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Indian Journal of Community Medicine

28th National Conference

Author(s): Dr. K.Raghava Prasad

Vol. 26, No. 2 (2001-04 - 2001-06)

28th Annual Confference of the Indian Association of Preventive and Social Medicine
Jammu, Feb. 9-11, 2001

Address by the President, IAPSM

Distinguished Chief Guest, Dignitaries on the dias, Delegates, Members of the Medical Faculty, Ladies and Gentlemen,

It gives me great pleasure to be here today in the midst of the august gathering on the occasion of the inauguration of the XXVIIIth National Conference of IAPSM. I am grateful to the members of IAPSM for bestowing on me the honour to be their President.

I express my sincere thanks on my behalf and on behalf of IAPSM to the Organising Committee who have spared no efforts in making the arrangements for the conference and to the authorities of Government Medical College, Jammu for extending all encouragement and assistance.

I take this opportunity to share with the learned colleagues a few thoughts of mine in relation to the main theme of the Conference, "Into the 21st Century; Challenges and Commitments in Community Health". I wish to confine myself to the challenges faced in the field of Health Care Delivery in the coming years and decades.

Several newly emerging and re-emerging health problems posing threats to Community Health world-wide are receiving our attention. However, the issues in the field of health care services are equally important in the context of the new health problems as well as of the emerging social, economic and environmental conditions.

First, we have to think about the current globalization processes. These are not merely economic involving liberalization, comprising deregulation and promotion of free trade and privatization, comprising disinvestment and contraction of public sector but also technological and cultural.

The economic policies characterised by Liberalization, Privatization and Globalization are likely to result in reduction in Government spending in health, education and welfare sectors and may strike at the concept of social justice. The resultant effects pose a threat to population health and to public health practice. Primary health care system which is predominantly oriented to promotion and prevention and is mainly government funded, is likely to suffer most unless specially safeguarded. The technological and cultural globalization also will have adverse health effects in areas such as nutrition, occupational health, environmental hygiene and social hygiene.

Secondly, there appears to be a public health crisis in India. There is a feeling that public health infrastructure in our country is deteriorating and there is diffidence on the part of the health system to face the threats posed by the new and old health problems. There is lack of standardized and effective public health interventions to tackle either disease outbreaks or natural disasters. We usually respond to various health problems with a `crisis approach' instead of a `planned approach' for prevention and control. Further, the ad-hoc vertical programmes launched from time to time are adversely affecting the implementation and monitoring of the existing health programmes and services especially at the level of primary health care.

Some of the underlying causes for the public health crisis are low priority for public health speciality; dominance of generalities in policy making and programme planning; inadequate training of public health personnel, both basic and in-service; lack of focussed public health research; lack of effective disease surveillance system and unsatisfactory curricula in PSM both at undergraduate and postgraduate levels. In the context of the rapid socio-economic changes with prospects of poverty associated health risks and the existing weak public health system, we as faculty of PSM have to examine our role in safeguarding the health of the population. To my mind the following activities are relevant to our members.

Policy Making:

Our members at various levels can influence the health policy such that the community and social perspective of the health programmes and services is taken care of. The issues may cover aspects like financing of health services, resource allocation, priority-setting, regulation of private sector in health, appropriate technology, etc. and should aim at reducing the social and health inequalities. As Rudolph Virchow said long ago, "Physician is the natural attorney of the poor".

Research:

Our endeavours are mainly in the area of operations research i.e., problem solving type. At present in many of the institutions at least in my state and in similar situations elsewhere, there is no focus for the research activities undertaken; whatever projects being carried out are ad-hoc, one time, either thesis-oriented or some repetitive evaluation studies for certain agencies and thinly spread over large unrelated areas i.e. lacking focus and depth. Instead, we should focus on specific problems or areas, identify the problems accurately and build up research expertise in the chosen area. For this a department (or an individual) should identify an area of interest and carry out sustained work in that area for a period of time. Even different topics on these can be allotted only in that area for several students so that the department can build up some database.

Research on themes such as alternative models of health care delivery and disease surveillance systems are most appropriate in the light of the issues raised earlier. The research inputs should enable us to provide relevant academic back-up to health services.

Medical Education:

Though there are some improvements in the new Medical Council of India MBBS curriculum, there are still many problems plaguing teaching of PSM. The main issue is need for skill based teaching and evaluation for which necessary inputs in terms of men, money and material are required. These are lacking in many state medical colleges which are the suppliers of medical manpower for managing the health services in the country. The field practice areas are woefully lacking in facilities; they are deteriorating instead of developing. The authorities are paying lip service to the needs of our faculty though they otherwise extol the need for and virtues of our discipline. Here it may be emphasized that the evaluation methods should lay stress on testing of skills so that skill training gets its due in curricula.

Even more important is the imparting of necessary skills to our postgraduate students, who are the future public health practitioners and teachers so as to equip them to confidently face the challenges in public health practice and to enable them to impart in turn the necessary skills to their students; otherwise we will be causing `longitudinal' damage to the discipline.

Hence we should improve and faithfully implement curricula based on sound principles of educational science at undergraduate and postgraduate levels.

Training:

The faculty has to play an important role in designing a variety of training programmes for different categories of health personnel at various levels of health care. These programmes should be need-based, well-targeted and scientifically designed to achieve their objectives.

I am sure by fully involving ourselves in above activities we can contribute our might in addressing the new challenges to community health.

I once again thank Dr. Bhupinder Singh and his team and the authorities of Government Medical College, Jammu for hosting our annual conference.

Thank You,

Dr. K.Raghava Prasad

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