10 Years On, ANIIMS Still Faces Infrastructure Gaps, Audit Finds

A decade after the Union government approved a flagship medical college in the Andaman & Nicobar Islands to bridge regional healthcare gaps, a national audit has found that the project remains mired in infrastructure shortfalls, equipment deficits, staffing gaps, and governance failures — raising questions about the viability of one of India’s most strategically located public health institutions.

A compliance audit by the Comptroller and Auditor General (CAG) has revealed that the Andaman & Nicobar Islands Institute of Medical Sciences (ANIIMS) continues to fall significantly short of mandated standards for medical education and tertiary care, despite receiving public funding for nearly ten years.

The audit concludes that the project’s central objective — strengthening healthcare access in the island territory and improving the doctor-population ratio — remains largely unfulfilled.

Infrastructure Delays Stretch Into a Decade

The audit found that only 8 out of 29 major infrastructure works planned for the medical college have been completed as of October 2024, pointing to serious gaps in financial planning and project management. 

Among the most striking delays is the Basic Science Block, considered a core academic facility, where administrative approvals alone took nearly nine years. Costs escalated significantly during this period, with the estimated cost of Block-A rising from ₹30.79 crore to ₹48.62 crore, reflecting a 58% increase. 

Residential infrastructure meant to house faculty also remains incomplete. Construction of 42 residential quarters approved in 2016 faced prolonged delays due to slow fund release and administrative bottlenecks, with some units still unfinished seven years later. 

Audit findings indicate that inadequate financial planning at the institutional level led to piecemeal sanctioning of works, ultimately slowing the pace of construction and inflating costs.

Equipment Deficits Undermine Medical Capacity

The report highlights a severe shortage of medical equipment across departments, with 476 out of 1175 required types of equipment unavailable, amounting to a shortfall of nearly 40%. 

Of the equipment that has been procured, 347 machines across 14 departments were found to be non-functional, some lying unused for periods ranging from six months to as long as ten years. 

Critical diagnostic equipment for cancer detection, including Automated Immuno-Histo-Chemistry (IHC) and Cryostat machines, has remained unavailable since 2015, forcing patients to travel to mainland India for tests. 

The audit also noted that against an estimated ₹25 crore earmarked for procurement of equipment, only ₹12.71 crore had been spent as of March 2024.

Shortage of Operation Theatres Delays Surgeries

The teaching hospital attached to ANIIMS currently operates with only five Operation Theatres (OTs) against the required ten prescribed by regulatory norms for institutions admitting 100 MBBS students annually. 

As a result, patients reportedly wait between seven days and one month for surgeries, raising concerns about timely access to tertiary healthcare services in the islands. 

The audit also found missing essential OT facilities such as waiting rooms, preparation rooms, and observation galleries for students, alongside the absence of key equipment including blood warmers and tracheostomy sets.

Intensive Care Units Lack Critical Equipment

Shortfalls were also identified in Intensive Care Units (ICUs), where 57 out of 220 prescribed items of equipment were unavailable across different ICU categories, including neonatal and paediatric intensive care units. 

These shortages impact the hospital’s ability to handle complex medical emergencies and critical care cases, particularly in a geographically isolated region with limited alternative facilities.

Persistent Faculty Shortage Raises Accreditation Concerns

According to the audit, shortages in faculty positions ranged between 23% and 34% between 2018 and 2024, while the shortage of resident doctors reached as high as 40% in certain years. 

Regulations of the National Medical Commission (NMC) require adequate faculty strength for continuation and recognition of medical colleges. Persistent vacancies could therefore affect long-term accreditation prospects for the institute.

The audit attributes staffing gaps partly to delays in creation of sanctioned posts. Although the governing body eventually approved 710 posts, proposals for approval were sent to the Union government only in 2024, nearly ten years after the institution was conceived.  

Governance Weaknesses and Administrative Delays

Institutional oversight mechanisms appear to have functioned irregularly. The audit notes that the governing body of the managing society met only twice between 2013 and 2024, reflecting weak monitoring of project progress. 

Another structural issue identified was dual administrative control of the teaching hospital, which continued to operate under the Directorate of Health Services even after being designated as the teaching facility for ANIIMS. This overlapping control structure complicated staffing, procurement, and decision-making processes.

Regulatory Compliance Gaps Persist

The audit identified several areas where regulatory compliance remains incomplete:

• Medical records have not been fully digitized despite initiation of an e-hospital system nearly a decade ago.
• Biomedical waste management systems lack required infrastructure such as Effluent Treatment Plants (ETPs) and Sewage Treatment Plants (STPs).
• Fire safety systems including automatic detection and sprinkler systems remain inadequate.
• The institution has yet to obtain accreditation from the National Accreditation Board for Hospitals (NABH) or National Accreditation Board for Laboratories (NABL). 

These gaps affect both patient safety standards and institutional credibility.

Diversion of Funds Raises Financial Concerns

The audit further observed that ₹9.22 crore of centrally sponsored funds meant for establishing the medical college was diverted towards maintenance and operational expenses of existing facilities, including repairs, electrical equipment and wages. 

Audit authorities noted that such diversion violated funding conditions, as capital grants were intended exclusively for infrastructure development.

ANIIMS was envisioned as a key intervention to address healthcare disparities in remote island territories and reduce dependence on mainland medical facilities. However, the audit indicates that delayed decision-making, funding constraints and weak institutional coordination have significantly slowed progress.

Even ten years after its establishment, core infrastructure remains incomplete, staffing gaps persist, and regulatory compliance requirements are yet to be fully met.

The audit concludes that the objective of establishing a fully functional medical college capable of delivering quality medical education and tertiary healthcare services in the Andaman & Nicobar Islands remains only partially achieved.