Punjab’s Controversial Move: Doctors Oppose New Medical Colleges Under PPP Model

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Punjab, India, November 2025 — The Punjab government’s recent decision to set up new medical colleges under a Public-Private Partnership (PPP) model in Sangrur and Nawanshahr districts has sparked a wave of opposition from doctors, students, and public health advocates across the state. While the government touts PPP as a means to accelerate medical education expansion and bolster healthcare infrastructure, medical professionals warn that the model risks deepening inequities, raising costs, and privatizing vital public assets.

In early November, the Punjab government, through its Punjab Infrastructure Development Board (PIDB), floated tenders for the development of new medical colleges in Sangrur and Nawanshahr under the PPP model. The initiative is intended to address a persistent shortage of medical professionals, expand access to modern facilities, and relieve fiscal pressure on state resources. However, prominent doctor associations, led by the Indian Doctors for Peace and Development (IDPD), have formally protested, calling for an immediate halt and warning of far-reaching public health consequences.

Key Developments & Stakeholder Concerns

Higher Fees and Social Equity: Doctors and students contend that PPP colleges tend to charge tuition fees substantially higher than those in government-run institutions — sometimes ranging from ₹5 lakh to over ₹20 lakh per year, compared to the ₹20,000–₹50,000 annual fees in state colleges. They argue this threatens to exclude students from lower-income backgrounds and undermine the principle of merit-based, accessible medical education.
Public Asset Control: Critics argue that long-term leasing of public hospital infrastructure to private partners may amount to the hidden privatization of district health assets. This, they say, could gradually erode the public healthcare system and reduce free healthcare services for the poor.
Free Care Ambiguity: While government representatives have indicated that patients would continue to receive free treatment at these institutions, many activists express skepticism, citing experiences in other states where “free” beds have been converted to paid ones under PPP arrangements.
Transparency and Oversight: Many worry about insufficient regulatory safeguards and lack of transparency in PPP contracts, potentially compromising the quality of medical education and the standard of care, especially for vulnerable patients.

Expert Perspectives

To provide broader context, Dr. Abhijat Sheth, Chairman of the National Medical Commission (NMC), has described PPP as “the way forward” for scaling up medical education in India, citing successful examples from states like Gujarat and Andhra Pradesh. According to Dr. Sheth, such partnerships can bring modern infrastructure, streamline project execution, and foster win-win outcomes when properly regulated. “Thousands of patients are receiving quality care. For private partners, this is more about recognition than profit, and it helps utilize their CSR funds effectively… a win-win for both public and private sectors,” Dr. Sheth stated recently.

In contrast, Dr. Arun Mitra, president of the IDPD, and other organizations have questioned the lack of clarity concerning fee structures, scholarship provisions for economically weaker students, and mechanisms to safeguard free public healthcare under the proposed model.

“While public-private partnerships aim to enhance infrastructure quickly, experience suggests that educational equity and the long-term viability of public health delivery must remain central concerns,” said Dr. R.S. Sharma, a public health expert not involved in the current policy process. “PPP models can work, but robust government oversight is crucial to ensure these institutions do not become unaffordable or compromise on service to the disadvantaged.”

Context and Background

The expansion of medical colleges through PPP is not unique to Punjab. Since 2014, India has seen a 71% increase in medical colleges and nearly doubled MBBS seats, with PPP models contributing to this boom. Proponents argue that private capital can rapidly expand availability and bring in technology, relieving government budgets and enabling fiscal sustainability. However, as observed in Madhya Pradesh and Andhra Pradesh, concerns persist regarding high fees, quality dilution, and reduced access for underserved populations.

In Punjab, the move comes at a time when medical students and resident doctors have protested fees approaching ₹11 lakh for an MBBS course, steep service bonds of ₹20 lakh, and stagnant stipends—posing additional strains on affordability and morale. Similar protests in 2025 forced the government to review fee and stipend policies, signaling heightened sensitivity to cost barriers in medical education.

Public Health Implications

Medical Workforce Expansion: Expanding medical colleges is crucial for addressing the doctor-patient ratio (currently around 1:1456 in Punjab versus the WHO standard of 1:1000). New colleges have the potential to train more doctors quickly.
Risk to Equity: If PPP colleges predominantly enroll those who can afford high fees, marginalized communities may lose out, both in education and healthcare access.
Healthcare Delivery: There is a risk that the PPP model, without strong regulation, could convert many free beds and services to paid ones, making essential healthcare less accessible to the poor. State officials assert that care will remain free, but concrete, enforceable guarantees were not highlighted in public announcements.

Limitations, Counterarguments, and Ongoing Debate

Advocates argue PPP allows for rapid upscaling, technology infusion, and public fiscal relief, especially when public funds are constrained. However, critics caution that the design of PPP contracts, lack of fee controls, and weak monitoring can create a pathway for profit motives to overshadow public health priorities. Lessons from other states underscore the importance of robust safeguards, transparent contracts, and inclusive fee and admission policies.

A formal government review of fees, bonds, and stipends is underway in Punjab after recent strikes, and the outcome may affect the PPP colleges’ policies moving forward.

Practical Implications for Readers

For prospective medical students: Carefully evaluate fee structures, scholarship availability, bond requirements, and recognition of degrees offered by new PPP colleges. Public advocacy may be required to ensure equitable access and transparency.

For the general public: Stay informed about how hospital service charges and free care provisions may change with new PPP facilities. Community engagement and feedback mechanisms are key to holding institutions accountable.

For policymakers: A balanced, transparent, and well-regulated PPP framework, with explicit protections for equity and access, is crucial to prevent negative unintended consequences.

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.