Opinion | The promise of bringing healthcare closer to home

By Sunny Singh

This era marks the rise of a politics of performance that refuses to separate ideological conviction from democratic legitimacy. It combines a clear political stance with the ability for the public to measure results. Elections in democracies often hinge on either identity mobilisation or political spectacle. This model asks the state to earn its authority through what it builds and delivers. Chief Minister Yogi Adityanath stands as its most visible practitioner. He has shown how firm executive resolve can turn an ideological mandate into roads, colleges and hospitals that keep serving citizens long after the election cycle ends. Health infrastructure offers the clearest test of this idea, and medical colleges show it best.

A state reveals what it believes about its citizens in the places where it builds. For decades, Uttar Pradesh trained its doctors in a handful of cities and told everyone else to travel. A mother in Sultanpur with a feverish child learned that the road to a specialist ran through Lucknow or Delhi. A boy in Siddharthnagar who topped his board exams learned that medicine belonged to someone else’s district. The politics of identity and spectacle left that arrangement untouched. The One District One Medical College programme aimed to change this dynamic, and the data show how far it has succeeded.

Global comparisons highlight both the magnitude of this infrastructure challenge and the shift in execution. With a population of nearly 24 crore, Uttar Pradesh is demographically comparable to entire nations like Brazil, Pakistan or Nigeria. Historically, however, its public health output lagged far behind such international peers. Brazil’s unified health system, built on a decentralised network of regional medical centres, has more than two doctors for every 1,000 people. Pakistan, despite severe fiscal constraints, managed to expand its network of public teaching hospitals across its provinces over the past two decades. By contrast, central agency databases, including historical public health metrics from NITI Aayog and MoSPI, confirm that Uttar Pradesh entered the late 2010s with severe infrastructure stagnation. For over six decades, the state’s public medical education was locked into just 17 government colleges for 75 districts, resulting in a doctor-to-population ratio that significantly trailed global lower-middle-income benchmarks. The post-2017 push under the One District One Medical College initiative directly addresses this structural backlog, attempting a rapid scale-up of public seats and specialised district beds that few sub-national entities of this size have attempted in a single decade.

The changes that took place after 2017 altered that baseline situation. In July 2018, the Union Health Ministry and official health matrices counted 48 medical colleges and 6,499 MBBS seats in Uttar Pradesh, of which 17 colleges and 2,199 seats belonged to the government. The National Medical Commission and recent health sector compilations now list 92 colleges and 14,400 seats. Government-run colleges today number 49 and hold 5,700 seats. Total seats have grown 2.2 times, government institutions nearly 3 times, and public medical seats 2.6 times.

Numbers like these invite a lazy reading, since any government can inflate a count by renaming a building. A seat in this matrix means a regulator approved an intake after reviewing faculty, wards and equipment. That makes the official record harder to dispute than any political claim.

Political philosophy has long evaluated a state based on how fairly it distributes essential public goods. Traditional theories of distributive justice argue that people with equal talent and effort should receive equal opportunities, regardless of geographic origin. A medical college seat in Balrampur or Hardoi translates that structural principle into brick and concrete. Concepts of governance and state capacity ask a direct question about what citizens can actually access in their daily lives. A person who cannot reach a doctor near home enjoys fewer effective rights than one who can, regardless of fiscal allocations. Access to healthcare serves as a prerequisite for every other civil economic freedom, and a state that locates it far away restricts all of them.

Government seats reinforce the welfare argument. They charge a fraction of private fees, so they open medicine to families that could never pay for it. Their share of all seats has risen from 34 percent in 2018 to 40 percent today. A farmer’s son in Ghazipur or a shopkeeper’s daughter in Chandauli can now train close to home. A college also brings a teaching hospital, and teaching hospitals bring specialists who must work in the district.

Distance works like a tax, and it falls hardest on the poor. A family that once sent a sick parent to a distant city paid for travel, lodging and lost wages before it paid for treatment. The government has long said it wants patients to stop travelling to other districts for care. A district college lowers that tax and keeps it low.

It is also necessary to understand politics in simple language. A voter knows her district better than she knows any state-level statistic. She measures a government by what stands in her own district headquarters. A medical college there is visible, local and permanent. It gives a legislator something to point to and provides a citizen something to hold him to. Earlier plans concentrated on seats in a few large cities. This programme reached Amethi, Lalitpur, Pilibhit, Sonbhadra and Kushinagar, districts that rarely featured in traditional development blueprints.

While some districts are still awaiting operational colleges, building physical infrastructure is only the first step. The real test lies in addressing faculty shortages, maintaining equipment quality, and ensuring these institutions retain skilled doctors in remote areas over the long term.

Extensive health workforce literature, including World Health Organisation guidelines on rural retention and studies in journals such as *Rural and Remote Health* and *The Lancet Global Health*, shows that training healthcare professionals in non-metropolitan areas is strongly correlated with higher long-term clinical retention in rural and underserved communities. A student who learns medicine in Etah or Fatehpur is statistically more likely to serve a district hospital than one who trained in a metro and never looked back. Over time that choice of location may do more for rural care than any single hospital building.

The state has built this kind of model before. One District One Product (ODOP) began in Uttar Pradesh and later became a national framework. One District One Medical College can follow the same path, because every large state shares the problem of concentrating care in a few cities. It sits beside the state’s record on public safety and direct benefit delivery as one more pillar of the Yogi model, a way of governing that builds services where people live. Politics and philosophy converge on a single question. What does a state owe the child born far from its capital? For decades, Uttar Pradesh has answered with distance. This programme answers with a building, a faculty and a seat. The answer is incomplete, but it is real, and other states can adopt it.

(Sunny Singh is a research scholar in the Department of Political Science at the University of Delhi and works as a Research Associate at the Dr. Syama Prasad Mookerjee Research Foundation (SPMRF) in New Delhi. The views expressed in this article are those of the author and do not necessarily reflect those of Zee News.)