Govt to set up nine institutes to train allied health workers

India’s health ministry has approved the setting up of nine institutes dedicated to training allied health workers as part of a shift towards a team-based system rather than a doctor-centric one. The institutes will generate 10,765 allied health professionals annually, setting the stage for rolling out universal health care under the 12th Five-Year Plan.

The decision is part of a policy change to reach under-served, semi-urban and rural areas of the country, where doctors have traditionally refused to relocate. The health ministry has allocated a budget of Rs. 1,100 crore (Rs. 11 billion) for the project.

There is a total national shortage of 6.4 million allied health personnel in India, according to the Health Ministry’s National Institute of Allied Health Sciences (NIAHS) report, which will be released on 21 December by health minister Ghulam Nabi Azad. The biggest gaps are in Uttar Pradesh, West Bengal, Maharashtra, Bihar and Andhra Pradesh.

Allied health professionals or AHPs are technicians and therapists, such as radiological technicians, medical laboratory technicians, occupational therapy assistants, etc., who acquire procedural skills. Investment in their training are usually considerably less than that for a physician. Training of AHPs takes around two years, making them a cost-effective and a reliable alternative in areas where physicians are not available.

“Allied health personnel-led services significantly reduce the costs of similar services structured around a consultant-physician model,” said Kavita Narayan, study coordinator, NIAHS, Public Health Foundation of India (PHFI). “This is an attempt to deliver seamless services to patients, creating a model of social solidarity. AHPs also provide rapid responses to patient needs in areas where services of general physicians are not available. They complement skills sets of doctors and nurses in therapeutic, diagnostic and curative realms of medicine.”

The national and regional institutes of allied health sciences will offer 26 different courses. The councils for each of these specialities, along the lines of the Medical Council of India (MCI), will also be set up to monitor and govern each subject, enforce norms, standardize course durations and training methodologies. Currently, there is no regulatory body to govern allied health sciences in India.

“Human resources are a critical factor which will have considerable impact on policies in the health sector. Investing in human resources and retaining skilled workers will be key to success of health reforms under the 12th Plan,” said Vishwas Mehta, Joint Secretary, Ministry of Health. “The nine institutions are a part of targeted intervention the health ministry is making to develop a skilled health workforce. Besides meeting demand-supply gaps in health workforce, the problem of availability of health services in under-served areas can be effectively addressed by task shifting and a team-based approach to health care delivery,” he said. The health ministry will set up expert panels to standardize course curricula for all 26 subjects, which will be reviewed periodically.

Source: Mint, December 18, 2012

India short of 236,000 dieticians

Diet-conscious Indians don’t have enough dieticians to consult for a healthy diet. A comprehensive study on the shortage of dieticians conducted by the Public Health Foundation of India (PHFI) and submitted to the Union Ministry of Health says the nation is short by nearly 236,000 dieticians.

Uttar Pradesh recorded the highest shortage of trained dieticians at about 40,000, followed by Maharashtra (21,925), Bihar (20,385), West Bengal (17,847), Andhra Pradesh (16,351) and Madhya Pradesh (14,128). Similarly, Tamil Nadu was short of 14,097 dieticians, Rajasthan (13,288), Karnataka (11,823), Odisha (8,170), Kerala (6,534), Haryana (4,936) and Delhi (3,317).

Lack of proper nutritional advice is posing a problem for India, which is suffering from the dual burden of under nutrition and over nutrition among children and adults. International Confederation of Dietetic Associations says India has less than one dietician (0.3) per 100,000 population. In comparison, there were 25 dieticians per 100,000 population in Denmark and Israel, and 56 for a similar head count in Japan.

National Institute of Nutrition (NIN) comes out with a nutritional guideline for Indians, but very few know what it actually recommends. Experts say dieticians were never given much importance till a decade ago. But, now their presence is of paramount importance in both hospitals and standalone clinics.

Kavita Narayan, hospital and health systems expert from PHFI, who directed the study, said, “The Paramedical Council being planned by the ministry should be broken under heads like therapeutic, curative, rehabilitative and non-direct care rather than have separate Councils for the 140 plus categories of paramedical disciplines. A faulty diet is behind many of India’s health problems.”

Dr Subhash Salunke, former director general of health services of Maharashtra, said, “The major constraints are that the number of institutes which are training qualified dieticians are few. Besides, the perception that dieticians are needed is low. Thanks to lifestyle changes, their role in promotive healthcare is vital.

Source: The Times of India, September 13, 2012

Norms eased to raise density of medical colleges

The Union Ministry of Health has decided to allow split campuses — medical college and a hospital within 10 kms of each other across the country — to reduce India’s skewed ratio of medical college distribution. So far, split campuses were allowed in nine cities like Mumbai, Chennai, Kolkata, Delhi, Bangalore, Hyderabad, Ahmedabad, Kanpur and Pune.

In a notification to be released within a few days the health ministry will allow medical colleges to start on 10-acre plots instead of 25 acres. Ministry officials say medical colleges in some states are shutting down hospitals inside towns due to unavailability of land and opening sprawling campuses on the outskirts, inconveniencing patients. Union health secretary P K Pradhan said, “We will allow split campuses across India now. Land unavailability should not hamper medical education.”

At present, India has a density of one medical college per 3.841 million population. Around 315 medical colleges are spread across 188 of 642 districts.

Experts say there is an acute need for medical colleges in certain states. “Sometimes a hospital does not have enough land to start a medical college. We have asked the MCI (Medical Council of India) to relax norms to allow a split campus provided facilities like transportation and telecommunication are in place,” a ministry official said.

The high-power expert group of the Planning Commission working on universal health coverage has proposed a phased addition of 187 colleges, according to which, by 2022, India will have one medical college per 2.5 million population in all states except Bihar, UP and West Bengal.

Source: The Times of India, August 14, 2012

Doctors going to US for studies will have to sign bond for return

The government today said any doctor going to the US for higher medical studies would have to sign a bond with it before leaving and honour the document by returning to India after finishing the study period. “From this year onwards, any student going for further medical education to the US will have to give us a bond that he will come back after finishing the studies. In the last three years, 3000 doctors went abroad for studies and did not return. Now if a student does not come back from the US, he won’t be allowed to practice there,” Union Minister for Health Ghulam Nabi Azad said.

He said the US from this year onwards is insisting on a government NOC to every student enrolling with an American institute for studies. “No other country except the US is asking for this NOC. Those who apply to go to the US for studies from 2012, will have to give us a bond saying they would come back after finishing the studies. If they don’t fulfill the bond obligation, we can write to the US to deny the student permission to practice,” Azad told reporters here.

The minister also expressed the hope that the MCI (Medical Council of India) will give its approval to the proposed three-year Bachelor of Rural Health Care course, which seeks to create a separate cadre of public health professionals in the country to serve in rural areas. He said the doctors’ organisations were not interested in the course. “Doctors’ organisations are opposing the course. I have no hesitation in saying that they have a vested interest to increase their practice,” Azad said.

Azad said there was a paucity of doctors in primary health centres as doctors only wanted to stay in urban areas. “The rural health care course was ready two years ago. The curriculum is also ready. States are free to implement the course, as Assam is doing, but we wanted the MCI’s recognition to ensure uniform standards for the course across India. We hope the MCI will move fast on it,” he said.

The course, Azad said, would create professionals above the level of paramedics and below the level of MBBS doctors. The move is aimed at not just taming the quacks, who have a field day in rural areas in the absence of adequate medical facilities there, but also provide good medical aid to the rural population at their doorstep. It is being opposed by doctors’ lobby as patients from rural areas rush to private practitioners in urban areas, even as doctors’ organisations feel the creation of a new set of professionals would confuse the population and lead to devaluing the doctors, official sources said.

Source: The Times of India, April 24, 2012

To boost NRHM, government to hike PG seats in some courses

The Union Ministry of Health has identified medical streams in which it wants to increase the number of seats. The move is aimed at catering to burgeoning demands of the National Rural Health Mission (NRHM). The streams facing shortage are gynaecology, paediatrics, anaesthesia, general medicine, general surgery, oncology and radiology.

“We are looking at the total output in these disciplines of which we are assuming 10 to 15 per cent would either join the private sector or leave the country. On the basis of projected demand for the NRHM and the National Programme for Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, we are ascertaining the total number of additional seats that would be required. We may for this year remove the cap of 200 in government medical colleges and then work towards an increase in seats in all medical colleges for the 2013-14 session,” said a senior official of the ministry. In the long term, the ministry hopes that the cap will be 250 for all medical colleges, but the details are being worked out by the programme division.

Though the last date for applying to the Medical Council of India (MCI) for starting new postgraduate courses was over in May 2011, the ministry hopes to be able to increase some seats at least in the government medical colleges for the 2012-13 session. This will be over and above the increase of 7,000 PG seats that have have been initiated by revising the student teacher ratio in postgraduate medical colleges. For the 2012-13 session, the MCI has received applications for 1,200 new PG seats across the country.

The state-wise NRHM progress report circulated internally in September shows that at least one-third of the sanctioned posts of specialists in CHCs remain vacant. While the ministry is hard-pressed for specialists, there is no plan to make entrance examinations easier. “We want quantity but not at the cost of quality,” the official said.

Source: The Indian Express, January 6, 2012

AIIMS creates 230 new posts to meet staff crunch

The Union Ministry of Health sanctioned the creation of 230 new faculty positions in the premier medical institution of the country — the All India Institute of Medical Sciences (AIIMS) —- to tide over acute faculty crunch. The new posts include 144 assistant professors, five professors, an additional professor, 10 lecturers in nursing and 70 technical personnel. A ministry official said “We have sent the order to the administration of AIIMS. The posts will be filled up soon. It will improve patient service and teaching and take the load off the present faculty.”

A recent study by AIIMS’ Department of Hospital Administration had said most of the departments in the premier hospital are grossly understaffed. Though 629 faculty positions are authorized at AIIMS, only 434 are filled — a deficiency of more than 30%.

The ministry has put out advertisements to recruit 120 assistant professors to fill the previous vacancies. “Screening is on to fill the previous vacant posts. Interviews will be held shortly. Besides, we have created 230 new posts,” said the ministry official. The lack of enough faculty members is hampering research, which AIIMS was earlier known for.

Faculty members told The Times of India that one of the main reasons for doctors finding no time for research is due to tremendous patient load. “Nearly 10,000 patients a day attend OPDs alone. Three-fourths of the faculty members interviewed felt that their department was understaffed. About 90% of the faculty disagreed that AIIMS has adequate strength. This is why male faculty members spent an average of 38.6% extra time over and above their official working hours for the purpose of teaching, research, patient care and institute-related activities. Female faculty members spent an average of 14.1% extra time,” the internal study had said.

The lack of faculty was also increasing waiting time for patients requiring an intervention. It could take as long as two years to get a date for a simple MRI scan. While a CAT scan has a waiting period of over four months. For patients requiring a total hip replacement or a total knee replacement, the waiting period is five months and six months, respectively.

Source: The Times of India, January 6, 2012

MCI says no to rural MBBS course

The Medical Council of India (MCI) has told the Ministry of Health that the rural MBBS programme of three-and-a-half years, as it has been envisaged for the last more than two years, is not feasible. It has said the course cannot be called Bachelor of Rural Medicine and Surgery (BRMS), degree holders cannot be replacements for MBBS doctors in sub-centres and the curriculum cannot be based on disease module.

MCI Board Chairman Dr K K Talwar said: “We have told the ministry that this can be a BSc degree for a family health worker or a community health worker. Using the word Bachelor in the name of the degree is misleading because it gives rise to a sense of equivalence with MBBS, which is creating confusion. The curriculum, too, has to be changed.” He also clarified that the course would in no way become a shortcut to an MBBS degree. A senior health ministry official said: “MCI is looking at the proposal and working out the modalities. They will get back to us in due course.” Dr Talwar’s stand is similar to that of the MCI Board led by his predecessor Dr S K Sarin.

At a meeting of the Parliamentary Standing Committee on Health and Family Welfare held last week, several issues were raised including the modalities of regulation of such a cadre, the apprehension that through a bridge course holders of the BRMS degree would be made full-fledged MBBS doctors and the logic of having two different types of doctors for urban and rural India.

The Committee also questioned the rationale of training BRMS students in module form — basically taking the common diseases and learning the symptoms, diagnosis and treatment of them — rather than first getting the kind of exposure to physiology and anatomy that doctors get. That, according to Dr Talwar, will now change as the MCI takes stock of the curriculum afresh.

Source: The Indian Express, January 4, 2012

MCI starts 3-year PG in Family Medicine

Family physicians medical practitioners that were fast disappearing are now being revived. With India witnessing a rush of medical students keen on becoming specialists, the Ministry of Health and Medical Council of India (MCI) have notified introduction of a new three-year postgraduate course MD in Family Medicine. Chairman of MCI’s board of governors, Dr. K K Talwar said, “The curriculum has been prepared and sent to all state governments that have been told to roll out this broad speciality course.” Experts say a doctor with MD (Family Medicine) will be the one who will know a little of every discipline, from pediatrics to gynecology and will be able to treat the community as a whole.

This will soon bring back the family physician in the forefront of primary healthcare. The steering committee on health has also been pressurizing the ministry to endorse family medicine. In its recent report finalized last week, it said, “family medicine discipline needs to be introduced in all medical colleges so that they can effectively manage most of medical problems encountered at primary level, and referral to specialists occurs only when necessary.” Till now, most family physicians were MBBS doctors. “The MD course on Family Medicine is more advanced than a simple MBBS and will help doctors wanting to increase their acumen in community health,” Dr. Talwar said.

At present, the only available post-graduate programme on family medicine was the DNB Family Medicine qualification, conducted by the National Board of Examinations-accredited community hospitals. NBE Executive Director Dr. Bipin Batra said, “The demand for DNB (Family Medicine) course run by the NBE is seeing a major increase. We have 300 seats for this discipline. As against just 50 MBBS students enrolling to become family physicians a couple of years ago, the numbers reached close to 300 in 2011. This is mainly because private hospitals have increased their recruitment for general practitioners.”

Students pursuing MD (Medicine) are taught more in-depth on diseases, functions of various organs and their treatment. Professor Ranjit Roychoudhury, former member of MCI’s board of governors, said, “A person with a postgraduate degree in family medicine will look at preventive, prophylactic and promotive healthcare. He will have extensive knowledge on healthcare for the elderly who cannot move out of the house and will be taught on everything from gynecology, psychology to pediatrics.”

Introduction of Family Medicine as a PG discipline has been emphasized by the Bhore Committee, National Health Policy 2002, National Knowledge Commission and the Task Force on Human Resource for NRHM. Dr. K Srinath Reddy, President of Public Health Foundation of India, said, “Family medicine is a required discipline. The rush for specialization has deprived doctors of the ability to look at individuals as a whole and families as one unit. We require large number of persons trained in family medicine, which combines a broad set of clinical competencies.”

American Academy of Family Physicians defines it as medical specialty that integrates the biological, clinical and behavioural sciences. The scope of family medicine encompasses all ages both sexes each organ system and every disease entity.

Source: The Times of India, January 3, 2012

Assam court finds MBBS admission criterion irrational

The Gauhati High Court has found the Medical Council of India (MCI) eligibility criterion for MBBS aspirants from the scheduled castes and tribes “irrational and in violation of Article 14 of the Indian Constitution”, officials said Sunday. According to MCI regulations, MBBS aspirants from these categories must secure at least 40 per cent marks in the combined competitive examinations or joint entrance examinations (JEE). The union health ministry and the MCI had earlier refused to further relax the criterion for north-eastern tribes and scheduled caste students.

A senior Tripura health department official said around 31 MBBS seats were lying vacant in the government-run medical college in Agartala and in the Tripura quota in other states because no student secured the minimum in the JEE this year in the state.

Some students and guardians have filed a writ petition in the Gauhati High Court against the MCI regulations. “The High Court has asked the authorities to admit those students in the MBBS courses within a week against their respective quota of seats,” the official said, quoting the court order passed Friday in Guwahati. “The division bench of the court, comprising I.A. Ansari and C.R. Sarma, said in their ruling that state secondary board examination results were sufficient,” the official said.

“Though the MCI regulations had been upheld by the Supreme Court in its various verdicts, the fact of the matter remains that in the decisions, cited and relied upon, the constitutionality of the regulation have been put to challenge,” the court is reported as saying. “When the issue has not specifically been raised and has not been decided, the constitutionality of the MCI’s regulation remains open for challenge on the ground of its irrationality,” the high court said.

Union Health Minister Ghulam Nabi Azad, responding to a letter of Tripura Chief Minister Manik Sarkar, has communicated the centre’s decision to follow the MCI guidelines. Azad had said: “Though the health ministry agrees in principle that there is need to make enabling conditions to encourage the underprivileged sections of the society, so far as medical education is concerned, it is felt that diluting the qualifying criteria would neither be feasible not desirable.”

Source: The Economic Times (Online Edition), September 25, 2011

Medical Council of India pulled up by CIC

The Central Information Commission (CIC) has expressed surprise at the Medical Council of India (MCI) for not having the document by which a particular medical degree is recognised. In a recent order, Information Commissioner Shailesh Gandhi said: “Medical degrees are recognised nationally based on the recognition of the Medical Council of India and such negligence must be stopped.”

Issuing the order on a case filed by a Noida resident, Dr. G. S. Thind, who had asked the MCI to confirm the correctness of information put out on January 12, 2008, on the website of Jawaharlal Nehru Medical College, Aligarh, that its MD preventive medicine / community medicine granted by Aligarh Muslim University was recognised by the Medical Council of India as per IMC Act, 1956.

The appellant had noticed that on the MCI’s website two different years – 1987 and 1997 – had been mentioned for recognising the degree of MD (Community Medicine) issued by Jawaharlal Nehru Medical College, Aligarh. He sought to know which of the two was correct.

The CIC said the MCI subsequently corrected the website and stated that the year for recognition was 1987. It said this was based on a record which is mentioned in the department index. Thereafter, Dr. Thind produced before the Commission a letter dated September 11, 1991, in which it appeared that the MCI was requesting the Ministry of Health and Family Welfare of Government of India to recognise the said degree. The MCI admitted that the recognition has to be authorised through a gazette notification which was not available presently.

Gazette notification?
At this the Commission said that despite the fact that the RTI application had been made in January 2011, this important gazette notification had not yet been procured by the MCI, which claimed it would request the Central Government to send it the same but was not in a position to commit when this could be sent to Dr. Thind.

Source: The Hindu, September 11, 2011