By Dr. Sachin Kuchya

We, as a country have excelled in delivering tertiary medical care & are emerging as a bright spot for medical tourism. But we have lagged behind when it comes to delivering basic medical care to our own countrymen, esp. the ones who are poor.

With the aim of improving the delivery of basic medical care, to achieve Antyoday, I hereby propose a solution, through two part – developing & nourishing the ecosystem.

The Road blocks,

  1. Lack of dedicated and motivated platforms for delivery of basic medical care.
  2. Lack of motivated, trained and Skillful manpower at Primary medical centers.

The Strategy,

  1. Developing the Ecosystem – We need to decentralize the delivery apparatus down to district level, so as to seek unmet needs, streamline medical care and be proactive, prepare for next few months in advance.
  2. Nourishing the Ecosystem, Overhaul of the Medical Education – We need to develop Medical Colleges as an Institution which recognizes, entrains and delivers customized medical care to the needy, in its home district (s), under its purview.

Implementing the same,

  1. Accept that there is difference between achievement and maintenance of Health & providing Medical care – carve out separate departments.
  2. Make medical colleges the Hub of Medical training & Resource platform for delivery of medical care in its home district (s), under its purview.
  3. Merge the departments involved in delivering medical services and medical education, at both Central & State levels.
  4. Create Indian Medical Services, to train and raise administrators who will be mandated and will ensure the health care delivery to the Antyoday.
  5. Revise the MBBS, Nursing & Paramedical curriculums, design it in a way that suits our objectives not that of world.
  6. Restore the Sanctity of Internship; Make the post graduation more crispy – save productive years.
  7. Move away from current Eligibility & Training criteria for Medical teachers, towards a problem solving team leader based approach.

Accept that there is difference between achievement and maintenance of Health & providing Medical care – carve out separate departments.

“Definition of health” – nowhere illustrates need for medical intervention – it just needs Clean Air, Clean water, Hygienic & Nutritious food, Clean Surroundings and a cheerful society, it doesn’t need Medical man. Relegate these duties (building, restoring, inspecting, promoting its awareness and fixing responsibility) to the Municipality.

Accept that Medicine is for prevention (Immunization), Diagnosis, Cure or Benefit of the Unhealthy, one who lacks health – the diseased individual or someone at risk of contracting the disease.

The two should be addressed by two different departments. However they may interact with each other, for the greater good of society. The Preventive and Social Medicine department in the medical colleges may be recognized as the Meeting point of the two.

The Municipality or Health Department may ask for specialist Inspections while the Medical Colleges may seek course correction or steps to ensure that the Healthy remains healthy.

A Medical graduate / Specialist will only do the Clinical Work, Training & lead the research to solve the unmet needs of the society.

Make medical colleges the Hub of Medical training & Resource platform for delivery of medical care to its home district (s), under its purview.

Assign the responsibility of delivery of medical care to the medical colleges. Relegate; remap the whole of current Infrastructure and manpower involved in delivery of medical services to the medical colleges. Henceforth every subPHC, PHC, CHC, District hospitals will be under the Medical college of home district or that of adjoining district. These shall be renamed as Sub Primary Medical Centre, Primary Medical Centre & Community Medical Centers (Sub PMC, PMC & CMC).

With the aim of one medical college in each district of the present government, the system shall gradually evolve and in the face of any epidemic – will have a response time of less than few hours at max.

Medical colleges should be the centers of Holistic training. They shall provide the training to undergraduates of Modern Medicine (Allopathy), AYUSH, Nursing, Paramedical etc. all side by side, rather than in Silos. This shall instill the understanding and respect for each other’s role in delivery of medical care. Currently, these are trained at different centers, which are as varied as Nonexistent or Ill equipped Nursing homes, private superspeciality hospitals, or in medical colleges, with no to minimal respect and understanding of each other’s role.

The Infrastructure for delivery of medical care should have a hierarchy and it should be adhered too. One cannot take up the role of every other and do it efficiently too. No primary OPD should be run at the Medical Colleges; these OPD’s will only see the patients referred from the PMC’s or CMC’s under the medical college.

The Infrastructure should be backed by a strong IT backbone, so that there is seemless transfer of data from PHC’s to CHC’s to Medical Colleges. This will help the referral centres to provide seamless medical care to those refered. This will also help the medical colleges to assess the UNMET needs, allocate the resources, initiate research and contribute to National registries.

Merge the departments involved in delivering medical care and medical education, at both Central & State levels.

As of now, the MBBS undergraduates are looked after by dept of Medical Education, while the government doctors, paramedical staff are looked after by dept of Health services.

Therefore, the MBBS undergraduates are not directly involved in National health programmes like, Universal Immunization, Polio day, National deworming day etc. So they are not able to raise the awareness, not confident while discussing the same in society – and we fail to train them, equip them and make their learning more productive esp when it comes to National Health Programmes. And therefore all the stake holders’ viz. Students, Govt and the society is at loss.

Therefore the two Departments should be merged immediately, with Infrastructure and Administration brought under the purview medical colleges.

The National Health Programmes, shall involve the medical undergraduates (most of them are run on Sundays or Weekend basis, which can be imbibed very well into PSM training hours). This way the motivation, training and feel of government led delivery of medical services will be with them from the moment they enter into a medical college. Just imagine an average of 600 – 750 MBBS undergraduates at each of the 439 medical colleges, you get them involved into National health proggrammes and we get 3 lakh ambassadors for our national health proggrammes. This will also become a feeder mechanism for the crucial dedicated manpower, which is willing to become the backbone of future medical care delivery mechanism.

Apart from National Health Programmes, use the Skills of MBBS Ist prof students for once a year – health screening camps at Sub primary medical centers. This will help us build & update Electronic Health records for every Indian national, search for Unmet needs etc.

Create Indian Medical Services, to train and raise administrators who will be mandated and will ensure the health care delivery to the Antyoday.

Each of the Department discussed above needs full time administrators. They are necessary for effective Implementation, Monitoring, Customization & further improvement of medical care delivery.

One of the basic conflicts is that the Medical fraternity esp. the Clinicians do not want themselves to be identified as Administrators. On the same hand none of the medical fraternity wishes to be ruled by a non- medical fraternity. The reasons are vary from very Rationale ones to Irrational ones. Irrespective of their rationality they shouldn’t be a stumbling block in delivery of medical care services to the last man standing in the queue,  Antyoday.

Therefore, a whole creed of Indian Medical Services should be raised –who will administer the delivery of medical care from Sub Primary Medical Care centre to, Primary – Community & District hospitals – Medical Colleges, as Hospital supdt and Dean, Director State & Central. This will leave the Government doctors to do the Clinical Work only, while the administrator & administration becomes a facilitator for delivery of medical care.

Having stressed on developing the Ecosystem, we can always improve it further by nourishing the same, with better Manpower. To be continued & concluded, in part II- Nourishing the ecosystem.

(Writer is MBBS MD DNB Physician and Associate professor, NSCB  MC  Jabalpur (MP India)

The Solution to improve the delivery of Basic Medical Care, achieving Antyodaya #2