MEDICAL EDUCAITON IN HARYANA
Medical education and its curriculum
is basically dependent upon general education system and type of health care
system in a country as a whole. The medical education status of a state will
depend upon general policies which are framed at national level.
A. GENERAL EDUCATION IN HARYANA
The existing system of
general education in our country has developed to a great extent but it has
failed to deliver the desired effects of education. As a result of this a large
number of people in Haryana are deprived from getting education. The literacy
rate of 55.85% is the testimony to the above statement. On the other hand the
economic development has been still faster, but the gainers are few.
The
education that is being taught in the institutions has little connection with
the day to day functioning of life. It is not helpful for greater number of
people in making them self confident and self reliant to lead a better life. In
such circumstance it is not surprising that scientific awareness is very much
lacking which in turn becomes a great rider for new scientific innovations to
be adopted for the development of the society. Continuance of higher education
in non-professional stream has become mostly an alternative for unemployment.
Even the science subjects are loosing their hopes. New subjects like computers,
commerce and M.B.A. have limited number of seats though they have a temporary
career for students.
In the
present system of education there is little scope for assessing the aptitude of
students which could direct their choice for vocational training or
professional education. For higher studies merit has become synonymous to
money. It depends upon the paying capacity of the parents that which area the
student will follow.
Because
of various reasons, most of the students cannot continue their studies beyond
eighth, so very few of them get the eligibility to complete for vocational,
professional or higher education. Even if a student quality he cannot compete
with students coming from an affluent family and trained in better institutes.
Even the competition is becoming stronger amongst the latter. Corruption and
manipulations are being reported in newspapers as the major mode of getting
into a carrier. Admissions, examinations and services in Haryana are reported
to be manipulated through all petty means.
B. HEALTH CARE
Every
country has got its own health culture. The present system of health care which
was introduced by our foreign rules didn’t care of the health needs of our
people in general because they wanted only to impart some treatment to their
own people and to those who could some to their proximity. The Indian system of
medicine was made to stagnate as there were prejudices against it. Ultimately
it got perverted also. Obviously such a neglected system could not compete with
the modern medicine.
PRESENT
HEALTH DELIVARY INFRASTRUCTURE OF HARYANA
If we compare the health infrastructure at the
time of independence and now, one can say that lot of progress has been made
but a lot more is desired to be done. The following tables give some insights
of health care delivery system in Haryana.
TABLE NO. 1
|
Administrative setup (1996-97)
|
|
Area (sq. km.)
Villages
Towns
Blocks
Tehsils
Subtehsils
Divisions
Subdivisions
Districts
|
42212
6759
94
111
65
31
4
45
17
|
TABLE NO. 2
|
Population of Haryana
|
|
1991
1996-97
Rural 1,24,08,904 1,42,05,135
Urban
40,54,744
46,42,065
Total 1,64,63,648 1,88,47,200
|
TABLE
NO. 3
|
Parameters Haryana India
|
|
Percentage of
scheduled
|
19.75
|
16.48
|
|
caste population
|
|
|
|
Sex ratio
|
865
|
927
|
|
Density of population
|
372
|
274
|
TABLE
NO. 4
|
Vital Rates (1995 SRS)
|
|
|
|
Haryana
|
|
|
|
Rural
|
Urban
|
Total
|
|
Birth Rate
|
31.2
|
25.4
|
29.9
|
|
Death Rate
|
8.5
|
6.8
|
8.1
|
|
Infant mortality Rate
|
70
|
65
|
69
|
TABLE NO. 5
|
Female age effective
marriage (1991 SRS) in years
|
|
|
Haryana
|
India
|
|
|
Rural
|
18.9
|
19.2
|
|
|
Urban
|
20.3
|
20.6
|
|
|
Total
|
19.2
|
19.5
|
|
TABLE NO. 6
|
Allopathic Medical
Institution as on 31.3.97
|
|
1. Hospitals
|
Number
|
No. of Beds
|
|
|
a.
State Public
|
43
|
4341
|
|
|
b.
State Special
|
12
|
202
|
|
|
c.
Private
|
20
|
2232
|
|
|
d.
ESI
|
4
|
405
|
|
|
Total
|
79
|
7180
|
|
|
2.
Community
Health Centers
|
63
|
1890
|
|
|
|
|
|
|
|
3. Primary health Centers
|
398
|
1690
|
|
|
4.
Dispensaries
a.
State Public
|
30
|
63
|
|
|
b. State Special
|
27
|
24
|
|
|
c. Private
|
5
|
-
|
|
|
d. ESI
|
69
|
36
|
|
|
Total
|
131
|
126
|
|
|
|
|
|
|
|
5. Urban Health Posts
|
16
|
-
|
|
|
6. Postmortem Centers
|
37
|
276
|
|
|
7. District T.B. Centers/ T.B. Clinic
|
15
|
141
|
|
|
8. MCH Centers
|
32
|
-
|
|
|
9. Others
|
1
|
-
|
|
|
10.
Sub Centers
|
2299
|
-
|
|
TABLE
NO. 7
Sub Centers, PHC’s and CHC’s required
as per 1991 population and in position as on 30.06.97
|
Sub Centers
|
Primary Health Centers
|
Community Health Centers
|
|
Reqd. In position Short Fall
|
Reqd. In Position Short Fall
|
Reqd. In Position Short Fall
|
|
2482
|
2299
|
183
|
414
|
397
|
17
|
103
|
64
|
39
|
|
|
|
|
|
|
|
|
|
TABLE NO. 8
|
Specialist Doctors and other Paramedical Staff as on
30.06.97 for CHC’s PHC’s and Sub Centers
|
|
|
|
|
|
|
|
|
Category
|
Required
|
Sanctioned
|
In Position
|
Vacant
|
Short Fall
|
|
Surgeons
|
64
|
63
|
14
|
49
|
50
|
|
Gynecologists
|
64
|
63
|
04
|
49
|
60
|
|
Physicians
|
64
|
63
|
05
|
58
|
59
|
|
Pediatricians
|
64
|
63
|
09
|
54
|
55
|
|
Radiographers
|
64
|
56
|
32
|
33
|
32
|
|
Pharmacists
|
461
|
553
|
517
|
36
|
-
|
|
Lab Technicians
|
461
|
213
|
132
|
81
|
329
|
|
Nurse Midwife
|
845
|
781
|
593
|
188
|
252
|
|
Block Extension
|
-
|
90
|
50
|
40
|
-
|
|
education
|
|
|
|
|
|
|
LHV / Health Asst. (F)
|
397
|
540
|
430
|
110
|
-
|
|
Health Asst. (M)
|
397
|
590
|
552
|
38
|
-
|
|
Doctors at PHC’s
|
397
|
674
|
486
|
188
|
-
|
TABLE NO.9
|
Position of buildings for
Sub Centers, PHC’s and CHC’s
|
|
Category
|
Functioning
|
Govt. Building
|
Rented
|
Under construction
|
To be Constructed
|
|
Sub Centers
|
2299
|
914
|
N.A
|
194
|
1191
|
|
PHS’s
|
397
|
165
|
N.A
|
45
|
187
|
|
CHC’s
|
64
|
59
|
N.A
|
22
|
-
|
The present
medicare system has given triple benefit to the vested interests.
1.
It has distracted the attention of the people
at large from demanding the basic prerequisites of good health which is food,
shelter, potable water, disposition of human and animal excreta and education.
In other words of social justice is being denied. This has become very clear
from effects of new economic policy in health sector.
2.
It
has helped the vested interests in using these institutions to keep social and political
control over the weaker sections making them subservient to the stronger
section to beg relief which otherwise should have been their right to obtain.
3.
It
has helped them in using this scientific and technological advance for their
commercial benefit i.e. enormous profit at the cost of human health and life.
To achieve
this sociopolitical and economic benefit the dominant social classes have
introduced a type of medical education which is bound to serve the interests of
these classes at the cost of people’s health at large. This is the story of the
last 50 years.
PRESENT STATUS OF MEDICAL EDUCATION IN HARYANA
There
are two medical colleges, four dental colleges and three ayurvedic colleges in
Haryana. Few more are being opened. Students coming from upper strata of
society get admission in medical colleges. Naturally they shouldn’t have social
orientation and commitment to serve the society at large. Students are not
selected on the basis of aptitude because of the commercial benefit paradigm.
Present
medical education is institutionalized and is dependant on sophisticated
investigations and therapies. The approach towards health problems is
predominantly unifactorial although it is a reality that health and disease are
basically multifactorial. The irony is that people are aware of the ill effects
of the unifactorial approach but don’t dare to change it because:
a.
those
who are entrusted to change it and are capable of doing so are the products of
these institutions and also the beneficiaries.
b.
training
itself is misdirected and actively obstructs the scope of viewing the patient
in totality i.e denying the multifactorial approach of medicare. Doctors and
paramedical personnels thus become agents of commercial benefits of the
planners. The planners have introduced the recipients in order to create a
market so that persons responsible for medicare don’t rise against this system
because of their competitive interests.
POLICY LEVEL
CHANGES
1. Change in the general education:
It
is suggested that to implement a people oriented, need based medical education,
one should change the present system of general education. The opportunity must
be opened to all sections of our society so that the children from the lower
strata get an opportunity to qualify of higher education (General, Vocational
and Professional). For this the change in the timings of the schools, creative
and innovative methods of teaching, change in the curriculum of general
education, well oriented teachers etc are some of the essential components.
PROPER SCREENING OF STUDENTS
There
must be screening to divert the students to different streams depending on
their aptitude and performance by continuous assessments by the teachers and
the parents as well. This will need a reorientation of outlook of the teachers
and also the parents. This is again very much dependent upon the job
opportunities and scope of employment in respective fields. It is
understandable that in mixed society like India this is difficult to implement
but it is time that we demand for it and change the direction of present system
of medical education.
LOPSIDED
PRIORITIES SHOULD CHANGE
Present
policy has created a situation in Haryana where more doctors are being produced
in medical institutions without giving proper attention to the training of
paramedical staff such as nurses, anganwadi workers, lab technicians and
pharmacists. We need nurses and paramedics in large numbers. We need
specialists for our community health centres which are starving because of lack
of specialists. Medical colleges which are being planned to be opened in
private sector will increase this disparity further as the seats for nurses
courses are being reduced.
Thrust
areas in special reference to specific health problems in Haryana e.g. residual
effects of pesticides on human beings, urinary system stones, psychiatric
problems, infant mortality rate, maternal health and gender problems are some
of the areas which need more attention.
EFFICIENT MANAFEMENT OF THE
INFRASTRUCTURE
Health
care is primarily the responsibility of the state. Individuals have a role to
play for care of his health but the individual can’t go beyond the influence of
their cultural, socio-political and economic environment.
The
staff in CHC’s PHC’s and Sub centres should be adequate. The necessary software
and hardware should be made available in these centres. Public accountability
of the persons working should be fixed. Required infrastructure should be
provided as per the norms laid down.
There
should be properly regulatory law for private nursing homes in Haryana.
The
burden on PGIMS, Rohtak is mainly from Rohtak district (about 60%). The serious
and problematic cases referred from the other districts may not get required
attention because of increased work load. PGIMS, Rohtak is having CHC Dighal,
Civil Hospital Beri, CHC Kathura (Chiri) and CHC Chhara under its direct
administrative control. A bilateral referral system can be started on
experimental basis between Rohtak District and PGIMS, Rohtak. The patients from
Rohtak city first should go to Civil Hospital Rohtak and from there they can be
referred to PGIMS, Rohtak. This may improve the functioning at PGIMS, Rohtak
also.
REORIENTATION
OF MEDICAL EDUCATION IS REQUIRED
Students
must be selected purely on basis of aptitude and performance assessed during
general education through continuous assessments. The objective of medical
education should be to prepare:
A.
Basic
doctor who will form the base for health care for the people.
B.
Medical
Specialists
C.
Medical
Scientists
D.
For
optimal use of new technological advancements by the medical institutions to
avoid exploitation of the poor patients by private sector and to teach
students.
E.
Nurses
and paramedical staff as per the required norms.
There shouldn’t be any capitation
fee.
TRAINING CURRICULUM
A.
Selected
students should be posted for 6 months in primary health centers to reorient
them to the socioeconomic and cultural needs of Haryana. There itself they will
learn basic anatomy, physiology and pathology.
B.
After 6 months they should go to sub divisional
/ district / regional hospitals for further one year under specialists of
different disciplines to get training. Further detail of anatomy, physiology
and pathology in relation to the disease under treatment will be taught.
C.
After
eighteen months of training the students will be taught in medical institutions
for next three years to learn basic science and clinical disciplines through
intensive and extensive teaching with well adjusted curriculum so that the
course will be for and a half years as it is at present.
D.
There
should be continuous assessment and monitoring of the students. This will help
them screen for basic doctors, medical specialists or medical scientists.
Students are also mature enough to plan their future at this stage. Medical
scientists for basic sciences need not get intensive training for clinical
medicare after obtaining their degrees. Medical specialists will be trained
extensively in their respective specialties. Internship after graduation should
be there for one year at CHC level.
The three years extensive training at medical colleges should be there to
strengthen to conceptual basic of different specialties. Specialist training
after A, B and C should be encouraged depending upon the requirements of
Haryana.
WHAT SHOULD BE THE CURRICULUM
In context of present scenario, there is globalization with open market
economy which has created a group of people (about 10 crores in India and
twenty laksh in Haryana), who can complete U.S.A, U.K and Japan in all aspects
and their expectations are definitely very different than rest of the people
(about 85 crores) who either can’t make their both ends meet or are surviving
with great difficulty.
More
rational approach will be to plan the curriculum of medical education which can
respond to the needs and expectations of the people at large. Keeping in above
things in mind, the curriculum can have following elements:
1.
Standard
text books on all subjects authored by Indian doctors must be prescribed.
2.
Applied
aspects of basic science – 18 months – should be scheduled for the field for
which a new curriculum should be developed.
a.
First
aid management in general and of particular diseases should get required
emphasis.
b.
Basic
knowledge about these problems should be imparted.
c.
Area
specific diseases should be taught.
3.
Theoretical
details should be taken up at PGIMS Rohtak in next three years.
4.
Honours
course ( extra paper ) for those who want to become medical specialists or
medical scientists should be undertaken ( computer course should be part of
this curriculum ).
5.
In
undergraduate period emphasis on social and preventive medicine should form a
major part.
6.
Learning
by doing alongside the bed of the patient in the field should be the approach
of teaching. Rational portions of other system of medicines should become part
of curriculum with a concept of “modern medicine”
7.
Region
specific curriculum:
a.
Farm
accidents and road accidents.
b.
Residual
effects of pesticides in human beings.
c.
Disturbing
trends in sex ratio and its implications.
d.
Urinary
tract stones etc.
8.
Exposure
to super specialties:
The basic principles of super specialties should be
undertaken.
EXAMINATION SYSTEM
A.
Uniform
pattern
B.
Major
credit should be given to continuous assessment.
C.
More
emphasis should be given to clinical diagnosis and treatment.
D.
Theoretical
knowledge may be assessed by written and practical exams at the time of final examinations.
E.
For
advance courses separate examinations should be held.
The conscious efforts should be made in this direction so that some
concrete policy level decision can be taken.
Dr. R.S.
Dahiya
Associate
Professor
PGIMS
Rohtak
2003-2004
