weak governance: the scheme had no operational guidelines, and its monitoring committees did not work [5].
• Misleading metric: OPD counts leave out admissions, surgeries and onward referrals [1]. Most of the growth in OPD came from more institutes opening, not from each one serving more patients.

Way forward

• Frame operational guidelines and plan construction, equipment and staffing together [5].
• Set up Standing Selection Committees, use deputation, and rehire retired faculty up to age 70 at the remaining AIIMS before they open [7].
• Publish working beds, filled posts and equipment in use for each AIIMS, alongside OPD counts.

PMSSY has spread tertiary care well beyond the metros, but slow commissioning and staff shortages have held back its results. If the scheme follows the CAG's advice and plans buildings, equipment and staff together, the new AIIMS can deliver equitable care in line with Article 47 and SDG 3.