Qualified versus Quacks

Ducking the Real Issues?

Satya Sivaraman

And

Dr Siddhartha Gupta

Trained Medical Personnel in India

• Medical Colleges (modern medicine): 266

• Dental colleges: 268

• MBBS doctors/year : 30,290

• Dental surgeons/year: 20,080

• Nursing colleges: 1,597

• GNM/year: 59,138

• Pharmacy colleges: 461

• Degree/ Diploma Pharmacists: 27,735

India: Shortage of Medical Manpower

o Population: 1.21 billiono Allopathic doctor to patient ratio:

1:1722o Including non-allopathic doctors: 1:781o Ratio in rural India: 1:25,000o Doctor Patient ratio in Cuba: 1:170

Health Personnel Shortage

o Estimated shortage of doctors: 600,000o Estimated shortage of nurses: 1,000,000

Major killer and other diseases in IndiaDisease Patients Death

Tuberculosis 15 million 0.5 million/year

Diarrhoeal diseases

4 million/year 0.8 million/year

(mostly <5 yr)

Acute Respiratory

Infection5.5 million/year 1 million/year

(approx)

Typhoid Fever 0.3 million/year N.A.

Malaria 15 million/year 20,000/year

Leprosy Total 0.5 million N.A.

Some Health Indices of India

• Maternal Mortality Rate (MMR): 301 per 1, 00,000

• Infant Mortality Rate (IMR):57 per 1000

• Under 5 Mortality Rate: 72 per 1000

Some Health Indices of India (continued)

• Malnourished Babies: 53%

• Anemia in Women:52%

• Children under 5 yrs dying of malnutrition related diseases: 2.5 million

Poverty/ lack of basic facilities

o People below poverty line (BPL): 27.4% (calculated on the price of food grain with 2200 calorie)

o Daily earning less than US$1: 35%

o Daily earning less than US$2: 74%

o Households with Electricity, Drinking water and Sanitation (all three):28.65%

The Fragile Infrastructure

• Formal medical education is unable to solve the problem of man power, particularly in rural areas

• Most of the villages are dependent of quacks or non qualified rural practitioners, unskilled dais, religious healers & witch doctors

• Health facility is almost non existent in many urban slum areas, labor colonies around sick/ closed factories, resettlement areas of displaced persons

The Fragile Infrastructure (contd.)

• Estimated 75 lakh non-qualified practitioners in the country

• 31 % of Indian population practices self-medication

• Number of pharmacies in India: 550,000

NRHM document (2005 – 2012)

“The goal of the mission is to improve availability of and access to quality health care by people, especially for those residing in the rural areas, the poor women and children”.

Primarily it aims about 650 million people in 18 states.

It realizes that the Herculean task cannot be done by mobilizing the qualified doctors and other health workers only.

Also the approach should be ‘Bottoms up’ rather than ‘Top Down’ i.e. participation of the target population through Panchayati Raj Institutions (PRI).

Integral part of core & supplementary

strategies of NRHM

• Introduction of Accredited Social Health Activists (ASHA) for immunization, RCH service, sanitation, assistance in delivery and use of formulations (drugs) for common ailments.

• Reorientation of formal medical education to support rural health issues including regulation of medical care and medical ethics.

Health Worker Training

Health worker training programmePilot Training Program in 2006

No. of trainees – Five.

From Swadhikar, an NGO working in tea gardens of Kalchini, Jalpaiguri.

From Madan Mukherji Smriti Janaswasthya Kendra, Beliatore, Bankura.

From Calcutta Ahead Centre for Inter-disciplinary Research. Working in Medinipur Village: Pathar Pratima Block, South 24 Pgs.

Regular program from 2008• Mid-July, 2008 to mid-September, 2008

No. of trainees – Ten. Five boys from Tripura Plant-growers’ Co-operative Society. Five girls from People’s Union for Development and Research, an NGO working in Kadamtala, Howrah.

• Mid-November, 2008 to mid-January, 2009

No. trainees – Ten. Five girls from Tripura Plant-growers’ Co-operative Society. Five girls from People’s Union for Development and Research, an NGO working in Kadamtala, Howrah.

Regular program from 2008 (continued)

• Mid-June, 2009 to mid-August, 2009No. of trainees – Eleven. Nine boys from United Milli Forum, a peoples’ organization working in Jharkhand. Two girls from Sambhavana Trust, an NGO working among the gas-affected people of Bhopal, Madhya Pradesh.

• Mid-August 2009 to Mid-October 2009No. of trainees – NineFour boys and 5 girls from different blocks and lands of Sunderbans ravaged by cyclone and flood.

Regular program from 2009

(continued)• November 2009 to December, 2009

No. of trainees – Five Four boys from United Milli Forum, a peoples’organization working in Jharkhand. One from Delhi.

• January 2010 to October 2010No. of trainees – SixteenTwelve girls from United Milli Forum and Four girls and One boy from JOAR, Jadugoda, Jharkhand.

Health workers’ training program

Trainers: Skin, Eye, ENT specialist

Gynecologist

Psychiatrist

Pathologist

Optometrist

Dentist

Pharmacologist

Physiotherapist

Health workers

Curriculum of Health worker program

• Anatomy & physiology of human body

• Pathological basis of diseases

• Different organ systems & common ailments prevalent in rural India

• Diseases related to child birth & child health

• Dental care

• Psychological disorders

• Skin & veneral diseases

Curriculum of Health worker program (contd)

• Basic pharmacology, use of formulations & their side effects

• First aid training

• Basic laboratory investigations

• Practical training on patient examinations

• Injection, transfusion, bandaging, plastering, suturing of wounds

Pre & post training assessment is done

Working with rural practitioners

A training camp for Rural Practitioners

( quacks) from 5 districts of West Bengal

Our View

Medicine developed as an occult science for use of a small group of people

In a capitalist system it is always a tool for oppression of the common people

The benefit of science did not reach the vast majority

Only in erstwhile Soviet Union, Communist China, Cuba and recently Venezuela there has been mass participation in health care delivery for all.

Our View (continued)

• Formal Medical education in our country is completely dissociated from the interest of commoners

• Demystification of medical science & stress on non formal education can solve the health problem in India

• Total revamping of curriculum of medical education & peoples’ participation is the

need of the day

Thank You!