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Indian Journal of Community Medicine

Strengthening Preventive and Social Medicine Departments in the Medical Colleges of Rajasthan

Author(s): SC Mathur

Vol. 32, No. 1 (2007-01 - 2007-03)

SC Mathur

Primary responsibility of the Department of Preventive and Social Medicine (PSM) in the Medical Colleges is to impart knowledge and skills in epidemiology to the medical undergraduates so that good public health practitioners are available to the community. Such training can be more effective and realistic when PSM departments are concurrently involved in implementing or providing consultancy to the public health program at topical level. With changing health scenario, advances in health care technology, increasing cost of health care and rising expectation from the community, it has become all the more relevant to invest in the growth of these Departments. This fact was taken into cognizance by a group of experts while developing a health sector investment program for Government of Rajasthan.

Government of India with the support from European Commission initiated a series of state specific heath sector investment program in a couple of large states of India in late nineties. The focus of this program was on reforms to be induced to expedite the process of achieving a better state of Community Health. Under this ambit, Government of Rajasthan also entered in a tripartite agreement with Govt. of India and European Commission to initiate a health sector investment program which over these seven years (between 1999 and 2006) has proved to be a project implemented in two phases with an investment of over Rs. 77 Crores between 1999 and 2006.

Amongst the various health interventions launched through this project, one of the major components was to strengthen the Preventive and Social Medicine Departments of the six Medical Colleges owned by the state government. Incidentally each of the six Medical College in the state is located in a large town, which happened to be the divisional headquarter of administrative/revenue division of the State. Since each of the division is a cluster of four to six districts with a social and culture homogeneity, it happens to be an ideal unit to demonstrate the operations of public health.

Overall objective of this component was to develop the functional linkages between the Medical Colleges (Producers of Doctors!) and Zonal Directors/CMHO’s (Practitioners of Public Health!). It was thought of that effective disease surveillance at zonal level by bringing the two parties together could pave the way to achieving the goals of various national health programs. Specific objectives of this component included: Conducting a need assessment of PSM Departments to elicit the requirement of physical resources and software inputs in terms of requirements to develop the capacity of their faculty; evolving a training program for the faculty which may fulfill the gaps identified through training need identified as a part of need assessment; establishing disease surveillance units at regional level in Rajasthan. European Commission supported Health Sector Reforms Project in Rajasthan had twelve components. Societies at state and district level were constituted to execute these components. State Health Society delegated the component of “Strengthening PSM Departments” to the State Institute of Health and Family Welfare, Rajasthan (SIHFW-R). The later is an apex level autonomous training and research institute in the health sector being led by a public health specialist. Incidentally throughout the implementation of the PSM strengthening component, SIHFW-R is being directed on full time basis by a Professor of Preventive and Social Medicine.

SIHFW-R initiated this task by conducting a Need Assessment of PSM Departments at the outset by involving two retired illustrious Professors of the discipline along with Director of IIHMR. Team of four experts collected a volume of information on the facilities available to PSM Departments and subsequently visited three of the six Medical Colleges where full faculty contingent was in place in the respective PSM Departments. Beside on the spot review of resources, brainstorming sessions were held with faculty. Major points elicited through this need assessment are given in the next section. Since training needs of the faculty could be determined through need assessment, in the second phase two training program to enhance the capacity of teachers of PSM Department were organized. State Government was also convinced through this logical need assessment to release the funds on priority directly to the Medical Colleges. Thus later may procure the physical resources like computers and photocopiers from local market on one hand and help PSM departments to undertake short-term research studies to consolidate their long term role as managers of disease surveillance units.

Faculty expressed a serious concern about the declining status of PSM department in the overall settings of Medical Colleges. Disillusionment was obvious on the dilemma of government expressing the need to prioritize the public health on one side and Medical Council pushing down such priorities in the overall frame of undergraduate medical education. PSM Departments as an organization have not been proactive in developing work relationship with health service delivery system. There was lack of initiative to create opportunities for developing field based training of the undergraduates and bring the departments at the centre stage. Department libraries are also redundant. There is a gradual decline in the arrival of hard copies of UN documents including WHO publications. In the want of arrangements to scan soft copies, faculty fails to update itself as much as is required. Limited budget for the central libraries of the Medical College results into low priority accorded to the requirements of PSM Departments.

Sustenance of departments without information technology and internet connectivity was surprising. Facilities for AV arrangements and reprography were also limited. Museums were found to be on extinction except certain efforts made through students of developing posters from petty grants accorded to observe IEC activities on WHO or Leprosy elimination day. Limited mobility in the want of vehicles resulted into a transition where undergraduate education has largely been circumvented into intramural teachings. Last but not least was the low morale of faculty. There was lack of enabling environment in the PSM departments. Pessimism of teachers was also refl ected in limited opportunities for faculty and career development.

Sharing of Need Assessment with the Secretaries and Directors of the Health and Medical Education Department at the state level paved the way to betterment. Its first outcome was achieved in terms of organizing two training program of one week each. Two full days in each of the two training programme were devoted to Organization Behavior Laboratory to deal with issues like personal effectiveness, role efficacy, leadership and motivation. Remaining four days were focused on group work on epidemiological exercises covering surveillance, risk analysis and designing research studies. Courses being residential in nature gave enough opportunities to participants to acquaint themselves with basic computer skills. Since 22 of the existing 39 teachers of PSM have gone through these one-week tailor made Management Development Program, it has certainly added to the capacity of respective Departments.

Report on Need Assessment also triggered the state government to release two installments to each Medical College. 1st installment of Rs.4 lakhs included Rs.2.1 lakh for purchase of equipment including internet connectivity and furniture; Rs. 1.2 lakh for library development, Rs. 20 000 for enrichment visit by senior faculty members and Rs. 5000 for Consultancy for developing PSM departments. 2nd installment of Rs 6 lakh released six months later included Rs. 1 lakh to further equip libraries; Rs.50 000 as mobility support for field visits; Rs.2 lakh to carry out short term research, Rs.1 lakh for deploying additional manpower; Rs. 1 lakh for capacity building of the faculty through nominations to conferences and workshops and Rs. 50 000 for office expanses.

SIHFW-R vigilantly observed the happenings at different corners to facilitate the strengthening and perceived the weaknesses and threats of this mechanism to bring on record the suggestions for corrections in future. Government of Rajasthan invested Rs. 65 lakhs over a period of three years in the PSM department of six Medical Colleges of Rajasthan as a part of health sector reforms project. It is yet to see the light of the day in terms of PSM departments playing the role of zonal disease surveillance centers for the health department albeit Integrated Disease Surveillance Project being launched during the course of strengthening of these departments.

Since the channel of funding to the PSM departments is through the offices of the Principals of Medical Colleges, a unique phenomenon of generously granted funds from autonomous State Health Societies getting stucked up in the grip of government accounts system was observed. Although all the six Medical Colleges could procure the hardware and library material but it would be premature to comment on the basis of this achievement as the soft activities towards strengthening remained standstill! It is really challenging to induce attitudinal change in the stakeholders in a short span of time. Head of respective PSM departments also did not want to confront with a large system which is obviously visible in terms of non-utilization of funds allocated for research activities including deployment of additional manpower and funds for mobility. It is really disappointing to observe that additional funds given to enhance the capacity of the faculty remained absolutely unutilized.

In large public systems like Medical Colleges under state government, wide and varying interest groups infl uence a time bound project. Nevertheless hope for strengthening cannot be given up as could be perceived from the faces of some of the teachers who have at their disposal photocopiers, computers and relevant journals in the respective departments. An idea fl oated by one of the younger faculty member of rotating the PSM teachers for minimum five years through health care delivery system speaks volumes to initiate future change.

SC Mathur
Director, State Institute of Health and Family Welfare, Jaipur, Rajasthan.
Received: 02.01.07

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