Utilisation indicators such as OPD footfall are better measures of health infrastructure outcomes than the number of institutions sanctioned. Discuss with reference to the new AIIMS.

The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) is a Central Sector Scheme launched in 2003 to correct regional imbalances in tertiary care [3]. Under it, 22 new AIIMS are approved but only 18 are fully functional [1]. This gap shows why footfall reflects outcomes better than the number of institutions sanctioned. Footfall is still only a partial measure.

Why utilisation is a better measure than sanctions

• A sanction is not a service: in February 2021, only 6 of the 22 sanctioned AIIMS were functional and 16 were still under construction [2]. Counting sanctions would have overstated working capacity nearly fourfold.
• It shows real demand: annual OPD consultations rose from 50.03 lakh (2021-22) to 144.96 lakh (2025-26). The cumulative total crossed 6 crore by October 2026 [1], which shows unmet demand outside the metros.
• It shows equity gains: patients treated nearby need not travel to Delhi, which cuts travel, lodging and lost-wage costs.
• It improves accountability: the CAG found Phase I delayed by 4–5 years and the cost of each AIIMS up 145% (₹332 crore to ₹820 crore) [4]. Tracking inputs alone hid these failures. Utilisation indicators move monitoring towards results.

Limits of OPD footfall

• It reflects expansion, not productivity: OPD per AIIMS was about 8.3 lakh in 2021-22 and about 8.1 lakh in 2025-26 [1][2]. The growth came from new institutes opening, not from each AIIMS seeing more patients.
• An OPD visit is not treatment: the CAG found bed shortages of 43–84% in the Phase I AIIMS [4]. A patient seen in the OPD may still be referred to a metro hospital for surgery.
• It says nothing about quality: with faculty shortages of 55–83% [4], high footfall can simply mean longer queues. The government release gives no data on waiting times or admissions [1].
• It hides idle assets: only about 47% of equipment ordered (by value) was in use [4].

Way forward: a composite dashboard

Inputs (sanctioned, built) → Capacity (beds, faculty, equipment in use)
→ Utilisation (OPD, IPD, surgeries) → Outcomes (referrals avoided, OOPE, waiting time)

Fig: Layered measures for the performance of health infrastructure (OOPE: out-of-pocket expenditure)

• Frame operational guidelines for PMSSY and publish capacity data for each AIIMS, as the CAG recommended [4].
• Continue Standing Selection Committees and contract hiring of retired faculty up to age 70 to close staff gaps [5].

Footfall is a better signal than sanction counts because it measures what citizens actually receive. To show real outcomes, it must be paired with capacity and quality indicators. Measured this way, PMSSY can deliver equitable tertiary care and advance SDG 3.8 (universal health coverage).