Eleventh Five Year Plan
Eleventh Five Year Plan Eleventh Five Year Plan
Health and Family Welfare and AYUSH 97Box 3.1.19Human Resources for HealthIssues• Growing shortage of all key cadre in rural areas—Doctor, Paramedicals, ANMs, Nurses, Lab Technicians, and OTAssistants.• Problems of absenteeism and irregular staff attendance.• Non-availability of drugs and diagnostic tests at health facility leading to demotivation of doctors.• No motivation or will to serve in rural areas.• Weak or non-existent accountability framework leading to powerlessness of local communities and Panchayat vis-à-visthe health system functionaries.• Non-transparent transfer and posting policy leading to demoralization.• Inadequate systems of incentive for all cadres especially in difficult area postings.• Lack of career progress leading to demotivation and corruption.• Lack of standard protocols to promote quality affordable care and full utilization of human resources.Possible Solutions• State-specific human resource management policy and transparency in management of health cadres.• Training and utilization of locally available paramedics, RMPs, and VHWs to meet the gaps in rural areas. Allow them toprescribe basic medication.• Reintroducing Licentiate course in Medicine• Incentives for difficult areas and system for career progression.• Accountability to local communities and Panchayats.• Devolution of power and functions to local health care institutions—provide resources and flexibility to ensure serviceguarantee.• Resources, flexibility, and powers to ensure that IPHS are achieved.• Adequate staff nurses and a minimum OPD attendance and service provision• Improved and assured tele-linkages.• Efforts of the National Board of Examinations(NBE) will be enhanced for overcoming the shortageof specialists and also to improve the quality oftraining.• Councils to create a scientific data bank of healthprofessionals.• Re-registration of all medical and dental practitionersincluding specialists after every five years tillthey are practising or serving.• New medical, nursing, and dental colleges will beestablished in the underserved areas.• As recommended by the NCMH (2005), prioritywill be given to reducing the existing inequalityby establishing 60 medical colleges in deficit States(UP, Rajasthan, MP, Orissa, Chhattisgarh, etc.) and225 new nursing colleges in underserved areas.PPP will be used to bridge this gap.• Experiences of University of Health Sciences set upin various States during the Tenth Plan, against medicalcolleges that are part of the general universities tobe evaluated before more such universities are set upduring the Eleventh Five Year Plan.• Implementation of recommendations of OSC fordevelopment of Human Resources for health.• Equip medical graduates with the skills essential forproviding broad-based community health care.• Stem the high rate of attrition of academics; teachingin professional colleges to be made attractive.Need to enhance the salary structure and providean innovative programme of incentives. PrivateOPDs in the medical colleges to be considered asone such incentive.• RMPs, after training, can contribute towards activitiesunder NRHM. Few suggested roles have beenlisted in Box 3.1.20.Public Health Education3.1.159 Currently several institutions are engagedin imparting public health and related educationin the country. Various medical organizations are in
98 Eleventh Five Year Planthe process of starting new Public Health Courses atthe Masters level, namely Indian Council of MedicalResearch (ICMR), AIIMS, PGIMER, etc. The supplyposition is bound to improve after institutions ofPublic Health under Public Health Foundation ofIndia (PHFI) and new Public Health Schools are setup within the existing Medical Institutions.3.1.160 During the Eleventh Five Year Plan, benefitsof knowledge and skills of modern Public Health willbe made available at all levels. For the development ofpublic health, multiple independent centres with acommon regulatory body will be a suitable approach.Some of these centres could be located in universitiesof health sciences and some with the multidisciplinaryuniversities. This would enable greater input fromdifferent disciplines to enrich the subject. During thePlan, therefore, efforts will be made to set up new publichealth schools within the existing medical colleges.MBA Programmes specially tailored for the healthcare and MD (Hospital Administration)/DiplomateNational Board (Hospital and Health Administration)/MD (Community Health Administration)/Masters(Hospital Administration) Programmes will be encouraged.Health Systems and Bio-Medical Research3.1.161 With the development and use of sophisticatedtools of modern biology, a better understanding ofcomplex interplay between the host, agent, and environmentis emerging. This is resulting in the generationof new knowledge. This scientific knowledge is tobe used to develop drugs, diagnostics, devices, andvaccines that should find a place in the health systemsof the country. A vibrant inter-phase between theresearch community, the industry, and the healthsystems is the only way to facilitate this. It is not onlythe technological advances in public health andmedicine that influence health of the population.The epidemiology of disease extends beyond biology.A sociological perspective is important to understandthe occurrence, persistence, and cure of a disease. Thediseases are not rooted in biological causes alone, butare multifactorial. This calls for an inter-disciplinaryapproach to health research.3.1.162 The Eleventh Five Year Plan, therefore, willmark a departure in orientation to research in health.No amount of pure bio-medical research will be ableto find solutions to health issues unless it addressesupfront the social determinants of health. While healthresearch has made appreciable progress, there remainsan unacceptable lag time in translating the researchoutcomes into tangible health products or in applicationof the knowledge generated through research.Thus, the task is how best to mobilize research to bridgethe gap between what is known and what is done—the ‘know-do’ gap. Equally important is to ensure thatthe products of health research reach and are used forand by the people who need it most. Health researchduring the Eleventh Five Year Plan will be directed toprovide ways and means of bringing about equity andimproving access to health technologies.3.1.163 With a view to re-organize the medical researchestablishments in the country in order to keepBox 3.1.20Role of RMPs as Sahabhaagis in NRHM• Running social awareness programmes in schools to cover topics like: ill effects of tobacco and alcohol, advantages ofgood sanitation, hygiene, nutrition, and safe drinking water• Running free camps for: vision tests, health check-ups, immunization• Training rural people in association with SHGs about: Hygiene, Sanitation, Nutrition, Safe drinking water, Needs ofpregnant women, Protection against unsafe sex, awareness about locally prevalent communicable and non communicablediseases• Providing non clinical contraceptives and referring for clinical cases• Acting as drug distribution depots and fever treatment centres• Supervising spray activities, water treatment, sanitary landfill, and sanitary latrines• Providing emergency primary health services and referrals
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98 <strong>Eleventh</strong> <strong>Five</strong> <strong>Year</strong> <strong>Plan</strong>the process of starting new Public Health Courses atthe Masters level, namely Indian Council of MedicalResearch (ICMR), AIIMS, PGIMER, etc. The supplyposition is bound to improve after institutions ofPublic Health under Public Health Foundation ofIndia (PHFI) and new Public Health Schools are setup within the existing Medical Institutions.3.1.160 During the <strong>Eleventh</strong> <strong>Five</strong> <strong>Year</strong> <strong>Plan</strong>, benefitsof knowledge and skills of modern Public Health willbe made available at all levels. For the development ofpublic health, multiple independent centres with acommon regulatory body will be a suitable approach.Some of these centres could be located in universitiesof health sciences and some with the multidisciplinaryuniversities. This would enable greater input fromdifferent disciplines to enrich the subject. During the<strong>Plan</strong>, therefore, efforts will be made to set up new publichealth schools within the existing medical colleges.MBA Programmes specially tailored for the healthcare and MD (Hospital Administration)/DiplomateNational Board (Hospital and Health Administration)/MD (Community Health Administration)/Masters(Hospital Administration) Programmes will be encouraged.Health Systems and Bio-Medical Research3.1.161 With the development and use of sophisticatedtools of modern biology, a better understanding ofcomplex interplay between the host, agent, and environmentis emerging. This is resulting in the generationof new knowledge. This scientific knowledge is tobe used to develop drugs, diagnostics, devices, andvaccines that should find a place in the health systemsof the country. A vibrant inter-phase between theresearch community, the industry, and the healthsystems is the only way to facilitate this. It is not onlythe technological advances in public health andmedicine that influence health of the population.The epidemiology of disease extends beyond biology.A sociological perspective is important to understandthe occurrence, persistence, and cure of a disease. Thediseases are not rooted in biological causes alone, butare multifactorial. This calls for an inter-disciplinaryapproach to health research.3.1.162 The <strong>Eleventh</strong> <strong>Five</strong> <strong>Year</strong> <strong>Plan</strong>, therefore, willmark a departure in orientation to research in health.No amount of pure bio-medical research will be ableto find solutions to health issues unless it addressesupfront the social determinants of health. While healthresearch has made appreciable progress, there remainsan unacceptable lag time in translating the researchoutcomes into tangible health products or in applicationof the knowledge generated through research.Thus, the task is how best to mobilize research to bridgethe gap between what is known and what is done—the ‘know-do’ gap. Equally important is to ensure thatthe products of health research reach and are used forand by the people who need it most. Health researchduring the <strong>Eleventh</strong> <strong>Five</strong> <strong>Year</strong> <strong>Plan</strong> will be directed toprovide ways and means of bringing about equity andimproving access to health technologies.3.1.163 With a view to re-organize the medical researchestablishments in the country in order to keepBox 3.1.20Role of RMPs as Sahabhaagis in NRHM• Running social awareness programmes in schools to cover topics like: ill effects of tobacco and alcohol, advantages ofgood sanitation, hygiene, nutrition, and safe drinking water• Running free camps for: vision tests, health check-ups, immunization• Training rural people in association with SHGs about: Hygiene, Sanitation, Nutrition, Safe drinking water, Needs ofpregnant women, Protection against unsafe sex, awareness about locally prevalent communicable and non communicablediseases• Providing non clinical contraceptives and referring for clinical cases• Acting as drug distribution depots and fever treatment centres• Supervising spray activities, water treatment, sanitary landfill, and sanitary latrines• Providing emergency primary health services and referrals