|DR. G. ANJANEYALU ORATION
|Year : 2010 | Volume
| Issue : 2 | Page : 81-83
Radical changes in public health - Need of the hour
T.S.R. Sai1, Kunal Kanti Majumdar2
1 Professor & HoD, Department of Community Medicine, S. V. Medical College, Tirupati - 517 507, Andhra Pradesh, India
2 Associate Professor, Department of Community Medicine, K. P. C. Medical College, Kolkata, West Bengal, India
|Date of Web Publication||27-Nov-2010|
Department of Community Medicine, S. V. Medical College, Tirupati - 517 507, Andhra Pradesh
|How to cite this article:|
Sai T, Majumdar KK. Radical changes in public health - Need of the hour. Indian J Public Health 2010;54:81-3
I am thankful to IPHA for giving me the opportunity to deliver the oration in the name of Dr. G. Anjaneyalu, my teacher and a great philosopher. Dr. G. Anjaneyalu, MD, Retired Professor of Community Medicine, is a well-known personality in the field of Public Health. He has a vision to look into the future of Public Health. He is also a leader capable of influencing young doctors and teachers.
| Basis for radical changes|| |
NRHM budget is available for manpower development, training, and infrastructure development in the 11 th plan. There are complaints that MOs posted in rural areas are not willing to work. The Government is seriously considering developing a new alternative MBBS course to meet the demand for rural health care unless radical changes are thought of regarding the quality of public health care. Minor changes and alterations in the health care delivery system will not deliver the results like successful implementation of 108/104 ambulance services. The success stories in public health in India are often measured and expressed in terms of quantities rather than quality. All these years, we are indulging in figures and target years to accomplish Public Health goals. Unfortunately, we are not able to reach in time even these quantitative targets. So conventionally we are trying to change these deadlines.
| Quality in public health services|| |
Quality in Public Health Services includes strengthening Public Health departments - expansion in medical colleges and manpower, training of mainly doctors, training new cadres to provide rural health care, changes in Primary Health center and subcenter concepts, introducing the concept of mobile medical care system in rural areas.
| Revamping community medicine department in medical colleges|| |
The department should be renamed as the Department of Community Medicine and Public Health. The department will have not only academic work in medical colleges but also extension work of public health in the district/region. The staff of the department should be strengthened to support, monitor, evaluate, and effectively implement public health activities.
Staff pattern suggested in the new proposed department
All program managers and DM and HO will be under the technical control of the Community Medicine Department.
| UG training|| |
The course should be of 5.5-year duration with 1 year of compulsory internship training. The course should be as follows: 1.5-year first MBBS period, 1.5-year second MBBS period, 1-year third MBBS period, and 1.5-year final MBBS period. Community Medicine examination should be at the end of the final year along with Medicine, Surgery, and OBG.
Community Medicine theory classes should start in the third MBBS period and continue in the final MBBS (total period of 2.5 years). During first and second MBBS period, there should not be any Community Medicine classes. In the first MBBS period, a paper on Medical Sociology and Clinical Psychology should be introduced. In the second MBBS period, a paper on Research Methodology and Biostatistics should be introduced. Clinical postings in Community Medicine should start in the third MBBS period for 1.5 months on rotation basis. These postings should continue in the final MBBS period also for 1.5 months on the same rotation basis.
In government sector medical colleges, statisticians with MCI-stipulated qualifications (M.Sc. Statistics) and diploma in Medical and Health Statistics should be recruited. Similarly posts of medical sociologists and clinical psychologists should be created.
| Internship training|| |
During internship training, only 1-month posting is sufficient in Community Medicine. The interns should work in rural health centers. Rest of the 11 months the interns should work in the hospital and learn all the basic skills in Medicine, Surgery, and OBG.
There is no mechanism in government medical colleges to supervise interns posted other than RHCs.
Induction training for doctors entering government service to work in health centers and hospitals
All doctors who wish to join government services and serve in the rural areas should have 1-year induction training. During this training, the doctors should be paid stipend equal to the final year PG student. For those doing 2-year DPH and 3-year MD, the first year training should be the same as induction training.
Training schedule for induction training should be as follows:
- 6-month training in State Institute of Health and Family Welfare
- 3-month training in PHCs
- 2-month training in district health organizations
- 1-month training in Forensic Medicine.
Yearly, two batches can be admitted with a strength of 30-40 candidates. Regional health institutes in the state should be geared up to start this induction training for doctors. No doctor should be allowed to join government service without undergoing this compulsory induction training. The doctors should be allowed to undergo this training immediately after the completion of the MBBS course and such doctors can be directly absorbed into health services.
| New MBBS course to provide care in rural areas|| |
The GOI and MCI are planning to have a condensed MBBS course to meet the need of doctors in rural areas. Creating a new health cadre parallel to the existing UG course is not at all a wise step. It will create lot of problems in the society as well as the governments. The professional associations like IMA, IPHA, and IAPSM should discuss these issues and make their recommendations to MCI and GOI.
Instead of creating a new cadre of doctors with an entirely new system, it is advisable to use the present health cadre available with some backup training. This cadre can be designated as rural health care providers (RHCPs). The present B.Sc. (N) and BPT and other paramedical cadres like health inspectors, lady health supervisors, PHNs, and CHOs could be roped in and can be used as RHCPs. Pilot projects can be taken up regarding the utilization of these cadres in rural health care. It is very advantageous to use these cadres who are already functioning in the health sector rather than going for a new cadre. Such rural health care providers can be kept at the PHC level also as suggested by me and the doctors can be pooled for providing a mobile health care system.
| Revamping primary health centers|| |
Questions may arise if there is any need to have a medical officer in a primary health center. They can be replaced by rural medical practitioners or rural health care providers as presently thought of by government and MCI.
Model Primary Health centers
They should provide Routine Medical Care daily from 9:00 AM to 2:00 PM and from 4:00 PM to 7:00 PM. Emergency delivery services should be provided 24 h. They should be linked to the mobile health care system. Routine emergency epidemic works should be continued.
ASHA workers and AWW should provide support at the village level. There should not be any field work for these staff except for epidemic emergencies. MCH work and deliveries should be conducted for 24 h. The subcenters should run from 9.00 AM to 2.00 PM and from 4.00 PM to 7.00 PM. All MCH services should be provided in these centers on a daily basis including routine immunization. Postnatal care should be through ASHAs and AWWs. Registration of births and deaths should be done . They should be linked to the mobile health care system.
| Mobile health care system|| |
At present, it works on the model of 108/104 mobile ambulance system. The team consists of 1 MO and 1 SN and paramedics. If needed, a specialist could also be added to this mobile team. This mobile team caters for a population of around 30,000. Five or six such mobile teams should operate around a CHC for covering a population of 2 lakh. User charges may be collected from the beneficiary.
| Conclusion|| |
If you are ignorant about anything, please deliver a lecture. You will become wise.