Table Inauguration by S.No . Contents Page No 1. Context 6 2. Objective of the conference 7 3. Expert Presentations 8 3.1 Right to health – An international perspective Dr Chandrakant Lahariya, National Officer, WHO 8 3.2 Law and Policy framework for rights based approach to health Amulya Nidhi, National Co convener, Jan Swasthya Abhiyan, India 14 3.3 Financing options for materializing Right to Health in MP Indranil Mukhopadhyay Assco Prof, School of Government and Public Policy; 18 3.4 Role of Local Governments and Community Institutions State level consultation with civil society and experts Dr. Yogesh Kumar, Samarthan NGO 26 3.5 Rethinking Medical Education and Skill Development in MP Prof. Dr. Sunil Nandeshwar Dean, ABVGMC, Vidisha, MP 28 4. Breakout sessions 32 6. Recommendations 33
Transcript
Table
Inauguration by Shri. Tulsiram Silawat Hon’ble Minister, Public Health & Family Welfare Department,
Govt. of M.P.
In the presence of Dr. Pallavi Jain Govil Principal Secretary, Public Health & Family Welfare Department,
Govt. of M.P.Shri Nitesh Vyas Commissioner, Health ServicesDr. J. Vijayakumar CEO, Ayushman Bharat “Niramayam” M.P.
ParticipantsProf. Sumit Shukla Prof. MGM College, Indore
S.No. Contents Page No
1. Context 6
2. Objective of the conference 7
3. Expert Presentations 8
3.1 Right to health – An international perspectiveDr Chandrakant Lahariya, National Officer, WHO
8
3.2 Law and Policy framework for rights based approach to healthAmulya Nidhi, National Co convener, Jan Swasthya Abhiyan, India
14
3.3 Financing options for materializing Right to Health in MPIndranil Mukhopadhyay Assco Prof, School of Government and Public Policy;
18
3.4 Role of Local Governments and Community Institutions State level consultation with civil society and expertsDr. Yogesh Kumar, Samarthan NGO
26
3.5 Rethinking Medical Education and Skill Development in MPProf. Dr. Sunil NandeshwarDean, ABVGMC, Vidisha, MP
28
4. Breakout sessions 32
6. Recommendations 33
Conference proceedings of “Conference on rights based approach to health” August 30, 2019 Bhopal
Mr. Jamil Qurashi CEDMAP Bhopal DC
Mrs. Nisha bari Parnami Technical Trainer
Dr. Sudhir Jesani Deputy Director, DHS
Mr. Amulya Nidhi Jan Swasthya Abhiyan
Dr. Chandrakant Lahariya WHO
Mr. Rahul Rokade Medical expert
Mr Anil Gulati UNICEF
Mr. S. N. SINGH Sedhwa Homyopethic Shikshan Sansthan
Mrs. Shakti Dalal, Technical trainers
Dr. Rajshree Bajaj Deputy Director, DHS
Dr. Sanjay Bhalerao Medical Expert
Dr. Sunil Nandeshwar Dean, GMC Vidisha
Dr. Dipak Ganvir Medical Expert
Prof. Dr. V Vijayakumar Vice Chancellor, NLIU
Mr. Mukesh Kumar Sinha MP Voluntary Health Association
Mrs. Laxmi Kolli Technical trainers
Asst. Prof. Amit Pratap Singh NLIU
Mrs. Arti Pandey Technical trainers, NHM
Mr. Amitava Guha Medicine and Health rights Expert
Dr. Shobha Khot Deputy Director, DHS
Dr. Himani Yadav DD, Ayushman Bharat
Mr. S. R. Azad MP Vigyan Sabha
Ms. Sudha Tiwari Technical trainers
Dr. Sameer Iyer Consultant
Mr. Indranil Mukhopadhyay Health Economics Expert
Prof. Tapan Mohanty Professor, NLIU
Dr. Vandana Bhatia Health Specialist, UNICEF
Dr. Anshul Shukla DD, Ayushman Bharat
Program Officer Hukum singh sewa samiti
Ms. Lalita (shilpa) Jain Social trainer
Dr. Pramendra Thakur Medical Expert
Dr. G.D. Verma Medical expert
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Dr. Sumitra Yadav MGM College, Indore
Dr. Yogesh Kumar, Samarthan
Dr. Ritesh Singh DD, Directorate Health
Dr. Dilip Acharya Medical expert
Ms. Jolly Shabu Technical trainers
Dr. Vandana Khare GM, Ayushman Bharat
Mr. A.D. Bhatnagar Medical Expert
Ms. Nikita Pathak Technical Trainer
Dr. Anil Kumar DD, Ayushman Bharat
Dr. O. P. Tiwari
Dr. Jose
Mr. Anil P. Singh
Mr. B.D. Khare
Dr. P.K. Chaturvedi
Dr. Sumit Shukla
Mrs. Usha Parmar
Ms. Neeta Sisodiya
Dr. Sanjay Kanth
Mr. Devendra Soni
Mr. Malkhan Singh
Dr. Sunil Nandeshwar
Mr. Nabeel Ahmed
Mr. Hemant Jain
Mr. Mohit Chalu
Mr. Mrunal Pant
Mr. Swadesh Sharma
Mr. Mukesh Shandilya
Dr. Muhel Dubey
Dr. Ramesh
Mr. Hari Charan Yadav
Mr. Ali Khurajiya
Dr. Vitthal Salve
DD, Directorate Health
Samarthan
NLIU
DD, DHS
Health & Family Welfare Department
Medical Education, Prof. M.G.M. College, Indore
AMD, NHM
Dainik Bhaskar, Correspondent
Medical Consultant, Ayushman Bharat “Niramayam” M.P.
SAMAYAK Welfare
SAMAYAK Welfare
Professor, Medical College, Vidisha
Sr. Program consultant, Ayushman Bharat “Niramayam” M.P.
Sr. IT consultant, Ayushman Bharat “Niramayam” M.P.
RAWS
IAEA
Media Welfare Society, Bhopal
Nandita Swasthya
PRO
VASODHA
Navdunia
Consultant KPMG, Ayushman Bharat “Niramayam” M.P
Shaheed Hospital Dalli Rajhara, Chhattisgarh
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Conference proceedings of “Conference on rights based approach to health” August 30, 2019 Bhopal
Mrs. Laxmi Kolli Technical trainer, ASHA cell
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Conference proceedings of “Conference on rights based approach to health” August 30, 2019 Bhopal
ContextOver the past years Government of Madhya Pradesh (MP) has taken a lot of
transformative steps to strengthen its health system. MP in its constant endeavor of accomplishing its role of ‘protecting’ and ‘providing’ its citizens, is now considering ‘right to health' and ‘right to water' legislation to ensure the basic services to the public. The Government of Madhya Pradesh envisions to ensure every citizen of the state to have lawful rights to health and healthcare services. The fundamental objective of right to health/ healthcare for all means that everyone should have access to the health services they need, when and where they need them, without any discrimination and suffering financial hardship. The Government of Madhya Pradesh is cognizant of National and International standing on health as a human right and right to health, and intends to leverage practices of implementing right to health across various countries that shall enable the MP state to enact comprehensive, implementable, attainable and sustainable framework for right to health/ healthcare in the state.
The Government of Madhya Pradesh understands the importance of good health of every citizen because there is a close interconnection between health and the quality of life of a person. The Government of Madhya Pradesh is persistently working towards health system strengthening and has budgeted Rs 15,150 crore in the current fiscal for Health & Family Welfare department with a 32.0% increase from the previous year. The government had launched the Swasthya Kshetra Nivesh Protsahan Yojana to promote investment for establishing hospitals and dispensaries. The Health & Family Welfare Department of Madhya Pradesh caters to its citizens through its institutions (51, District Hospitals, 76 Civil Hospitals, 330 CHCs, & 1199 PHCs & over 10,000 Sub centers). Ayushman Bharat “Niramayam” was launched in September 2018 to provide a cover of INR 5 lakhs to approximately 1.4 crore families per annum for over 1399 procedures mainly secondary & tertiary. Over 400 Public and private hospitals have been empanelled to cater under the scheme. In the last 10 months, more than 1.0 lakh patients have been treated under Ayushman Bharat “Niramayam” in MP State.
To further strengthen the health systems in Madhya Pradesh, government is desirous to adopt appropriate framework towards rights based approach to health. Accordingly, Steering Committee, under the chairmanship of Shri Gopal Reddy, ACS, Water Resources Department, was constituted on 3rd August 2019 vide GAD order no F 19-59/2019/1/4 Bhopal for consideration of Rights based approach to Health in Madhya Pradesh. Steering Committee in its first meeting on 14 th August 2019 recommended state level consultation with civil societies, experts and state health department officials to ascertain issues for deliberation to arrive at appropriate framework relating to Rights based approach to Health in M.P.
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Objective 1. To gather experts, activists, technical experts, medical professionals, policy makers,
media professionals, academicians etc.2. Understanding components of rights based approach inter alia; right to health,
health rights, health economics etc.3. Considering international laws and health rights model globally. 4. Examining issues for deliberation towards rights based approach to health in M.P.5. Leverage learnings from participants in challenges towards formulating and
adopting rights based approach to health in M.P.6. Outlining various determinants such as socio-economic and environmental
determinants to rights based approach to health in M.P.
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Expert Presentations
I. Right to Health: An international perspectiveDr Chandrakant Lahariya - MBBS, MD, DNB, MBA, FIPHANational Professional Officer- Healthcare, Access & ProtectionWorld Health Organization India
WHO constitution (1946) envisages “……. the highest attainable standard of health as a fundamental right of every human being.”
• What ‘the Right to Health’ mean?
Health as a human right creates a legal obligation to ensure access to timely, acceptable, and affordable health care services which meets certain quality standards.
A rights-based approach
Requires that health policy & programs must prioritize the needs of those furthest behind first towards greater equity,
Ensuring meaningful participation of stakeholders – including non-state actors, involving them in all phases of programming: assessment, analysis, planning, implementation, monitoring and evaluation.
The Right to Health
Core components of approach
1. Availability
2. Accessibility
3. Acceptability
4. Quality
Core elements
1. Progressive realization using maximum available resources
2. Non retrogression: Existing protection of economic, social and cultural rights not to deteriorate
3. The Right to Health –evolution (1/2)
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WHO Constitution (1946)
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition (...)”
Universal Declaration of Human Rights (1948)
Art.25.1 : “Everyone has the right to a standard of living adequate for the health of himself and of his family, including food, clothing, housing and medical care and necessary social services”
Right to Health – evolution (2/2)
International Covenant on Economics, Social and Cultural Rights (1966)
Article 12 recognizes the “right of everyone to the enjoyment of the highest attainable standard of physical and mental health”
Article 12.2 illustrates a number of steps to be taken by States parties to achieve these rights
Art.12.2.c: Right to prevention, treatment and control of diseases
Art 12.2.d: Right to health facilities, goods and services includes appropriate treatment of prevalent diseases, preferably at community level;
How world is doing?
68 of 191 UN member states had included constitutional provision to right to health (Heymann J, et al; 2013)
6 of 11 countries in WHO SEAR has right to health through constitutional provisions
– DPR Korea, Maldives, Indonesia; Nepal, Thailand, & Timor Leste
– In other, the word ‘Right’ in context of health is not mentioned
Right to Health in India:
Evolution of idea
Mechanisms where the RTH is enshrined
The Constitution of India
Statutory Laws (Central and State)
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Protection of Human Rights Act
Common law – judges made law and judgements where constitutional provision are interpreted.
International Law (enacted by Parliament or read in by The Supreme Court)
Right to Health in the Indian Constitution
Directive Principles of State Policy – Part IV
Article 47.
Duty of State to raise the level of nutrition and the standard of living and to improve public health.
The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties.
The right to health is not a fundamental right (enforceable in court of law) in India
Evolution of Health provision & India
Health Survey and Development Committee (Bhore Committee, 1946) set forth a vision of health services in India based on equity, universality, and comprehensiveness.
In 2000, National Human Rights Commission recommended that the right to health be expressly transformed & declared as a fundamental right.
In 2009, the Government of India drafted a National Health Bill proposing the legal framework to recognize the ‘right to health and ‘right to health care’.
A number of Supreme Court judgements
Health of workmen
Provision of adequate medical facilities
Right of every citizen
Standards for government hospitals
Safe medicines
Safety of blood transfusion
Iodization of salt
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Payment of compensation for violations in government health programmes
Regulation of clinical trials
Rollout of HIV treatment programme
Supreme Court verdict used as reference for the Right to Health
CESC Ltd. vs. Subash Chandra Bose, (AIR 1992 SC 573,585)
“The term health implies more than an absence of sickness. Medical care and health facilities not only protect against sickness but also ensure stable manpower for economic development… Health is thus a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. In the light of Arts. 22 to 25 of the Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights and in the light of socio-economic justice assured in our Constitution, right to health is a fundamental human right to workmen. The maintenance of health is a most imperative constitutional goal whose realisation requires interaction by many social and economic factors.”
Supreme court judgment on Section 377
“The operation of Section 377 denies consenting adults the full realization of their right to health, as well as their sexual rights. It forces consensual sex between adults into a realm of fear and shame, as persons who engage in anal and oral intercourse risk criminal sanctions if they seek health advice. This lowers the standard of health enjoyed by them and particularly by members of sexual and gender minorities, in relation to the rest of society.”
Right to Health in recent Indian Laws
HIV/AIDS Act 2017
No discrimination based on HIV/AIDS
Informed Consent
Confidentiality
As far as possible
Mental Healthcare Act 2017
Right to dignity, privacy & Against discrimination
Consent
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Confidentiality
Statutory right to mental healthcare services
(run or funded by the appt governments)
Persons with disabilities Act 2016
Right to dignity
Right against discrimination
Right to live in community
Consent
Within the limits of its economic capacity
NHP 2017, RTH & Indian states
India’s NHP 2017, does not assure ‘right to health’ and one of the question it raised is that “whether when healthcare is a state subject, is it desirable or useful to make a central law”
Rights which are not fundamental rights, can be given by the state as statutory rights. Understandably, level of protection from such legislation would be lower than fundamental rights. Yet, much desirable.
The time is ripe when Indian states gives serious consideration to the right to health legislations.
The Way Forward
A lot can be done with existing laws and legislations to improve health outcomes
Recent right based legislations in India (on Food, Education, Work and Information) suggests that it is important not to let perfect be the enemy of good.
In India & Indian states, in the time ahead, ‘the Right to Health’ is likely to be an incremental process and a journey; yet a very important one.
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Right to Health in Recent Laws
HIV/AIDS Act 2017
14. (1) The measures to be taken by the Central Government or the State Government under section 13 shall include the measures for providing, as far as possible, diagnostic facilities relating to HIV or AIDS, Anti-retroviral Therapy and Opportunistic Infection Management to people living with HIV or AIDS.
Persons with Disabilities Act, 2016
24. (1) The appropriate Government shall within the limit of its economic capacity and development formulate necessary schemes and programmes …provisions of aids and appliances, medicine and diagnostic services and corrective surgery free of cost to persons with disabilities with such income ceiling as may be notified;
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II. Law and Policy framework for rights based approach to healthAmulya NidhiNational Co convenerJan Swasthya Abhiyan, India
Background
The State Government today has created a progressive atmosphere where civil society is being given space to talk about the human rights approach to ensure quality health care services for all citizens
Universal health care Sustainable development goal
Background
Article 21 of the Indian Constitution guarantees the right to life, and the health and wellbeing of all citizens is one of the underlying determinant to right to life
Article 39 states that
“The state shall, in particular, direct its policy towards securing; that the health and strength of workers, men and women, the tender age of children be not abused and that citizens are not forced by economic necessity to enter a vocation unsuited to their age or strength”.
Article 47 of the Constitution states that
“The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties…….”
Public health sector – guaranteed health services, free medicine & diagnostics,……
Private health sector – Rates, Transparency, Standard treatment protocol, grievance redressal
Public private partnership – Public funded initiatives
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Service Provider and User Perspective
From Panchayat to District level, a public health system exists with certain infrastructure, manpower, services, supplies
However today the citizen is lost among the plethora of acts/policies/programs
There is no one single understanding of what the government provides and what the citizen can ask for
Service Provider User
Rights based perspective
Community has a role in design, planning and implementation of health care needs
As the state becomes accountable to the citizen, the citizen develops faith in the system
A mutual relationship of trust grows
Community automatically owns the system and takes up the responsibility of monitoring the functioning of the health system
Charter of Patient’s Rights
Community based Monitoring
Need for a Comprehensive Public Health Act
• Improving and reorganizing financing of public health, adequate and equitable public health financing
• Strengthening of existing public health system with pro-people orientation and substantial expansion of primary, secondary, tertiary, rural and urban health facilities
• A framework of people’s health rights, community control and accountability of health services, with effective grievance redressal
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Widening Gap
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Need for a Comprehensive Public Health Act contd.....
Implement minimum set of standards and regulatory mechanisms to ensure patients don’t incur catastrophic out of pocket expense and that no citizen is denied health care, by any pubic or private health care provider
Health care services is accessible to all, in terms of various specified distances for basic services, full primary care, treatment of serious illnesses and critical illnesses
Build effective coordination with other relevant departments who are crucial in relation to health, like supply of adequate drinking water, sanitation, nutrition, and basic housing
Need for a Comprehensive Public Health Act contd…
Set specific standards and norms for safety and quality of all health care services, treatment protocols, infrastructure, equipment, drugs, diagnostics, and health care providers within the Government, private and other non-government sectors
Effective private sector regulation, including minimum standards, standard management protocols, patients rights, transparency and standardization of rates
Meeting the specific healthcare requirements of various groups with special needs/conditions/illnesses/occupational health
Need for a Comprehensive Public Health Act contd…
Safety, availability and accessibility of drugs and diagnostics including medical devices free to all in all the public health facilities; rational use of drugs, diagnostics and monitoring of drug resistance and adverse drugs reactions
Comprehensive Health Information System – Public and Private
Participatory and inclusive Health Impact Assessment (HIA) of new development projects in the state
Implementation Mechanisms
A State level body Right to Health Care is responsible for governance, monitoring, policy formulation, implementation and maintenance with appropriate local bodies at district and local levels along with convergence with all other departments whose policies and programmes impact right to health directly or indirectly
The planning and monitoring methods shall involve citizens as active co-facilitators for articulating their needs, helping in identification of key indicators,
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conducting social audits and creation of tools for monitoring & providing feedback through public platforms
Such an act will ensure that the followings do not occur:
Denial of health care Medical negligence Unethical practices Irrational practices Violation of health and human rights.
Regional and district level Swasthya Samvad should be organised to ensure opinion of all stakeholders while finalising :
Madhya Pradesh Right to health and health care Act
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Public spending on health is very low in India: in terms of per capita expenditure as well as % of Gross Domestic Product
BRICS countries like South Africa, Brazil, China spend more than ten times per person compared to India.
Several SAARC neighbours spend much more
Conference proceedings of “Conference on rights based approach to health” August 30, 2019 Bhopal
III. Financing options for materializing Right to Health in Madhya Pradesh
Indranil Mukhopadhyay Associate Prof. School of Government and Public Policy Jindal Globla University Sonipat
Health care expenditure: India in comparison with BRICS and Asian neighbours (2014)
Sources of Resources for Health in MP17
Out of Pocket Expenditure (OOPS) as %
of Total Health Expenditure
(THE)
General Government
Health Expenditure per
Capita in Int$ (Purchasing
Power Parity)
General Government
Health Expenditure
(GGHE) as % of Gross Domestic Product (GDP)
Regions Countries 2004 2014 2004 2014 2004 2014
BRICS
South Africa 11 6 292 554 3.2 4.2
Brazil 33 25 344 607 3.3 3.8
Russia 33 46 316 958 3.1 3.7
China 54 32 79 408 1.8 3.1
India 68 62 26 32 1.0 1.2
Asian Neighbours
Bangladesh 58 67 17 25 1.0 0.8
Bhutan 28 25 120 206 3.2 2.6
Pakistan 61 56 24 45 0.7 0.9
Myanmar 85 51 5 48 < 1.0
Nepal 55 48 23 55 1.6 2.3
Sri Lanka 44 42 96 207 2.0 2.0
Thailand 26 12 206 467 2.3 3.2
Malaysia 34 35 317 574 2.1 2.3
Conference proceedings of “Conference on rights based approach to health” August 30, 2019 Bhopal
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BHRJH
KDODI
APRAJ
MAH TN
KARJ&
kTEL
425 66
766
874
576
290
792
310
6310
7811
1911
2011
2312
3412
3912
66 1461
1533
1627 19
80 2316
852
1308
1652
1745
1880
1483 24
2024
1523
1033
7541
69 4492
3822 40
6838
9539
9522
9039
8554
5840
30
Current spending (INR)Expenditure needed to achieve 2.5% of GSDP
Public spending on Health is among the lowest in MP among Indian states.Achieving 2.5% of GDP to be spent on health needs considerable resource mobilisation
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States where public spending on health is higher has been able to reduce out-of-pocket expenses more effectively
Conference proceedings of “Conference on rights based approach to health” August 30, 2019 Bhopal
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Share of health in total government spending
Even though many states have lower government spending as share of GDP they have prioritised health in public spending
Conference proceedings of “Conference on rights based approach to health” August 30, 2019 Bhopal
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Share of own tax revenue in MP is
higher than national average
Long term GSDP growth is higher than
national average
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A large part of the household spending goes into Medicines and outpatient
care
Public spending has low priority on Medicines
Conference proceedings of “Conference on rights based approach to health” August 30, 2019 Bhopal
Median OOP due to hospitalizationSl. No State Govt.
Special Finance Commission Transfers for meeting HR and Infrastructural gaps in underserved districts
Innovative sources of revenue: short term capital gains tax etc.; reduction in tax exemptions
Withdrawal of Fiscal Responsibility and Budget Management Bill
Multi-year budgeting: different reporting cycle for capital and revenue accounts
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IV. Rights Based Approach to HealthRole of Local Governments and Community Institutions State level consultation with civil society and expertsDr. Yogesh Kumar, Samarthan NGO
Defining Right to Health: Peoples perspective
Can know benefits and receive entitlements at doorstep
Should get health services at any time- regular need and emergency
Provided preventive and community health services in timely manner
Should get secondary and tertiary services with dignity, equity and sensitivity
Citizens with different needs should receive facilities differentially
Denial, negligence and poor quality of services should be penalized
Local Governments and health: 3 Tier PRIs and Urban Local Bodies
Devolved subjects of health, water, sanitation etc.
Defined structures for addressing community health issues – Standing Committees
on Health at the GP level, JP and ZP level
MP Act on District Planning Committees – sub-committee on health
Gram Sabha level Standing Committee on Health
URBANMuhalla Samitis have legal mandate- dormantRogi Kalyan Samitis in hospitals- exist but not vibrantEmpowering local governments in realizing health rights• Empower Zila Sarkar and District Planning Committee• Greater clarity in functions in relation to the defined rights• Real powers and institutionalized practice of monitoring of services• Certain level of staff to be accountable to local governments –ANMs/AWW/non
technical or semi technical staff • Resources to plan and improve services- facility level committees (Rogi Kalyan
Samiti)
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• Reinforce practice of community led health- participation of CSOs• Powers and funds to the Village Health and Nutrition CommitteeQuestions to be discussed• How can the demand for the realization of rights be activated? Should these be the
existing SHGs, thematic committees, youth groups etc. or any other alternatives?• What are the additional powers and resources that will be critical for the PRIs and
ULBs to play catalytic role in realization of rights?• Which of the overlapping functions of the PRIs and ULBs with the Public Health
Institutions to be sorted out for more clear accountability and performance measurement?
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V. Rethinking Medical Education and Skill Development in Madhya Pradesh
Prof. Dr. Sunil Nandeshwar Dean, ABVGMC, Vidisha, MP
Status of UG Medical Education in Madhya Pradesh
Total Medical Colleges: 23 (Govt. and Private) Total MP Government Medical Colleges: 13 Total MBBS Seats in Govt. Medical Colleges: 1970 New Medical Colleges in last 2 years: Government Medical College, Shahdol (2019) Government Medical College, Chhindwara (2019) Government Medical College, Shivpuri (2019) Government Medical College, Khandwa (2018) ABVGMC, Vidisha (2018) Government Medical College, Ratlam (2018) Government Medical College, Datia (2018)
Competency Based Undergraduate Curriculum 2019
According to Graduate Medical Education Regulations, 2018 Goal to create an “Indian Medical Graduate” (IMG) Guidelines for Each subjects available with Defined Competencies, Domain, Level
of competency, core or desirable, Suggested methods, suggested assessment methods, integration with other subjects.
Batch 2019 onwards Competencies to be achieved by Indian Medical Graduate (IMG) Clinician, who understands and provides preventive, promotive, curative, palliative
and holistic care with compassion Leader and member of the health care team and system Communicator with patients, families, colleagues and community Lifelong learner committed to continuous improvement of skills and knowledge Professional who is committed to excellence, is ethical, responsive and
accountable to patients, community and the profession Attitude, Ethics and Communication (AETCOM)
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Goal: Indian Medical Graduate (IMG) possessing requisite knowledge, skills, attitudes, values and responsiveness, so that she or he may function appropriately and effectively as a physician.
AETCOM is:
Case Based Module Case scenarios with discussion points Structured programme Distributed all over years Assessment Foundation Course For Undergraduate Medical Education
One-month program
It will give Orient the learner to
a. The medical profession and the physician’s role in society
b. The MBBS programme
c. Alternate health systems in the country and history of medicine
d. Medical ethics, attitudes and professionalism
e. Health care system and its delivery
f. National health priorities and policies
g. Universal precautions and vaccinations
h. Patient safety and biohazard safety
i. Principles of primary care (general and community-based care)
j. The academic ambience
Foundation Course continues…
Enable the learner to acquire enhanced skills in:
a. Language (Local Language or English Classes)
b. Interpersonal relationships
c. Communication
d. Learning including self-directed learning
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e. Time management
f. Stress management
g. Use of information technology (Computer Skill Classes)
Foundation Course continues…
Train the learner to provide:
a. First-aid
b. Basic life support
Early Clinical Exposure For Undergraduate Medical Education
1. Basic science correlation: To apply and correlate principles of basic sciences as they relate to the care of the patient (this will also become part of integrated modules).
2. Clinical skills: To include basic skills in interviewing patients, doctor-patient communication, ethics and professionalism, critical thinking and analysis and self-learning
3. Humanities: To introduce learners to a broader understanding of the socio-economic framework and cultural context within which health is delivered through the study of humanities and social sciences.
Skills labs at Medical Colleges
Every medical institution must provide students access to a skills laboratory where they can practice and improve skills pre-specified in the curriculum.
The purpose of the skills lab is to provide a safe environment for students to learn, practice and be observed performing skills in a simulated environment thus mitigating the risks involved in direct patient exposure without adequate preparation and supervision.
The skills lab attempts to recreate the clinical environment and tasks which future health care workers have to perform with various levels of complexity and fidelity.
Skills labs are used to enhance - clinical, motor and communication skills - as well as team work.
Other Initiatives taken by ABVGMC, Vidisha Sensitization workshop on International Classification of Diseases (ICD-10) CME on Corticosteroid – A double edged sword CME on Cervical cancer prevention and management
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Reorientation Workshop RNCTP Latest update in Carcinoma Breast Haemophilia update Update of New Guidelines for Hypertension
Way Forward
IMPLEMENTATION OF FOUNDATION COURSE DEVELOPMENT OF LEADERSHIP SKILLS EXPOSURE OF NEW TECHNIQUES & TECHNOLOGY EARLY CLINICAL EXPOSURE NEW CURRICULLUM IMPLEMENTATION
Breakout sessions
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Conference proceedings of “Conference on rights based approach to health” August 30, 2019 Bhopal
Post expert presentations, the participants regrouped themselves in 6 groups for 90 minutes to discuss and on the following items respectively. Subsequently, the groups were allowed to present their discussion points before all participants through a chosen group leader.
1. Appropriate policy or legislative framework to achieve rights based approach to health;
2. Progressive realization of other socio-economic & environmental determinants of health rights;
3. Streamlining supply chain management for achieving rights based approach to health;
4. Health economics for achieving rights based approach to health;5. Empowering patient through patient rights and health rights 6. Right to health policy and legislative framework.
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Conference proceedings of “Conference on rights based approach to health” August 30, 2019 Bhopal
Recommendations The key recommendations from the deliberations are enlisted below:-
1. Revisiting all archaic laws relating to health such as Nursing Home Act, Clinical establishment Act, Trial and Experimental Studies Transparency (TEST) Act of 2012. Amending or repealing the laws and reinforcing them whilst providing more powers to health department.
2. Bringing transparency and accountability in health department operations. Increasing dialogue with stakeholders and partners in matters of health issues.
3. Increasing funding in health budget to 8%. Progressive increase in health department funding.
4. Leveraging learnings from National Health Bill 2009, National Health Policy 2017 and Draft Rajasthan Right to Health Bill, 2018 (as shared by JSA) and other legislations formulated around rights pertaining to food, education, work, information etc.
5. Restructuring Centre-State fiscal relations for greater share in taxes to be apportioned towards health expenditure
6. Special Finance Commission Transfers for meeting HR and Infrastructural gaps in underserved districts
7. Creating innovative sources of revenue and exemptions such as short term capital gains tax, reduction in tax exemptions
8. Withdrawal of Fiscal Responsibility and Budget Management Bill9. Multi-year budgeting: different reporting cycle for capital and revenue accounts10. Health rights to be integrated with nutrition, water supply and sanitation.11. Decentralized and participatory planning, implementation, monitoring and
accountability.12. Public health partnering with urban local bodies and panchayat raj institutions for
accountability and performance measurement.13. Increasing technology and innovation for reaching to maximum medical
