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Indian Journal of Community Medicine

Vol. 25, No. 3 (2000-07 - 2000-09)

Editorial

Population Policy, Preventive Medicine and Primary Health Care

On 11th May, 2000, a girl child born to a mother from middle class family was felicitated by the mandarin from Nirman Bhawan. The effort was an eye catching approach to ring the bell - India crosses 100 million marks. It was not an occasion to rejoice but an opportunity for introspection and that too for the promoters and providers of services expected to limit family size. After all that was the slogan adopted with the declaration of National Population Policy in the year 1960. Much has been written about socio-demographic profile of the family planning services during last 40 years. But there is very little data on the preparation of the training of service providers who have played a key role to provide family planning services country wide. About 80 percent or even more service providers have been trained in institutions for health professionals, e.g. medical and nursing colleges. It would be, therefore, natural to presume that this service care delivery system for the new Population Policy would continue to utilize the existing resources with such modification as may be required based on the past experiences of about 40 years in the training of service providers.

Since application of family planning required the support of health services - an entirely new network of health. The academia had been supportive of the need for training the health professionals to provide family planning services. The recommendations in the early stage were the academician's nightmare. What should be the ranking of family planning in academic field? Is it a subject like anatomy or biochemistry. If not, is it a service component and if so, for what group of clinical sciences?

Looking back, one can identify the dilemma of the academic world. The demand to teach family planning through medical colleges and other institutions grew almost over night. The medical council recommendations approved teaching but the rest was left to the medical fraternity. Some of the aspects related to the introduction of teaching of family planning have remained unanswered. Would the students benefit from teaching or from learning about family planning services? How can learning be strengthened so that family planing is learnt through experience in the hospital? Should the services be provided as part of separate clinic? This approach has been used by most of the medical colleges/hospitals. There are practically no studies on medical students interest and competence as a result of teaching family planning. Very little is known as to how the contents and methods of teaching family planning have changed over the last two decades or more. An effort to implement the `Population Policy' may not form a part of the undergraduate curriculum, but student understanding and ability to provide related services would be of regional/national importance.

How to merge the three important factors - students academic interest and the institution's national interest to implement the National Population Policy. If an opportunity was needed, time is now to review (a) the entire teaching system for teaching the undergraduates (b) hospital care system, which reinforces learning and (c) opportunity to provide primary health care through placement at a primary health centre.

The ceremonial warning of 11th May, 2000 applies also to the institutions that trains the service providers. The outline of the Population Policy takes a holistic view of the situation demanding sharing of efforts for positive action. The demand for service goes beyond family planning to include adolescent and reproductive health. The new Population Policy presents a variety of challenges to the medical education.

One - Curricular content and the learning process - The undergraduate medical curriculum though defining time spent in lectures, demonstrations, hospitals does not deny an opportunity to the medical fraternity to consider a shift from teaching to learning. The modern educational technology has opened its gate wide for the medical colleges to benefit from the educational science input.

The student's opportunity to learn would improve through practice in the hospital environments what they learn in the classroom. The medical faculty members may once again serving the interest in the social component of medicine. It would be relevant to consider aspects of social obstetrics and social pediatrics - the terms that created news in sixties but very soon the interest died with the passage of time.

For the practitioners and teachers of preventive and social medicine this is an opportunity to demonstrate their wisdom, teaching skills and learning opportunities through demonstration of the applicability of terms like social medicine, clinical prevention, a problem based learning approach for providing adolescent and reproductive health services.

Primary health care still remains the corner stone of providing people friendly, cost-effective program of basic health care. Having achieved to a certain extent freedom from major communicable diseases like small pox, plague, cholera, how can the medical science help in securing and promoting health by not only concentrating on physical and biological obstacles but also the social obstacles. The later by and large are presenting challenges for which the present day medical education system in India needs to harness all the efforts. The Population Policy of India provides a variety of opportunities to offer services for removing social obstacles that stand in the way for attainment of social and mental well being.

This in brief, is the challenge thrown at the door of medical professionals by the release of National Population Policy, 2000.

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