Workshop for Developing Landscape on Project for Augmenting Paramedical Training...

Report on proceedings

Workshop for Developing Landscape on Project for Augmenting Paramedical Training

Capacity

By

NIAHS project team

Health Systems Support Unit

Public Health Foundation of India

National Initiative for Allied Health Services

Health Systems Support Unit

Public Health Foundation of India

Email: [email protected] ;

mailto:[email protected]

Confidential Property of PHFI –Health Systems Support Unit Page 2

CONTENTS

SITUATIONAL ANALYSIS: OVERVIEW OF THE LITERATURE ........................................................ 7

Background and Introduction: .............................................................................................................. 7

Definition of Allied Health Professionals (AHP): ................................................................................ 9

Regulation of paramedics in India: .................................................................................................... 10

Training of Trainers: .......................................................................................................................... 11

Management of Paramedics/Allied Health Professionals: ................................................................. 12

Conclusion: ........................................................................................................................................ 12

INTRODUCTION AND OBJECTIVES OF THE WORKSHOP .............................................................. 15

TOR 1: PHYSICAL INPUTS ..................................................................................................................... 16

TOR 2: PEDAGOGY ................................................................................................................................. 20

TOR 3: REGULATORY FRAMEWORK.................................................................................................. 24

TOR 4: DEVELOPING BUSINESS MODEL FOR SETTING UP, MANAGEMENT AND ROAD MAP

FOR SUSTENANCE OF NIPS, RIPS ........................................................................................................ 28

TOR 5: TRAINING OF TRAINER AND FACILITATION GUIDES ...................................................... 33

ROAD AHEAD FOR THE ENTIRE INITIATIVE ................................................................................... 38

Dr. P.H. Ananthanarayanan ................................................................................................................ 43

Mr Basab Banerjee ............................................................................................................................. 43

Dr. Bipin Batra ................................................................................................................................... 44

Dr. R. Chandrashekhar (PhD) ............................................................................................................ 44

Lt. Gen. Narayan Chatterjee (Retd.) ................................................................................................... 44

Dr. Ameeta Joshi ................................................................................................................................ 45

Mr. Sameer Mehta .............................................................................................................................. 45

Mr. Jwala Prasad Mishra .................................................................................................................... 46

Prof Deoki Nandan ............................................................................................................................. 46

Dr Sita Naik ....................................................................................................................................... 47

Dr Subhash Salunke ........................................................................................................................... 47

Dr. Sangeeta Sharma .......................................................................................................................... 48

Col. K. Srikar ..................................................................................................................................... 48

Dr Thamma Rao ................................................................................................................................. 49

ANNXURE-1: SITUATIONAL ANALYSIS ............................................................................................ 50

ANNXURE-2 (Situational Analysis) .......................................................................................................... 51


Message by Dr Sita Naik

Member, Medical Council of India

Allied Health providers are the bedrock of technical services in any

health facility. The availability of a competent team of support

cadres in adequate numbers and with appropriate skills is imperative

for providing quality health services. India faces acute shortage of

almost all cadres of allied health providers at all levels. An important

reason for this is the acute shortage of institutions to undertake

paramedical training. There is also an absence of standardization of

training and a misplaced focus on “end of training certification”

without adequate emphasis on development of skills. The lack of an

effective, national regulatory body has contributed to the current

dismal scenario.

The current initiative of Govt of India for augmentation of paramedical training capacity and

development of guidelines for assuring quality of training is long overdue and very welcome.

The National centre of excellence planned under the initiative should provide the strong

leadership to develop and widen the field of allied health service training. It will also provide the

opportunity for the new, cutting edge technologies to be introduced. The NIPS and RIPS will

play an important role in developing new training programs, expanding existing programs being

conducted under diverse management/regulatory protocols and bringing about cohesion and

standardization of these efforts.

The content of the discourse on the concluding day of the workshop was very enriching. The

group work undertaken for various terms of reference has given a logical road map for future

work on the themes. I appreciate the hard work put in by the desk review secretariat of PHFI in

developing the base line for these deliberations. The inputs of the experts were invaluable and

their enthusiastic participation in this historical initiative is highly appreciated.

I wish the PHFI all success in this initiative and seek to continue the engagement for this

important initiative.


Message by Dr Deoki Nandan

Director, National Institute of Health and Family Welfare

The National Institute of Health and Family Welfare is happy to be

associated with this historical project for augmentation of paramedical

training capacity in the country. It is imperative to have skilled human

resources for various disciplines available in adequate numbers to

ensure availability of comprehensive health care to the citizens. The

initiative of the Govt of India is indeed timely and would help reduce

the service gaps in the health facilities.

The National and Regional level institutes of paramedical sciences are

expected to provide the much needed leadership to the development

of allied health services in the country. Robust, sustainable models for

these institutions along with well thought out benchmarks for training inputs shall make India a

hub for training in paramedical disciplines.

The PHFI has positioned a competent secretariat to co-implement this initiative with the Govt of

India and I congratulate them for the excellent work undertaken by them. I look forward to

continued engagement with the PHFI on this important initiative


Message by Dr Subhash Salunke

Senior Advisor, Health Systems Support Unit, PHFI

The project for augmentation of capacity for paramedical disciplines

in the country through the establishment of National institute of

paramedical sciences, regional institutes of paramedical sciences and

supporting state government medical colleges for conducting

paramedical courses through one time grant is a landmark initiative

of the Govt of India. The project seeks to compensate the serious

shortage of skilled human resources which are required in the health

system to ensure availability of comprehensive services at health

facilities.

The project components allocated to the PHFI include undertaking

situation analysis, developing benchmarks for inputs, recommending management protocols for

NIPs, RIPS and regulatory frameworks for the paramedics. The workshop at NIHFW marked

the beginning of the project activities. The workshop was undertaken to develop the landscape

for this project for the six month duration. The experts who participated in the workshop helped

create a clear roadmap for the various activities of the project. The enthusiastic participation of

institutions like JIPMER, PGI Chandigarh, AIIMS, CMC, Vellore, AFMC, Safdarjung Hospital,

IGNOU, Manipal University, Symbiosis institute of Health Sciences and others has given

immense credibility to the initiative. The participation of subject experts, management gurus,

paramedic faculty, CPWD and others has helped develop broad consensus on the methodologies

which are to be adopted for the project.

The PHFI project secretariat has gained substantially from the engagement and is grateful to the

participants for sparing their valuable time for this historical initiative. The insights received into

the physical infrastructure needs of the institutes, possibilities of identifying commonalities

between courses to optimize deployment of faculty, other input needs for training shall be

further developed during the project to arrive at robust recommendations. The framework for

regulation of paramedics is noted to be a complex subject and it is necessary to build consensus

across a wide variety of stakeholders. It is understood that the time allocated for the mammoth

task is short. The PHFI Project secretariat shall therefore need all the support and mentoring

from the Govt of India and other stakeholders including the states where RIPS are going to be

set up to arrive at a workable roadmap for successful implementation of the project.

The PHFI Project secretariat is grateful to Sh Debasish Panda, Jt Secretary, MoHFW for support

and encouragement for the project. We are also grateful to Dr Deoki Nandan and the NIHFW

for providing guidance and logistics assistance. We are also grateful to Dr Sita Naik, member

Board of Governors, MCI, for her guidance on the concluding day of the workshop.


EXECUTIVE SUMMARY

The Ministry of Health and Family Welfare, Government of India, aims at augmenting the

supply of skilled paramedical manpower and to promote quality of paramedical training through

standardization of such education/courses across the country through the establishment of

National and Regional institutes of Paramedical Sciences. The Public Health Foundation of

India has been entrusted to conduct a situational analysis and provide comprehensive solutions

for augmenting the supply as well as improving the quality of education in the paramedical

education systems. Under the initiatives, a workshop for developing landscape on project for

augmenting paramedical training capacity was conducted at the National Institute of Health and

Family welfare, New Delhi.

The participating organisations included department heads from the leading medical and

paramedical institutions in India, development partners, industry leaders and leading

Government and Ministry experts on the subject. The highlights of their initial discussions are as

listed below:

Nomenclature: The nomenclature of Institutes may be revisited from “paramedical

institutes” and changed to „Institutes of Allied Health Services‟ to be in conformity with

the nomenclature advocated by World Health organization as well as international

organizations.

Pedagogy: “Skill needs and competency” should remain as the primary focus while the

courses are being redesigned.

Infrastructure: The NIPS and RIPS may have all necessary basic infrastructure and

staff which could be complimented by the faculty of medical college or selected training

hospitals.

Structure and regulation: Various options were discussed for NIPS and RIPS,

including i) autonomous status ii) state-controlled iii) centrally administered iv) NIPS as

Paramedical Academy or v) having over all technical and administrative control for

standardization of pedagogy, regulatory mechanism and smooth functioning. The issue

of affiliation for awarding a degree needs further detailed deliberations with experts and

the public sector, before arriving at a conclusive option. Alternatively, one of the central

universities may create a faculty of Allied Health Sciences for awarding a degree and

overall academic governance. The role of accreditation in ensuring quality of both

institutions and graduating professionals was also stressed.

The workshop also included discussions and planning of activities for the overall project as

discussed in the chapter on “Road ahead”. The deliberations lasted one and a half days and

concluded with key note addresses by Dr Sita Naik representing the Medical Council of India

and Mr Debashish Panda, Joint Secretary, MoHFW. The ability of the project team and

associated experts to arrive at a manageable yet effective regulatory structure, ensuring key

stakeholder consensus at both national and regional levels without compromising on the

quality of the institutions and professionals, could be summed up as the priority issue reiterated

by the expert group.


SITUATIONAL ANALYSIS: OVERVIEW OF THE LITERATURE

Background and Introduction:

On reviewing the available national

and international literature, the

project team found that there is no

universally accepted definition for

„Paramedic‟ internationally. In some

countries, the word Paramedic and

Allied Health are used to mean the

same thing but in many to mean

different professions1. Currently, in

India there exists a vast variety of

allied health service professions with

newer categories of allied health

personnel coming on board each day.

Major categories of allied health

personnel are physiotherapists,

occupational therapists, medical

laboratory technicians, radiology

technicians (diagnostic imaging technicians, radiotherapy and radioisotope technician), speech

therapists and audiologists, clinical technicians, operating theatre technicians, and ophthalmic

technicians. For education and training of allied health personnel, there are a number of courses

ranging from short-term (up to 3 months), certificate, diploma, and graduate level.2

Who is a Paramedic:

The term “allied health or paramedical professionals” is interpreted differently within and

among countries. The Kerala paramedical council bill describes a “Para Medical Technician” as

an ECG Technician, EEC Technician, EMC Technician, X-ray Technician, Medical Laboratory

Technician or Ophthalmic Assistant and includes such other technicians as may be specified and

notified by the Government as para medical technicians from time to time.

Most commonly, paramedics are those who respond to medical emergencies out in the field for

the purpose of stabilizing the victim's condition so s/he can be transported to medical facilities

and function as an emergency medical technician (EMT). In the United States, emergency

medical technicians are classified according to their level of training3.

Emergency medical services in France are provided by a mix of organisations under public

health control, with the lead taken by a central control function called SAMU, which stands for

'Service d'Aide Médicale Urgente' or urgent medcal aid service. This central hub is supported by

1 Terminologies of different categories of Allied Health Professions have changed names in different countries.

Australia uses speech pathologist where the U.S. uses speech language pathologist and the U.K. uses speech

and language therapist. Physiotherapists in Australia and the U.K. are physical therapists in North America. 2 Report of an Inter country Consultation Bangkok, Thailand, 20-24 March 2000 “Health (Paramedical)

Services and Education” (December 2000 ); World Health Organization, Regional Office for South-East Asia,

,New Delhi. Available at: < http://whqlibdoc.who.int/searo/2000/SEA_HMD_212.pdf> 3 From Wikipedia, the free encyclopaedia.

As part of the NIAHS, “Desk Review of the

Paramedical Training Landscape” (D.R.) is being

conducted for requisite information on the subject

(Global/National). Initially this was taken up by the

Project Team (P.T.) primarily through search of

electronic databases and studying the published

documents/ literature. However, this D.R. would

need to be taken forward by studying and analysing

the collected literature, reviewing it, holding

interaction with subject specialists and other

stakeholders, through field visits to selected

paramedical institutes, getting relevant information

from states and other mechanisms listed later in this

note before submitting the report to the MOHFW by

15 June 2011.

http://www.wordiq.com/definition/Emergency_medical_technician


resources including first response vehicles or ambulances provided by the fire service and

physician led ambulance provision from SMUR (Service Mobile d'Urgence et Reanimation -

literally translated as mobile emergency and resuscitation service) which are 'mobile intensive

care units' (MICU) that have one or more physicians on board4.

However, as per the International Standard Classification of Occupations (ISCO)5, Paramedical

practitioners provide advisory, diagnostic, curative and preventive medical services for

humans more limited in scope and complexity than those carried out by medical doctors. They

work autonomously or with limited supervision of medical doctor. Occupations included in this

category normally require completion of tertiary-level training in theoretical and practical

medical services. Workers providing services limited to emergency treatment and ambulance

practice are classified under 'Ambulance workers'-3258. Some of the categories, called

Paramedical in India are included in “Other health professionals” provide health services related

to dentistry, pharmacy, environmental health and hygiene, occupational health and safety,

physiotherapy, nutrition, hearing, speech, vision and rehabilitation therapies. Since, “allied

health or paramedical professionals” is interpreted differently; comparative paramedical/allied

Health workforce analysis may not be possible because such an exercise can be meaningful only

when the available information is based on common definition and classification. For instance,

the Douala plan of action by the World Health Organisation to create a compendium of

competencies and a directory of health professions by December 2008 could not happen6.

4 National SAMU website< http://www.samu-de-france.fr/en>

5The International Standard Classification of Occupations (ISCO) is one of the main international

classifications for which ILO is responsible. It belongs to the international family of economic and social

classifications. ISCO is a tool for organizing jobs into a clearly defined set of groups according to the tasks and

duties undertaken in the job. Its main aims are to provide:

a basis for the international reporting, comparison and exchange of statistical and administrative data

about occupations;

a model for the development of national and regional classifications of occupations; and

a system that can be used directly in countries that have not developed their own national classifications.

It is intended for use in statistical applications and in a variety of client oriented applications. Client oriented

applications include the matching of job seekers with job vacancies, the management of short or long term

migration of workers between countries and the development of vocational training programmes and

guidance. Health professionals: conduct research, improve or develop concepts, theories and operational

methods, and apply scientific knowledge relating to medicine, nursing, dentistry, veterinary medicine,

pharmacy, and promotion of health. Tasks performed by workers in this sub-major group usually include:

conducting research and obtaining scientific knowledge through the study of human and animal disorders and

illnesses and ways of treating them; advising on or applying preventive and curative measures, or promoting

health; preparing scientific papers and reports. Supervision of other workers may be included. Occupations

in this sub-major group are classified into the following minor groups: 221 Medical doctors, 222 Nursing and

midwifery professionals, 223 Traditional and complementary medicine professionals, 224 Paramedical

practitioners, 225 Veterinarians and 226 other health professionals. Available at<

http://www.ilo.org/public/english/bureau/stat/isco/isco08/index.htm> 6 Meeting Report- Human Resources for Health in Africa: Experiences, Challenges and Realities,” which was

held in Douala in June 2007. Available at <http://www.who.int/workforcealliance/Douala_EN_WEB.pdf>

http://www.samu-de-france.fr/en

http://unstats.un.org/unsd/class/

http://unstats.un.org/unsd/class/

http://www.ilo.org/public/english/bureau/stat/isco/isco08/index.htm

http://www.who.int/workforcealliance/Douala_EN_WEB.pdf


Definition of Allied Health Professionals (AHP):

AHPs are clinical health care professions distinct from medicine, dentistry, and nursing.7 One

estimate reported allied health professionals make up 60 percent of the total health workforce.8

There are roughly 3 million people employed as allied health professionals across all healthcare

settings in the United States9. It is estimated that there may be three times as many informal,

traditional, community and allied health workers globally as there are “modern” health

workers10

. In USA, there are two types of Allied Health Professionals- Technicians and

Therapists. The main difference is that echnicians are trained for less than two years and report

to Therapists or Technologists. Typical technician careers include: ophthalmic technician,

cardiovascular technician and clinical laboratory technician. Therapists/Technologist receives 4-

6 years training. Therapists have more responsibilities including supervising technicians.

Allied Health Professionals comprise the majority of the health care work, decrease cost,

improve quality of patient care and include approximately more than 85 distinct occupations,

exclusive of physicians and nurse. They are experiencing a workforce shortage greater than that

currently seen in nursing. (Came out of the interactions with different participants during the

first workshop on the subject held on 26-27 April in the NIHFW premises in New Delhi)

WHO SEARO2:

In many countries of the Region, the term “paramedical health personnel” was used for health

care providers who were non-physicians and non-nurses. Other countries used the term “allied

health personnel” or “auxiliary health personnel”. That the term “allied health” would be used in

place of “paramedical” for uniformity as well as to correctly reflect the services that these

personnel provided to the health service delivery system.

Definition in the context of SEARO2:

Allied health personnel are personnel who have specific connections with the art and science of

health care and are recognized as members of health team in the national health system. They

are educated, at either professional or lower levels, in a recognized or accredited health or

health related or academic institution.

Report of an Inter country Consultation Health (Paramedical) Services and Education2

identified strategies to strengthen allied health education in the countries of the Region. These

are attached as an Annexure to this report.

Regulation and pre-service training of Allied Health Professions:

In many countries regulation and education standards are regulated through proper legal bodies.

For example, Health Professions Council of South Africa (HPCOSA) controls the training,

registration and practices of practitioners of health professions, and to provide for matters

incidental thereto. Different professional boards are co-ordinating bodies for all the healthcare

practitioners registered. The respective boards that are established for a specific profession deal

7 Association of Allied Health School, Definition of AHPs: < http://www.asahp.org/definition.htm >

8University of California, San Francisco, Centre for the Health professions.

http://www.futurehealth.ucsf.edu/Public/Center-Research/Home.aspx?pid=88 9<http://www.chanet.org/NR/rdonlyres/E0C7E1C3-33A7-4463-B47C-

D6D75D83C374/199/NEONIHospitalandNursingFactSheetsinglesheets.pdf> 10

The JLI Strategy report: human resources for health, overcoming the crisis. Cambridge, MA, Joint Learning

Initiative, 2004 (http://www.globalhealthtrust.org/Report.html, accessed on 22 April 2011).

http://www.futurehealth.ucsf.edu/Public/Center-Research/Home.aspx?pid=88

http://www.chanet.org/NR/rdonlyres/E0C7E1C3-33A7-4463-B47C-%20D6D75D83C374/199/NEONIHospitalandNursingFactSheetsinglesheets.pdf

http://www.chanet.org/NR/rdonlyres/E0C7E1C3-33A7-4463-B47C-%20D6D75D83C374/199/NEONIHospitalandNursingFactSheetsinglesheets.pdf

http://www.globalhealthtrust.org/Report.html


with any matters relating to a specific profession. These boards consist of members appointed by

the Minister of Health, educational institutions and nominated members. There are 12 Boards

under HPCOSA: Dental Therapy and Oral Hygiene, Dietetics, Emergency care,

Environmental Health, Medical and Dental (and Medical Sciences), Medical Technology,

Occupational Therapy, Medical Orthotics/Prosthetics and Arts Therapy, Optometry and

dispensing Opticians, Physiotherapy, Podiatry and Biokinetics, Psychology, Radiography and

Clinical Technology, Speech Language and Hearing Professions11

.

Anyone wanting to work in the UK as Allied health professional must register with the Health

Professions Council. The Health Professions Council (HPC) is the body that regulates allied

health professionals in the UK. The HPC sets standards of professional training, performance

and conduct and hold a register of health professionals who meet the registration standards12

.

Complete list of Allied Health professions in UK is attached as an Annexure of this report.

In Australia, Allied Health typically includes all health professions other than medicine,

dentistry and nursing that require a tertiary degree to practice. Countries studied have taken

different routes for regulating the Allied Professions. SEARO report2

applicable for India has

recommended the following:

I. Need for effective mechanisms for quality assurance in allied health practice and

education.

II. Need to examine licensing (or registration) and re-licensing (or re-registration) of

paramedical professionals.

Regulation of paramedics in India:

In India, MOHFW has been in the process of regulating Paramedics/Allied Health Profession,

for which a draft bill, proposing one council for all the paramedical professionals and other

professions supporting medical professions with separate registers is in the approval process.

However, there is no central council for paramedical professionals, although in some states there

are Paramedical councils functioning. Kerala, Maharashtra, Chandigarh, Madhya Pradesh

Himachal Pradesh are few among other states having Paramedical Councils/Boards.

Karnataka constituted the paramedical board in the year 1997 to control and conduct

paramedical courses. The main functions of the Board include granting affiliation, regulation of

admissions and control of the functioning of institutions conducting coursework. Such functions

also include imparting quality educational programmes and conducting examinations. The

Karnataka paramedical Board also ensures that scientific training translates into knowledge and

skill acquisition.

Similarly, the Government of AP per the ANDHRA PRADESH PARAMEDICAL BOARD

ACT of 2006 constituted the AP paramedical board to recognize the institutions for the conduct

of such courses and also for the maintenance of a registry of qualified paramedical technicians in

the state.

In addition, MP and Himachal already have Acts to provide for the establishment of Paramedical

education in the State and to regulate the practice by paramedical practitioners and institutions.

11

Source: http://www.hpcsa.co.za/board_overview.php 12

Source: http://www.hpc-uk.org/

http://www.hpcsa.co.za/board_overview.php

http://www.hpc-uk.org/


Nearly 33 paramedical courses are currently being conducted in the country. These include

certificate, Diploma, Bachelors and Masters degree courses. A few training institutes, both from

the public and private sector are imparting high quality education in this field but largely the

pre-service education/training is mostly unorganized and lacks standardization. The following

are some real issues plaguing these professions:

Teachers and trainers are often part time, ill-trained, and far less than adequate in

number.

Infrastructure/Teaching/Learning Aids, Simulation Tools/Mannequins are not available

as per the minimum requirements.

Paramedical professionals in the country do not have a career path and avenues for „life

long learning‟.

There is a definite lack of hospital and real time work exposure. Preliminary studies

show that many have not even visited relevant hospital facilities.

No standardized entry level qualifications and examination procedure is currently

present in the country. Fee structure and facilities in these institutions are not regulated;

ethics standards are not uniform and are not being enforced and lack of regulatory

mechanism for the skill assessment (Final Qualification Examination) are some of the

additional observations that require attention.

Training of Trainers:

Preliminary enquiries on the subject shows that most of the “Trainers” involved in paramedical

trainings are not trained as trainers. This is not a high priority activity or initiative in almost all

institutions involved in training allied health professionals.

Some private and public training institutes of eminence have already put in place “Trained

Trainers” and are using new tools of evaluation of students. Establishment of NIPS and RIPS

shall be considered as an avenue for regulations, pedagogy, training practices (selections and

training of trainers, career development and management of the training capacity) and we

envision the development of comprehensive TOT protocols for the same.

Shortages in Allied Health Professionals:

We acknowledge that a true estimate of the number of health workers including Paramedics in

India presents several challenges. Routine sources of information are fragmented and generally

unreliable. According to the RHS bulletien-2009, the country has a 59% shortage of

Radiographers in the CHC‟s, while a shortage 54 % in case of Laboratory technicians at PHC

and CHC. There is a shortage of 31 % in case of the Health worker (male) while it is 32% in

case of Health assistant (female). As per WHO statistics, the Lab Tech per 1000 population in

India is 0.02 where as in countries like USA, UK and China it varies from 0.16 to 2.15. These

are figures based on in-position against sanctioned posts in the Public health system in the

country and as such do not reflect the real picture. In the absence of reliable data from within the

country a „Dip test‟, was conducted through a Questionnaire circulated to the different stake

holders for getting information on the Capacity (Existing paramedical training capacity in the

country (state wise, subject wise) and Inputs (Faculty, infrastructure and teaching aids

provisions for various courses in India and at selected International institutes, Curriculum for

various courses in India and international locations and Review methodology of teaching in

paramedical streams / 33 courses in the country).


Business Model for NIPS/RIPS:

A business model that is implementable, sustainable and flexible, such that it draws from best

practises available internationally and yet is in line with our national policies will be the desired

end product at the end of this discussion. The project secreteriat is currently studying various

feasible models that may be used as the starting point to develop our recommendation.

Management of Paramedics/Allied Health Professionals:

The conspicuous lack of involvement of paramedical health personnel in policy development

related to their work within the healthcare team only served to highlight the “doctor-centered”

nature of provision of medical services in the country. Many experts in the field are of the

opinion that paramedics do not get the respect they deserve as part of a “Medical Team”; we are

certain that there will be more clarity on this topic following customised “Focus Group

discussions” with each of the different specialties and associated allied professionals. The

profession of Paramedic/Allied Health needs to become attractive to catch the fancy of the

student pool in the country so as to begin the process of setting minimum quality standards for

the healthcare profession.

Role of Private Sector in Strengthening the Allied Health Production/Services:

Private sector has a major role to play in strengthening the Paramedical/ Allied Health Education

in the country and discussions, initiated by the project team are expected to be path breaking.

Involvement of Industry in strengthening pre-service/in-service education for Allied Health is

expected to accelerate the growth of this sector with win-win for all. First formal meeting with

the Private Sector is proposed on May 13, 2011.

Problem identification on the subject:

The analysis of data (some that is currently available and others that would be generated as a

result of the nation-wide mapping exercises) would help identify the problems. However we

propose to expand and validate the scope of analysis through:

I. Interviews with key informants, senior policy-makers in the government (State/Centre)

academic institutions, professional associations, bodies and councils.

II. Focus group discussions with community leaders and clients of health services

III. Any other activity that is required to be performed, suggested by experts/specialists or

other stakeholders during the project period.

Conclusion:

Situation analysis has just begun, and is an ongoing process that is expected to provide greater

insights on international and national realities to the project Team (refer to the Gantt Chart

attached with this document). The project secretariat at PHFI is currently on schedule and is

expecting to submit a full project report by the first week in October 2011.

***


DIPSTICK STUDY TO MAP AVAILABILITY OF PARAMEDICAL

STAFF IN SELECT DISCIPLINES

In the referral chain, as per the current structure of Health Care Service provider matrix, CHC is

the first point of contact with a specialist doctor. However keeping in view the limited number

of CHCs available, practically it is the District Hospital or Taluk Hospital where the patients get

in touch with Specialist services. The following chart would testify the position.

These hospitals service the largest number of patients in terms of providing basic Specialties like

Surgery, Medicine, Ophthalmology, ENT, Obstetrics and Gynecology, Orthopedics supported

by diagnostic facilities such as X-Ray, Lab, Radiography ECG etc. These hospitals on an

average provide OPD services to approximately 800 patients per bed per annum. Therefore an

attempt was made to look into the aspect of availability of paramedical technical manpower in

this establishment.

A questionnaire was thus designed to conduct a “dip stick” study in randomly selected hospitals

in the states like Uttar Pradesh, Chhattisgarh, Uttarakhand, Andhra Pradesh, Manipur, Mizoram,

Nagaland, Rajasthan. The method involved collecting data on availability of certain technical

staff matching the scope of specialist services being provided by the hospital and then obtaining

the view of the concerned specialist on the numbers needed in such domain.

The findings were as follows:

The state of Andhra Pradesh has a large number of Taluk hospitals which are bigger than CHCs

in the scope and functions and are complimentary to the large District Hospital. The availability

of technical paramedical personnel was adjudged by scanning through real time data collected

by one agency in 2010.

Keeping in view the scope of services provided by the Govt hospitals at secondary level of care

the following categories were taken into account. A total of 30 facilities were taken into the

study.


Lab Technician

Radiographer

ECG Technician

Dialysis Technician

Medical Record Technician

Audio and Speech Therapist

Optometrist

Category Average Deficiency Remarks

Lab Technician 24% Multi Skilled Technician,

No Cyto technician available

in District Hospital

Radiographers 10% CT Technicians are present

wherever CT Scan has been

installed.

Dialysis Technician Nil No reserve available

ECG Technicians 56% In many places part time and

contractual ECG is being

used

Medical Record Technicians 95% Medical Record keeping is

low priority

Audio and Speech Therapist 80% The deficiency worked out

against need

Optometrist 5% Almost assured availability

There are a number of other categories which are relevant to Tertiary care hospitals i.e.

Medical colleges. A detailed response from them is awaited.

However it can be safely concluded from the above representative data that there is a

deficiency of paramedical staff in basic scope of services. With the strengthening of the

district hospital with advanced technology like Echo Machines, Pulmonary Function Tests

lab, CT Scan, MRI, and Oncology services the need for support staff is voluminous and

people with inappropriate skills have to be available to facilitate services.

***


INTRODUCTION AND OBJECTIVES OF THE WORKSHOP

The workshop for developing a landscape on project for augmenting paramedical training

capacity was conducted at NIHFW conference hall on 26th and 27

th April 2011. The objectives

of the workshop were as follows:

a. Identify key experts for various Terms of Reference (ToRs) and brief them about the

scope of the TOR and its contribution to the project.

b. Identify additional experts and key institutions for engagement and/or partnership as

part of this initiative

c. Engage in facilitated small group discussions on each of the five terms of reference so as

to scope out the broad nature of direction of the recommendations that may then be

explored further

d. Allocate Terms of Reference to identified champions and provide them with the

necessary secretarial support to help arrive at recommendations

e. Incorporate recommended plan of action and activities as part of the overall project plan

including timeline for site visits, focus groups, data mapping and other key activities.

The deliverables of the workshop were explained to the participants with the aim of arriving at

the outcomes described above on each of the Terms of Reference, viz, Inputs, Pedagogy,

Regulatory Frameworks, Business model and protocols for training of Trainers.

The workshop further utilised group work method to generate views on methodology to be

selected for the desk review, format of the report and field visit plans, the outcome of the work

shop is detailed in the chapter on way ahead.

The detailed list of participating experts and organisations follows the description of technical

deliberations on each ToR.


TOR 1: PHYSICAL INPUTS

Introduction:

The aim of the Term of reference is to develop benchmarks for physical inputs for paramedical

Services. This encompasses a physical facilities for NIPS and RIPS, training aids as applicable

to the courses, the staffing requirements including medical and allied medical staff, support staff

and a wide range of equipment which would be required to provide sufficient skill to the Allied

health personnel of the 33 specialities currently envisaged.

Deliverables:

The deliverables for Infrastructure, Training aids and Equipment were as follows:

1. To review the Infrastructure, Staffing and Equipment requirement for the various allied

courses based on available literature and successful models.

2. To prepare a broad framework for physical inputs for NIPS and RIPS and to ensure

standardization

3. To define the broad outline for the infrastructure and staffing for the Allied services

after the brainstorming session with special emphasis on additional requirements for

particular courses.

4. Inputs on Training aids, standardization for courses and methodology for Quality

assurance.

5. Drawing-up the scales of equipment against intake of personnel

6. Benchmarking of staffing norms and developing a strategic framework to augment the

availability of skilled paramedical human resources

7. Strategising the road ahead.

Background:

In most universities in developed countries, there is a well-defined Allied Health cadre and an

unambiguous description of who would be classified under the ambit of Allied Health providers.

In India, however, there exists a significant gap in terms of Allied Health services being

provided and what is required co-existing with a wide variation in the quality of services

rendered.

With regards to physical facilities only a few states have standards for physical layout with

policies for building norms in place for various paramedical institutions requiring independent

buildings. The infrastructure has been found to be mostly inadequate and ill conceived. Issues

such as the minimum bed strength, range of services provided as well as the infrastructural

growth to be planned in tandem with technological advances are other aspects that have not been

considered by these institutions.

States such a Karnataka have delineated a staffing pattern to include both full time and part time

faculty members. Paramedical boards have also defined the qualification, teaching experience

required and the number of posts. Some courses run by institutes which rely solely on hospital

infrastructure for functioning, have defined the number of hours that a faculty needs to devote to

paramedical training. There is no check list available for the number and type of equipment

requirement to equate with the intake strength of paramedical personnel.


From an architectural perspective, land, institutional building and residential facilities are the

three components known to be the essential tenets on which the planning of physical

infrastructure has to be envisioned. Modular structures have been used abroad with some

success to design the buildings for allied sciences in order to make it convenient to customize

them as per the requirement.

There is a need to look at the best practices in this country and understand their functioning.

Experts have opined that institutions like CMC Vellore, Manipal University, Sri Ramachandra

University, Chennai, AFMC Pune, JIPMER Puducherry and MUHS Nasik, to name a few,

produce quality allied health workers.

Highlights of the group discussion/group work held during first day of workshop:

The group work started with a brief introduction of the speaker, facilitator and group members.

The key discussions and decisions taken by the group were as below:

Recommendations:

1. Physical Infrastructure: The facility for NIPS and RIPS is envisaged as being in close

proximity to a hospital (with 2-3 km radius) to facilitate training that is closely associated

with on the job training. It was recommended that the facility consist of three components:

i. Institutional or teaching block

ii. Administrative block

iii. Residential Complex

The planning parameters were calculated and recommended based on the premise that an area

requirement of 1000 sq. mtr. / 40 students were to be taken as a model. Twelve courses were

recommended in four blocks on three floors with the total area being 12,000 sq. mtr.

b. Area requirements: The following area requirements were deemed appropriate after

inputs form architects in the expert group:

i. Building area

1. Institute = 12,000 sqm

2. Hostel = 19,860 sqm (residential) + 1,500 sq m (mess area) (for

2680 students). The proposal incorporated 100% residential facility

for students. It was suggested that no residential facility was to be

included for the staff.

Physical Input

Equipments (actual

laboratory and class

equipments)

Training aids

Infrastructure (teaching,

class room, labs,

administration, Hostel) Man Power


Total built up area for NIPS or RIPS = 32,360 sqm

ii. Land Area: 6 to 8 Acres considering 25 % as ground coverage

c. Modular structure was deemed an appropriate design model for the buildings for

allied sciences since it can lead to major cost savings and allow for future addition

in the number of courses as well as student intake.

d. It was recommended that „Comparative Area Statement’ from existing paramedical

institutes like PGIMER Chandigarh, JIPMER Puducherry and Manipal University

may be taken into consideration before arriving at the individual course area

requirement.

e. Environmental factors: Planning stage to include environmental factors such as

subsoil condition, availability of electricity, water head, and service conditions need

to be considered at the planning stage.

2. The planning premise should incorporate future expansion, which must be incremental and

not proportional.

3. It was proposed to include Learning Resource Centre and Skills Labs

4. The pre-visit checklist and the infrastructural check list were perused and recommended for

use during field work.

5. It was proposed that a similar equipment checklist be prepared both, Equipment specifically

for training – only purpose and those for on the job training.

6. Good Procurement Practices (GPP) models must be standardised. Tender document must be

drafted with emphasis on maintenance contracts and training of personnel by the firms.

7. Training aids to be obtained from National Knowledge Network (NKN)

8. To overcome the lack of large human resource of trained trainers, newer modalities such as

skill sharing, WiFi (LAN/ WAN),e-libraries, simulators, mannequins, Audio- Visual

training aids, Specialty related books/ Journals (E Resource) skill labs and virtual learning

were discussed as options.

9. In the context of staffing, the ratio of 1:10 or 1:15 was recommended, with a need to include

at least four adjunct faculties per course. It was deemed that the need in certain subjects with

an acute shortage of faculty could be fulfilled from industry pool resource, technical experts

from industry, consultants or retired teaching faculty.

Reactions of the group members:

It was observed that the concept for physical proximity with hospitals also has to be

revisited, as there are several successful examples, like nursing in Indonesia, where the

entire programme is run with mannequins and the latest simulation technology. Short-

term affiliations to hospitals, however, was thought necessary as part of the curriculum.

An opinion was expressed that merely producing the right number of allied health

personnel would not serve the purpose. In fact, an attempt to satisfy number may come

at the cost of course content and the impetus needs to be on quality in training and skill

acquisition must be the priority.

Public Private Partnership (PPP) model was suggested, especially for Equipment and

Staffing, since there is a severe resource crunch in the government sector and it was felt

that there is an imminent need to learn from industry best practices and from


international experiences. Fresh impetus has to be given to standardizing the Training of

Trainers, training material, clinical processes and protocols.

In view of the term „paramedical personnel‟ deemed inappropriate by the expert group,

it was suggested that NIPS and RIPS be rechristened as NIAHS (National Institute of

Allied Health Sciences) and RIAHS (Regional Institute of Allied Health Sciences)

An expert observed that there is an overarching need to prepare a procurement guide for

equipment as there is no specification currently stated in curriculum, required for

equipment related to allied health courses.

To ensure quality in terms of teaching, PG faculty members who follow-up with PhD

can be assured career progression and other benefits could be linked to their

performance. Such experiments were being carried out in certain Institutions with

encouraging results. It was also suggested that having different levels or grades of

trainers/ teachers would help skills for training and supervising to be differentiated.

It was commented that there was an undue emphasis being given to degrees in our

country, with a resultant an enforced hierarchy, when the curriculum itself is only

fractionally different. Therefore a paradigm shift towards certification of skills and

competencies was opined.

The Road Ahead:

The group decided that similar steps would be taken for the entire project.

Resource Faculty:

Dr. Ananthanarayanan P.H, HoD, Dept. of Biochemistry, JIPMER, Puducherry

Dr. R. Chandrashekhar, Chief Architect, DGHS, MoHFW, GoI

Dr. R.P. Pai, Member of Board, Institute of Paramedical Sciences. Manipal

Maj. Gen. (Dr.) S.K.Biswas, Founder Member and Patron, Academy of Hospital Administrators

Dr. Rajashekhar, Director -Institute of Paramedical Sciences, Manipal

Col. Anurag Salwan, Vice President (IP) HLL Lifecare Limited

Mr. S.K.Kalra, Assistant Vice President (IP) –HLL Lifecare Limited


TOR 2: PEDAGOGY

Introduction:

Nearly 92 paramedical courses have been known to constitute the thematic basis of training to

prospective Allied Heath personnel. Of the recommended 33 courses, only 17 have a well

defined pedagogy, curriculum and skill sets. The endeavour under this term of reference was to

analyse the myriad courses, their curriculum, duration, course structure, grading of certification

and subsequently draw a broad landscape for the pedagogy and development of skill sets in

order to streamline the formation of NIPS and RIPS.

Deliverables:

A group of experts reviewed the existing list of 33 recommended courses and deliberated upon

the various aspects of pedagogy in order to make a framework for uniformity of curriculum

design, eligibility criteria and admission procedure. The deliverables assigned were as follows:

Figure 1 Deliverables of ToR 2

Nomenclature: To review and analyse the existing list of recommended course

nomenclatures, obviate duplication and propose modifications and vision for future

expansion.

Course Design: To review the course content and curriculum available both in India

and elsewhere and suggest methods of standardisation

Duration of Courses: To provide inputs on the levels and duration of different courses

Eligibility criteria: To review the eligibility criteria, norms for admission

Skill sets: To quantify the desired skill sets

Context:

Technological advances in Healthcare are increasingly provided by a team of professionals with

a range of different skills, the allied health professional being an integral and distinct member of

that team. The allied health professional needs to bring with him a particular expertise for

patient care, thus requiring a course pedagogy which would help build a knowledge base and a

unique set of skills which would equip him for the same.

Situational Analysis:

Training occurs both in public and private sector with marked difference in focus of the courses

being run as well as in the content. Private sector has traditionally placed impetus on revenue

producing courses and courses with shorter duration while the public sector institutions often

provide hospital oriented courses on a need basis. There is a lack of standardized evidence based

training. The following were some key findings:


There is a wide variation in the curriculum among the states. Better performing states

have either Paramedical Councils or Acts in place. This variation makes skill

standardization and assessment difficult. There is also a lack of norms and standards of

paramedical education and training due to absence of a paramedical council.

Unlike many countries abroad, there is absence of Quality control, raising issues of

Patient Safety and Occupational Safety.

There is a tendency towards addition of newer categories of personnel rather than on

role expansion of existing cadre. This had led to duplication of course content and

narrowing of job profiles.

In-service education is not well established for many cadres. No policies exist on career

planning as seen in many countries abroad resulting in significant brain drain. There is

also a lack of involvement of paramedical health personnel in policy development

related to their work within the health team.

In certain states/courses, however, there is a system of a well defined course structures

and entrance examinations. Boards such as the Paramedical Board in Karnataka not only

grant affiliation and regulate admission for paramedical courses but also ensure that

scientific training translates into knowledge and skill acquisition.

Highlights of the discussion:

The expert group discussed aspects of TOR as (1) Types of courses: Certificate, Diploma,

Degree or Post-graduation (2) Desired skill sets and knowledge (3) Course duration (4)

Curriculum (5) Course mix in terms of Theory, Practical and Demonstration (6) Simulation (7)

On-job-training (8) Assessment and examination (9) Internship/apprenticeship (10) Best

practices.

Further the group made following set of recommendations:

Uniformity in the nomenclature of courses conducted by NIPS and RIPS.

Standardisation of curriculum design was recommended, which would be feasible with

the advent of the Paramedical Council, NIPS and RIPS.

An All-India level Common Entrance test or the Pre-Medical tests presently conducted

by MCI would assure certain caliber of the candidates, which would in turn improve the

quality of paramedical personnel passing out. Eligibility criteria for admissions into the

paramedical courses as proposed by the expert group is 10+2 with PCB at least 50%

It would be prudent to consider bringing the various modalities of pedagogy under the

ambit of the Council and also incorporate standardized and successful models as in

Madhya Pradesh, Andhra Pradesh and Kerala across the nation while considering

regional variations.

Standardized duration of courses was recommended. It was proposed that the duration

of one year be set for certificate courses, two years for diploma and three years for

degree. Setting norms for registration of candidates by the proposed council (after

internship is applicable).

Internship, paid or unpaid as required, to build up practical skills and to ensure safe

practices

A mix of external and internal evaluation was proposed. The concept of log books, on

job training and modalities of theory and practical was also proposed.


In view of the shortage of staff, outsourcing of teachers (technologists, psychologists

etc.) as required for medical colleges or teaching institutes was recommended.

Equipment training could be provided through industry interface. It was suggested that a

PPP model be promoted to ensure that firms required installing equipment on a turnkey

basis also responsible for training of paramedical personnel.

Compulsory training on simulators for first aid, medical and surgical emergencies in

addition to the skill specific to respective technical trade.

Since newer technology demand greater expertise CMEs, seminars, short-term courses

and hands-on training should be form an integral part of institutional policy for career

enhancement.

Arrangements to be made for the in-service candidates for admission in terms of

deputation, study leave and relaxation of age.

Setting of accreditation standards for quality control of curriculum and collaboration to

be initiated with accreditation bodies and UGC.

The group reacted to these recommendations with great interest and suggested that:-

A study of the model of B-schools and IITs to be made and a pattern of education on

similar lines be attempted.

Nomenclature to be decided before collaboration is initiated with UGS or other

professional bodies.

Certain specialities which would not have faculty normally working in the hospital like

physics, physiology etc. may need to be outsourced.

An interdisciplinary approach needs to be undertaken considering the fact that certain

specialities may become obsolete, merge or expand.

An expert opined that a „must know modules‟ should be introduced to supplement the

regular courses, power point presentations, and videos to tackle the shortage of staff.

Another expert expressed his view that the focus should be restricted to curriculum for

RIPS and NIPS. For most specialities, internship is not a viable option as there is a

dearth of paramedical institutes that have affiliations to hospitals. As far as the issue of

paid internships is concerned some institutions are providing a stipend to all the allied

health personnel doing internship in the institute.

It was suggested that faculty development is an area which needs to be focussed. There

is a huge deficiency of faculty whether full time or part time. E- learning and other

simulation models can only supplement the traditional learning module, not be a

replacement it was felt.

There is was a need expressed to consider grouping of the various courses so that the

actual need to run certificate, diploma and degree courses of the same specialty can be

critically analysed to bring down the possibility of duplication and confusion in the job

market.

An esteemed member commented that a holistic approach needs to be taken before

deciding the various training levels or courses; for example, there is also a need to

address the increasing need for trained psychiatric/mental health allied health specialists.


Road ahead for NIPS and RIPS

Expert groups to vet the curriculum from desk review: The subject-wise course

content and curriculum generated through desk review, or otherwise, (henceforth called

first draft) shall be presented to a group of experts selected for the purpose to vet and

come out with the second draft pedagogy.

Field visits to institutes: The second draft curriculum will then be further improved by

field visits to the institutes of repute identified for the purpose to develop the third draft

pedagogy. Template formation should incorporate acceptable variation in Pedagogy and

skill sets.

Inclusion of best practices in teaching pedagogy: National and International best

practices observed during the field visits shall be included to generate the third draft

pedagogy.

Standardisation of skill sets required for 33 courses: Needs to include technical,

human, conceptual and managerial skills.

Ongoing review and feedback: Draw a plan for continuous upgradation of course

design to keep pace with technology

Accreditation of institutions (to be interlinked with inputs and regulatory ToRs).

Resource Faculty:

Col. K. Srikar, Colonel Training (PMT), AFMC, Pune

Dr. Sammita Jadhav, Programme Director, SIHS

Dr. B. B. Thukral, HoD, Safdarjung Hospital

Dr. A. K. Mukhopadhyaya, HoD , Dept. of Laboratory Medicine, AIIMS

Dr.Lalit , Dr.RP Centre for Ophthalmic Sciences


TOR 3: REGULATORY FRAMEWORK

Deliverables:

The goal of the ToR is to develop a regulatory framework for the NIPS and RIPS. The ToR

deals with the formulation of the regulatory framework for training, skill assessment and skill

needs, accreditation and monitoring of all the paramedical disciplines proposed under this

initiative. The group worked together in direction of following deliverables:

Figure 2: Regulatory Framework

Developing goals and principle of regulation that sets the purpose of the system to

regulate the education and practices of paramedics.

To develop methodologies to deal with legal constraints by investigation and analysis of

current laws and regulation, which may inhibit the role of paramedic in delivering health

care matching the skills set attained.

Monitoring and evaluation- it is necessary to ensure that a Regulatory Framework is

implemented and the intent behind the changes is being understood and complied.

Background:

The government of India has committed to establish one apex National intuition (NIPS) and 8

regional institutions (RIPS) as a pioneering step in this field. The Endeavour is to ensure quality

manpower availability across the country to fill up demand in public as well as private domain.

The framework aims to connect these national and regional paramedical institutes so as to

develop a robust model for the paramedical health profession. It also envisages regulation of

coordinated development in the education of paramedical professional, maintain standards of

such education, and create a central data base for qualified paramedical personnel in the country.

Situational Analysis:

There is no central council for the paramedics, though there exist a few state councils such as

Maharashtra, Chandigarh, Himachal Pradesh, Madhya Pradesh to name a few. Till date, only the

state of Madhya Pradesh and Himachal Pradesh has a statute governing the state paramedical

council that regulates education, recognition of courses and maintaining registers.

In absence of regulatory mechanisms and organization to control these categories, the

mushrooming of training institutes has continued unabated and has the potential to

impact the quality of patient care at large. The training imparted is not under any


standardized curriculum to ensure adherence to quality. Therefore there is always a gap

between the training and expected role.

There is dissatisfaction among the huge cadre of paramedical professionals whose career

prospects are uncertain and they remain unsung warriors of the heath care sector. There

has not been any effort for up gradation and advancement in the categories so identified.

The RHS Bulletin has reported shortage in certain identified paramedical categories in

the Public Health Care facilities.

Table 1: Shortage of Paramedical personnel in India

Radiographers at CHC 59%

Lab technicians at PHC and CHC 54%

Male Health Assistant 31%

Female Health Assistant 32%

Source: RHS 2009

As per WHO statistics, the Lab Tech per 1000 population in India is 0.02 where as in countries

like USA, UK and China it varies from 2.15 to 0.16. However norms for India are yet to be

defined. There has always been a need for an omnibus statutory body/regulatory authority with a

view to prescribe uniform standards of training and registration to practice.

Best practices:

For health care professionals, regulation has raised awareness of the scope of practice, education

levels and general clinical ability within other groups of health care professionals like nurses.

Councils like the Madhya Pradesh state council has been supported by a statutory act for

regulating the paramedical cadre in the state, which can be duplicated to other states with minor

customized changes.

Private universities such as Manipal University have taken pioneer steps in designing the

paramedical course to meet the need of the market. Some of these courses are M.Sc. Nuclear

medicines, M.Sc. Nanopharmaceuticals, to name a few.

The National Health Services of UK overseas the training of all the disciplines of allied health

personnel. The health professional council acts as a regulatory body for all these disciplines.

Highlights of the discussions:

Followed by the group work, the experts made below listed recommendations:

1. Goals and principle of professional and regulation to be developed and explore the

principles that should underlie the regulation of paramedics.

2. Councils already functioning, like the Madhya Pradesh state council supported by a

statutory act for regulating the paramedical cadre, can be customized and duplicated in

other states.

3. Stress on educating the medical fraternity about the need for the legislative changes.

Networking should be attempted amongst the functioning councils so as to improve the

coordination between them. Governance models of IIM‟s and IIT‟s can be studied for

this purpose.


4. Three models were considered by the group members keeping in view the overall

scenario namely:

A single umbrella model

A single paramedical council

Dissociating Physiotherapy from the proposed paramedical council bill since

Physiotherapy as a discipline under Paramedical Council has been the subject of

debate for quite some time and consensus has yet not reached.

5. There is a need to address the issue of designation at all levels of the system to ensure

demarcation. Emphasis should be to adapt the best practices from the present system.

6. The inclusion of Government sector, representative from state councils, representatives

from the accreditation body and medical education bodies as stakeholders for the

formulation and implementation of the regulatory framework is critical to ensure buy in.

Academic societies like associations of surgeons of India, API, and others may also

approached for inputs as to what their practices expect out of supportive staff.

7. It was also suggested to have the uniform curricula, examination pattern and evaluation

criteria across the country.

8. There is a need to have a minimum standards solution and/or broad-based requirements

since all the regions have varied needs relating to medico-social requirements and hence

autonomy of every region is to be safeguarded.

9. Setting norms for registration of qualified personnel and accreditation standards for

quality control of curriculum should be a role of the proposed regulatory body.

Reactions:

1. It was also suggested by members that a model be developed where NIPS and RIPS are

taken as academic bodies and let regulation be handled by the proposed superior body.

This would enable NIPS and RIPS to comply with the regulations without conflict of

interest.

2. Standardisation across curricula, examination pattern (central) and evaluation criteria

was suggested.

3. Based on the above deliberation a fourth model was agreed upon by the members, in

which a common board would be governing the functioning of the NIPS and eight RIPS.

It was proposed that the board so constituted would regulate the functions of all the nine

institutions. Board of members could have its member secretary position rotating among

the participating institutions.

Road Ahead:

Study the various regulation in the field, both nationally and internationally

Expert groups to vet the Regulatory Framework

Visits to institutes where the system of paramedical training is stabilized in both the

private and Government sector.

Modes and Means to Standardize Allied health -services education

Promotion of Including best practices in teaching pedagogy

Accreditation of institutions

Pattern of Examinations and assessment, appeal mechanism


Create NIPS and RIPS as Centers of Excellence in academics and research. They can be

bodies for affiliation of courses run by institutions that are already functioning. This will

be promoted through incentives for students graduating from such affiliated courses.

Subsequently, a formal Paramedical Council can be established based on the experience

of the affiliated model of NIPS and RIPS for three to five years.

Resource Faculty:

Mr. J P Mishra, ED, SHSRC Chhattisgarh

Dr S B Arora Director SOHS, IGNOU

Dr Mrs Naseem Shah, Chief, Centre for Dental Education AIIMS

Prof Dr Sangeeta Sharma Secretary MCI

Dr Arvind Rajwanshi, Prof, PGIMS Chandigarh

Prof Dr George Tharion, CMC Vellore


TOR 4: DEVELOPING BUSINESS MODEL FOR SETTING UP,

MANAGEMENT AND ROAD MAP FOR SUSTENANCE OF NIPS,

RIPS

Background:

Business model is the transformation of existing conditions into preferred ones – Herbert Simon,

1969. “A business model describes the value an organization offers to various customers and

portrays the capabilities and partners required for creating, marketing, and delivering this value

and relationship capital with the goal of generating profitable and sustainable revenue streams.”

Figure 3: Business Model framework13

Situational analysis:

Considering the contemporary paramedical education situation as described in the cabinet note

and the requirements of paramedical or allied health services professionals in various domains,

certain issues need to be considered before planning a strategy to run the NIPS and RIPS such

as;

Growth in Healthcare sector in this millennium equals the growth in IT sector in the last

millennium, thus creating wide range of requirements in the supply side.

When considered in terms of bed capacity, the health care sector is expected to double

its bed capacity in the next ten years.

Involvement of private sector is expected to be more in terms of investments and

funding as it was seen in the past few decades.

Various Accreditation systems have identified presence of skilled paramedical staff in

the hospital as one of the major variable resulting in quality of health care. since India is

also expected to play a pivotal role in the health care delivery system in the global

virtue, it is not irrational to comply with these set of standards and accreditation

procedures.

Prima facie the existing models of educational institutions for training of allied health workforce

can be classified in three broad categories such as

(1) Government aided autonomous bodies

(2) Private Schools and

13

Adopted from Osterwalder (2004) The Business Model Ontology


(3) Unorganized private models.

The work force being created through these institutions may or may not suffice the

requirements, as indicated by various formal and informal projections there is huge increase in

the demand of health care services, thereby calling for an increase in the availability of human

resources for allied health services in the nation (Chidambaram, et al., 2005).

Variation in the identification of allied health professionals, nomenclature limits us from

estimating the exact number of professionals required in the health care delivery system;

however they are required for the public health functions, hospital based functions, diagnostics

and outreach functions broadly (Satpathy and Venkatesh, 2006).

Initiatives like NRHM14

have bolstered the recruitment of paramedics; however there exists a

huge gap in availability of trained human resources in allied health services to enable the

delivery systems (private and public) for performing better.

Figure 4: Factors contributing to market opportunity of establishing institutes for allied health

sciences capacity building:

Key strategies for sustenance:

Reduce attrition among students and teachers, and improve accessibility and equity:

Attrition of health workers is a serious problem. These rates are mirrored in education

institutions, resulting in serious shortages of teachers for existing students who require

clinical placements, and ultimately undermining efforts to replace health workers lost from

the system. Student attrition is also high. Young students are sceptical about pursuing the

allied health courses due to absence of quality education system in place. As most of the

courses are offered by the private sector, student financing may considerably increase the

pool of prospective students and could catalyse increased growth in the allied health

sciences cadre.

Retaining more teachers through initiatives such as better financial aid and quality housing,

may have a quick, cost-effective impact on health workforce scale-up. With appropriate

support structures, admissions policies that promote the participation of students from

disadvantaged backgrounds or the underrepresented gender will improve accessibility and

will likely produce more graduates prepared to work in underserved communities and rural

14

21528 paramedics across the nation


communities improving health-system equity for both providers and patients. Initiatives to

improve the workforce‟s gender balance will also improve the accessibility of careers in

health.

An additional accessibility factor is the location of education facilities. Most health worker

education and training institutions are located in urban areas, as are most health-service

facilities, and their focus on hospital-based instruction may not reflect the most prevalent

community needs. The development of new higher education institutions and campuses of

existing institutions distributed into rural, semi urban and urban disadvantaged communities

would improve access for both students and citizens needing health services.

Integrate pre service and in-service education and training: Pre-service curricula that

emphasize lifelong learning and relevant health issues and competencies better prepare

graduates for in-service work and ongoing training. Lifecycle, modular approaches to

learning, which allows health workers to access training or join the workforce at different

entry points, promote career ladders – a potentially important tool for enhancing health

worker performance. Health workers generally enter pre-service education after completion

of secondary school. It is necessary to ensure that there are enough qualified secondary

school graduates to allow successful transition to tertiary education, on the one hand, and

sufficient pre-service capacity in tertiary education institutions to receive the students, on

the other.

Develop common educational platforms for different types of health workers: Large medical

universities /colleges offering multiple disciplines – given that most forms of medical and

allied health require similar types of fixed investments in laboratories, medical equipments

,and buildings , colleges /universities that have multidisciplinary courses can become

financially sustainable through optimization of available resources.

Open and distance learning mode and action aided learning: A hybrid model using both

classroom and distance learning is becoming prevalent. The practical in-clinic element of

these programs imparts the hands-on parts of the coursework while distance learning imparts

theoretical elements. Distance education can reduce the overall cost of training by

eliminating large cost elements such as boarding, transportation, and lost wages due to

student time spent on site (rather than at their employer).

Continuous improvement and quality assurance: Approaches to quality assurance include

academic audits and institutional or programme accreditation. The ultimate objective of

quality assurance is to improve the educational process, the curriculum, the teachers and,

ultimately, the graduates. It assures the public that a programme of study prepares

competent practitioners for the country‟s health priorities, provides institutional

accountability and allows each institution to undertake self-assessment to guide future

change. The presence of quality assurance mechanisms may allow governments to develop a

more effective mix of public and private sector education providers by licensing only those

that meet accepted standards. When performance does not comply, governments have the

authority to impose stringent conditions to promote improvement.

Build Institutional capacity–Health worker education and training institutions aim to scale

up their capacities by expanding the number of qualified teachers, building on twinning and

partnerships, and exploring regional approaches to their work. First and foremost are cost-

effective approaches, maximizing the use of existing capacity in the country. In the longer


term, significant investment, with scope for novel approaches to financing and enhanced

public–private partnerships is needed.

Expanding teaching capability, identification of level of trainers and developing ToT

protocols: One major obstacle to scaling up education in developing countries is the severe

shortage of qualified teachers, which constrains the implementation of innovative learning

approaches. These shortages exist for the same reasons as underlying health worker

shortages: poor working conditions, low pay, limited career advancement and no access to

study leave. Scaling up the numbers and capacity of teaching staff is a vital prerequisite for

scaling up education.

National and institutional policies that promote the use of non-traditional teachers from

different backgrounds will increase the range of available instructors, as well as promote

quality teaching within a new curriculum environment. Other options for scaling up teachers

in low-resource environments include: providing a supportive work environment through

meaningful incentives (in Malawi, one faith-based organization doubled its staff of nurse

tutors by providing targeted salary supplements and free staff housing);hiring part-time

teachers from the clinical sector ; recruiting teachers from the diaspora (as the Public Health

Foundation of India is doing for its institutions); twinning institutions to create opportunities

for teacher exchanges and placements ; using educational facilities for teacher training, in-

service learning and continuing education when students are not present; and moving to a

semester system that provides year-round instruction, reducing overall training time.

Fostering twinning and partnerships - for e.g. some nursing schools are reaching out to the

future potential employers of their students in order to subsidize a portion of tuition in return

for access to top talent. These cross-subsidization models helps finance a greater volume of

students, which, in turn, helps amortize costs over a larger revenue base.

The essential elements for successful twinning ventures are the similarity of institutional

vision, the willingness to establish and promote long-term bilateral exchanges, the quality

and depth of the interpersonal relationships and the development of institutional trust.

Above all else, such partnerships must centre on the needs of the institution as it defines

them. Key outcomes of twinning arrangements include the delivery of education and

training in the short term, the development and distribution of educational materials, the

development of networks that facilitate and encourage best practice, and leadership training

opportunities. Education institutions could collaborate with government, the health system

and business schools to offer short courses on leadership and management skills for existing

health workers. Over the longer term, these offerings can migrate to full degree courses in

evidence-based health administration and management.

Maximizing impact through regional approaches - Economies of scale can be gained

through regional centres of excellence with specific expertise that supports scale-up.

Harnessing public private partnerships- Medical / allied health schools are usually publicly

funded because of their high costs. However, many private schools – for-profit, non-profit or

faith-based – are of high quality and educate a significant proportion of health workers in

the regions where they operate.

Highlights of the group discussion or group work held during first day of workshop:

The group discussed the issues related with sustenance and business model for the NIPS and

RIPS, major issues discussed within the group and with the other groups are:-


1. The business model should have following characteristics- sustainable, viable, flexible

and light weight to enable the ease of implementation.

2. As the location of these institutes is still not defined, it may be possible for the group to

come out with certain suggestions on possibilities of successful model.

3. The existence of RIPS as a separate entity or a department within the well established

medical college is questionable.

4. All the RIPS may not follow to run all the 33 courses within the same time frame; they

may do it in phased manner.

5. Specific skill training may be imparted in private or public sector training centers, this

may allow the existence of RIPS as separate entities which may or may not be attached

to multispecialty hospitals.

6. Public healthcare system is incorporating posts for allied healthcare staff- expansion is

liability of health care system.

7. Existing successful business models in international as well as Indian context, details of

various “Centre of Excellence” within the country may be revisited to derive a

reasonably sustainable model.

8. The system should be designed in a way such that, the final product (students) is well

absorbed within the healthcare ecosystem which includes the private as well public

sector entities.

9. Faculty and training facilities need to be shared between the private and public sector.

10. Ownership and regulatory authority should be thoroughly addressed

Road Ahead:

Desk Review - Study the various Institutes of National Importance on the basis of

framework, governance structure and operational architecture - the business or

operational model so generated through desk review, (first draft) shall be presented to a

group of experts selected for the purpose to vetting the model.

Field visits to institutes: The second draft will then be further improved by inputs

collected during the field visits to the various existing institutes of repute identified for

the purpose to develop the third draft of Business Model.

Draw a governance plan for RIPS to function within a region serving group of states in

congruence to the suggested Regulatory framework for RIPS.

Draw a final Business model /Operational model framework for NIPS and RIPS.

Resource Faculty:

Dr. Bipin Batra, ED –National Board of Examinations

Mr. Sameer Mehta, CEO – Everonn Medial Education

Dr. B D Athani, Additional DGHS and Director- AIIPMR

Dr. Niranjan D Khambete, PhD, Engineer (Instrumentation) - Sree Chitra Tirunal

Institute for Medical Sciences and Technology

Ms. Lalita Shankar, Director Global Health – BD

Dr. Sanjay Sarin, Director Global Health- India and South East Asia- BD


TOR 5: TRAINING OF TRAINER AND FACILITATION GUIDES

Introduction:

The importance of appropriate training capacity is recognised since independence through

committee recommendations and expert group comments; however there are poor or no efforts

recorded for enhancing the training capacities of existent institutions engaged in training in

disciplines of paramedical or allied health sciences.

These “TORs for TOT protocols and facilitation guides” are prepared in purview of

establishment of national and regional institutes for paramedical sciences in India. Objective of

the TOR is to formulate TOT protocol (for all courses or groups of courses identified there off,

for the NIPS, RIPS and medical colleges involved) and facilitation guidelines (e.g. for enabling

the trainers to achieve the anticipated level of knowledge, skills along with management skills,)

using literature review, group work and relevant methods.

As a part of workshop organised on 26th April following essential aspects of the “TOR subject

matter” were discussed, such as:

1. Situational Analysis (Brief history, present policy provisions, or any other relevant

issue)

2. Best practices in allied health services (about TOT protocols and facilitation procedures)

3. Gaps and Issues coming up (in the area of Training of trainers as a whole)

4. Cross cutting issues, Deliverable (describes the contours of „TOT protocols‟ with

respect to chronological cascade, strategies of implementation of TOTs, selection

criteria of trainers, other relevant issues)

5. Illustrative list of stakeholders (non exhaustive list of stakeholders identified primarily

through web based research)

6. Road Map (plan of action to meet the deliverable over the relevant period of time)

Situational analysis:

Detailed accounts on establishment, training, pedagogy and history of auxiliary nursing work

force are present however comprehensive description of paramedical education its pedagogy and

development is not much discussed. In their recommendation, Mukherjee Committee (1969)

identified need for accelerating training of paramedical personnel, nurses, ANMs, required for

family planning program. Currently the approximate number of courses taught across the nation

through various institutions is 33, of which the curricula can be classified into diplomas, degrees

and post graduate courses targeting students either with graduate degree or completed 10+2

education. The training of allied health services professionals is done by professors in medical

colleges, medical doctors, nurses and some of the essential skills are taught by the experienced

allied health services professionals. While referring back to the experiences she mentioned that

the trainers are also not cognisant of the skill sets that are to be imparted to „paramedics‟ which

creates a confusion and conflict in the roles assumed by various types of allied health

professionals.

Owing to the poor or no regulations, mechanisms followed in the private sector for

identification, recruitment and training of paramedical/ allied health professional are not very

clear in the Indian setting. Since the training capacity across the private and public sector

institutions in all the states is variable it is reflected as a gross inequity in training capacity as

well as availability of human resources. Further barriers (such as language and differential


development) limit the interstate migration (of paramedical / allied health professionals) posing

a new challenge to the states and national level administrations.

The eleventh five year plan identifies need of producing more paramedical workforce in the

nation and provides avenues for establishment of regulatory framework, separate paramedical

and physiotherapy council which in turn may choose to enhance the training capacity of the

paramedical institutions. Thus the establishment of NIPS and RIPS shall be considered as an

avenue for regulations, pedagogy and training practices (selections and training of trainers,

career development and management of the training capacity). Since there are no similar

mechanisms for instruction of the trainers it is suggested that a uniform, comprehensive TOT

protocol be developed to identify, train and deploy the trainers in the NIPS and RIPS.

Figure 5: The diagram depicts the process of formulation of TOT protocols and its contents, the

deliberations of the TOT protocols will be discussed in the subsequent consulting workshops

and meetings.

Best practices in allied health services: TOT and facilitation procedures: There are many

instances of best practices being followed in various setups, the description of such best

practices will be elaborated with the progress of the initiatives; below are some of the examples

feasible and practical in the Indian setup.

i. Groups of trainers can be trained similarly, and deployed to the regional institutes. For

instance Ali Yavar Jung institute has extended their services in the various regions with

establishment of regional centers and a possible sharing of the experts.

ii. MUHS Maharashtra: recently changed the course patterns of courses conducted for the

paramedical / allied health sciences. One year of common studies will be followed by

For various group of courses and professions

Core Values Pedagogy Sustainability

Infrastructure

TOTs 1. Knowledge and Skills required for the teacher or trainer

Type of application (Hospital, Diagnostic Services, Field based)

Equipment, Teaching aids

etc.

2. Understanding of the objectives for allied health courses in NIPS and RIPS


specialized studies. This has resulted in availability of trainers/ teachers for the institutes

and ensured the uniform evaluation of students.

iii. Some private Institutions in the country have kept strict criteria for up gradation and

development of faculties. (e.g. Manipal University).

Gaps and Issues:

Various gaps and issues noticed in the instance of TOT protocols and facilitation guides can be

related to the lack of comprehensive regulatory framework. Altogether the literature review

suggest that training protocols are either missing (when searched with the key words training,

allied health professional trainer), except for the program specific guidelines (e.g. malaria

control program provides TOT for MPWs, lab technician, IDSP with a thrust on surveillance

activities to be done by paramedic such as pharmacists, nurses and record technician) or

incorrect and with inconsistencies and gaps.

The TOT protocols and facilitation guidelines need to address the wide range of knowledge

domains (which are recognised through the courses available), a common training protocol

addressing all of the courses and TOT protocols separately for the individual courses may need

to be prepared.

Since the deliverables of the trainers are not identified, the precise estimation of trainers required

cannot be calculated beforehand. Similarly the nature of training in existent paramedical

institutions has to be improved accentuating the importance of TOT protocol and facilitation

guides. Since wide range of knowledge domain is required for the training of any paramedic,

TOTs to be formulated will have to be multidisciplinary.

Stakeholders:

The stakeholders identified here belong to beneficiaries (Service providers and students), the

regulator bodies (GoI, State Governments, professional bodies) and the existing national level

institutes (e.g. AIISH, Mysore, AYJHH Mumbai, to name a few).

Deliverable:

These will be the protocols developed at the end of workshops emerging out of discussions. The

format of protocol should essentially present the various contours (see fig). The primary

components of the TOT protocol and facilitation guidelines may include:

The duration of TOT sessions

Eligibility criteria for being a trainer

Evaluation criteria of these trainers (pre and post)

Strategies to successfully accomplish the number of trainers to be trained.

Highlights of the group discussion or group work held during first day of workshop:

The group work started with a brief introduction of the speaker (Dr Joshi), Facilitator (Mr Basab

Banerjee) and group members. The key discussions and decisions taken by the group were as

below:

The scope of training specifications for the allied health services is very huge, thus it

might not be possible to think about the TOT protocols for all courses separately. Thus

the group finalised to discuss the TOT protocols and facilitation guides as a broader

framework.


One of the group members suggested that the eligibility criteria of the trainers in allied

health services should be specified. The group members indicated that the trainers for

any allied health course should be from the similar domain, although the group was firm

on the educational qualifications that are required for being a trainer in NIPS and RIPS.

The group came up with the decision that either a post graduate with sound experience

will be considered as a trainer; in absence of the post graduation the NIPS and RIPS

collectively may consider the graduates with more than five years of experience as

potential trainers.

Other group member while opening the discussion on the competence of trainers

pointed that in absence or shortfall of highly qualified allied health professionals we

might have to divide the trainers in specialists and generalists. The group agreed to term

them as core competent trainers (eligible to provide basic dimensions of the paramedical

or allied health) and specialist trainers (based on the subjects of specialization of the

allied health professional). He also mentioned the practice in their institute at Manipal

where they ensure that the trainer/ teacher take up further studies and enhance their

teaching or training skills as well as the subject knowledge.

Further the group identified that as the medical pedagogy is also developing, the

protocols for training the allied health services professionals should also be developed.

The majority of the participants felt that regulatory framework along with legislative

teeth are of immense importance which will further enhance the scope of establishing

and implementation of protocols and facilitation guides as well; however they akk

agreed on setting up protocols for the interim period.

The group while discussing the methodology for preparing the protocols and guidelines

suggested that the existent curriculum should be reviewed in the institutions identified

as regional institutes. The protocols will then be based on the gaps identified in these

protocols or facilitation guides (if any).

The group also collated list of institutions which are known for their contribution in the

field of paramedical and allied health services.

Plan of action:

The group collectively decided that the TOR should advice the members (both present and

future) to analyse the protocols already in place in various institutions across the nation and

internationally. Thus the group suggested following plan of action. The activities submitted by

the group will finally lead to formulation of TOT protocol and facilitation guide.


Initially, the group would locate resource institutions within a short duration, followed by a

secondary data analysis on training practices and facilitation procedures. The TOR team shall

then decide the centers for visit by 10th May 2011. The field visits will help us to revalidate the

training practices mentioned in the secondary data with a firsthand primary data. The group

would then prepare a data collection tool for generating insights on the other facets of the

paramedical training situation. The team will be responsible for coordination with other TORs

for cross cutting issues.

Resource Faculty:

Dr. Ameeta Joshi, HOD-Department of Microbiology, Grant Medical College

Mr. Basab Banerjee, Head – Standards and QA, NSDC

Dr. Tapan K. Jena, Professor- School of Health Sciences, IGNOU

Dr. Raj Shekhar, Director Institute of Paramedical Sciences-Manipal

Mr. Gulshan Baweja, COO- Everonn Medical Education

Dr J S Dhupia, HOD-Dept of Laboratory Medicine, Safdarjung Hospital

Dr. Sanjay Aggarwal, Addl Prof-Department of Nephrology, AIIMS


ROAD AHEAD FOR THE ENTIRE INITIATIVE

The work shop was followed by a discussion within the expert group and following decisions

were taken.

As mentioned in the objectives the TOR experts were to be identified, accordingly the

team has created a list of people who will be consulted in order to generate deep insights

of the various TORs, similarly persons are identified for dealing with the cross cutting

issues. The NIAHS project secretariat will be in continuous terms with the groups of

experts for completing the terms.

The plan of field visits is outlined in the select institutions in the field of allied health

services with the differential purpose based on the speciality of the institutions. For

instance to study pedagogy in details institutes with repute in the sector will be visited

and consulted.

The activities during the field visit include overlapping observations for all the five

aspects of paramedical training, in addition the field visit activities will be optimally

utilised to generate qualitative contours of paramedical education in the country.

The training protocols will now consider participation from institutes such as SIHFW,

NCERT, UGC, Association of Indian Universities, national Teacher Training Centre,

NIDM who have shown developments in management of teaching protocols and

facilitation procedures.

Similarly for inputs and infrastructural up gradation and benchmarking the project team

looks forward to borrow feasible examples from Malaysia, Skills Labs of Dr. Pai,

Malaysia ,

One of the major objectives of the work shop was to identify experts and allocate the

TORs for consultation, following experts have shown their availability for the respective

TORs such as

Overall cross cutting Dr Ameeta Joshi

Benchmarking inputs Dr Ananthnarayanan

Benchmarking Pedagogy Col Srikar

Regulation JP Mishra

NIPS,RIPS management Dr Bipin Batra

ToT Dr Raj Shekhar, Manipal

Desk review methodology: The desk review is ongoing process for the period of six

months; however the project team has evolved a methodology with timeline to complete

desk review for each of the TORs. The documents will be searched using the established

and scientific data bases such as (PubMed, Cochrane review) to generate insights on the

subject matters on each TORs along with the liaisons with various institutes (such as

BCIT, Harvard partners International, Arizona, Ohio State University, National

University of Singapore, Nanyang technical university) and several community colleges

in the USA, UK and Australia.

Industry Engagement: The secretariat is planning detailed consultations with key

players in the hospital, device and equipment and diagnostic space as well as agencies


such as the CII, NSDC and ICRA in understanding skill gap requirements based on

future demand, technology and medical care trends.

Field Visit: The team of experts will visit the institutes identified for fact finding and

generating insights on pedagogy, training protocols and ToTs.

Visiting the Regional institutes: Selected sites will be undertaken for discussions with

the health leadership of the states where the RIPS are likely to be established. It is

critical to get buy-in and inputs from these states on the situation within their regions in

ensuring that solutions proposed are customisable to address state-specific issues.

Desk review workshop in Mid June: The compilation of the desk review will be

presented to the expert group during a three day workshop to whet phase 1 of the

findings.

Finalisation of Recommendations and report writing retreat: This is being planned

in the month of August as a 4-day writing workshop at any of our partner expert

institutions such as JIPMER, AFMC or PGICER.

Final report dissemination workshop: This will be a 1-day event held at the Vigyaan

Bhavan in the first week of October to formally present the report findings to the

Ministry of Health and Family Welfare, Government of India.

***

NIAHS Project Team

1 Dr. Subhash Salunke Senior Advisor, HSSU [email protected]

2 Dr. Tarun Seem Head, Health System Support Unit

(HSSU)

[email protected]

3 Ms. Kavita Narayan Head, Hospital Services [email protected]

4 Maj Gen (Retd) M.Srivastava Head, NIAHS Project [email protected]

5 Dr. Ashish Gupta Consultant [email protected]

6 Dr. Sajal Sen Consultant [email protected]

7 Ms. Ruchi Sharma Program Support Coordinator (HSSU) [email protected]

8 Ms. Shivangini Kar Program Support Coordinator (HSSU) [email protected]

10 Dr. Amar Ramdas Nawkar Project Manager (NIAHS) [email protected]

11 Ms. Namita Gupta Project Manager (NIAHS) [email protected]











PARTICIPANTS AND PARTNER ORGANIZATIONS

Participant list of Workshop on developing landscape of project for augmenting paramedical training

capacity on 26th -27th April, 2011 at NIFHW

Sl.

No.

Name of Participant Name of Organization Email Id

1 Col K. Srikar AFMC, PUNE [email protected]

2 Dr. Ameeta Joshi J.J. Hospital, Mumbai [email protected]

3 Dr. Arvind Rajwanshi PGIMER, Chandigarh [email protected]

4 Mr. S.K Kalra HLL LIFECARE LIMITED [email protected]

5 Ms. Aparna Sharma MoHFW [email protected]

6 Mr. Suresh Kumar PHFI [email protected]

7 Prof. Gouri Pada Dutta Planning Commission , WB [email protected]

8 Dr. B. Rajashekhar Manipal university [email protected]

9 Dr. R.P Pai Manipal university [email protected]

10 Dr. Ananthanarayanan P H JIPMER [email protected]

11 Lt Gen Narayan Chatterjee PHFI [email protected]

12 Dr. Niranjan D Khambete SCTIMST, TRIVANDRUM [email protected]

13 Maj Gen S.K Biswas AHA [email protected]

14 Dr. S.K Agarwal AIIMS [email protected]

15 Dr. B.D Athani AIIPMK and DGHS [email protected]

16 Dr. J.P Misra ED, SHRC Chhattisgarh [email protected]

17 Dr. R Chandrashekhar Chief Arch. CDB, DGHS [email protected]

18 Prof. Deoki Nandan Director, NIHFW [email protected]

19 Dr. Sammita Jadhav SYMBIOSIS [email protected]

20 Dr. Bipin Batra NBE [email protected]

21 Dr. Prasad B. M. NHSRC [email protected]

22 Mr. Prankul Goel NHSRC [email protected]

23 Dr. Naseem Shah AIIMS [email protected]

24 Dr. Ritu Duggal AIIMS [email protected]

25 Dr. Adarsh Pal Singh BD [email protected]

26 Dr. Anita Singh BD [email protected]

27 Ms. Lalita Shankar BD [email protected]

28 Mr. Basab Banerjee NSDC [email protected]

29 Dr. Supriyo Ghose Chief RPC AIIMS [email protected]

30 Dr. Rajesh Sinha Associate Prof. RPC AIIMS [email protected]

31 Dr. Lalit Mohan RPC AIIMS [email protected]

32 Dr. Alok K. Ravi RPC AIIMS [email protected]

33 Dr. Hanimi Reddy SDNCD, PHFI [email protected]

34 Dr. Rohit Saxena RPC AIIMS



































35 Dr. Paijat Chandra RPC AIIMS

36 Nakul Verma Wipro GE Health Care [email protected]

37 Parag Varshney Wipro GE Health Care [email protected]

38 Dr. Madhu Gupta WHO India Country Office [email protected]

39 Dr. J S Dhupia SJH and VMMC [email protected]

40 Dr. Sangeeta Sharma MCI [email protected]

41 Dr. Anjan Prakash RML Hospital, New Delhi [email protected]

42 Dr. Shubnum Singh Max Health Care [email protected]

43 Dr. Somil Nagpal World Bank [email protected]

44 Dr. S. B. Arora IGNOU [email protected]

45 Dr. Sameer Mehta EVERONN [email protected]

46 Mr. Gulshan Baweja EVERONN [email protected]

47 Dr. T Sundararaman NHSRC [email protected]

48 Dr. George Tharion CMC Hospital Vellore [email protected]

49 Dr. A. K. Mukhopadhyaya AIIMS [email protected]

50 Dr. Gowri N Sengupta DADG (Public Health) CHEB [email protected]

51 Dr. B. B. Thukral SJH and VMMC [email protected]

52 Dr. K. S. Prema AIISH, Mysore [email protected]

53 Col Anurag Salwan HLL LIFECARE LIMITED [email protected]

54 Dr. V. P. Sah AYJNIHH [email protected]

55 Mr. S. Vivek Adhil NIHFW [email protected]

56 Dr. N. K. Arora INCLEN [email protected]

57 Dr. D. Thamma Rao PHFI [email protected]

58 Dr. Sanjay Sarin BD [email protected]

59 Dr. S. Naik MCI [email protected]

Organizations:

List of participating Organisations/Institutions for Workshop on Developing Landscape of Project for

Augmenting Paramedical Training Capacity

Sl.

No

Name of Organisation/Institutions

1 MoHFW

2 AFMC, Pune

3 AIIMS

4 Ali Yavar Jung Institute of Hearing Handicapped, Mumbai

5 All India Institute of Physical Medicine and Rehabilitation, Mumbai

6 All India Institute of Speech and Hearing, Mysore

7 Apollo Group of Hospitals


























8 Baxter (India) Private Limited, Gurgaon

9 BD (Becton Dickinson India Pvt. Ltd.)

10 Central Health Education Bureau, New Delhi

11 Centre for dental education and research, AIIMS, Delhi

12 CMC, Vellore

13 DFID

14 Dr Lal PathLabs Pvt Ltd, Gurgaon

15 Everonn Medical Education, Chennai

16 Fortis Health care Limited

17 GE Healthcare , Gurgaon

18 Govind Ballabh Pant Hospital

19 Grant Medical College, Mumbai

20 Hamdard University

21 IGNOU

22 Indian Spinal Injuries Centre, New Delhi

23 JIPMER, Puducherry

24 Johnson and Johnson Ltd.

25 Mahajan Imaging Centre

26 Max India Limited

27 Medanta- The medicity

28 National Accreditation Board for Education and Training (NABET)

29 National Institute of Occupational Health, Gujarat

30 National Skill Development Corporation , New Delhi

31 NHSRC

32 NIHFW

33 Osmania Medical College (OMC), Hyderabad

34 PGIMER Chandigarh

35 Ram Manohar Lohia Hospital

36 RP Centre for Ophthalmic Sciences, New Delhi

37 Safdarjung Hospital

38 Saral Diagnostic

39 Shree Dutta Hospital, Karnataka

40 SHSRC, Chattisgarh

41 Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanthapuram

42 Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack

43 Symbiosis Institute of Health Sciences (SIHS)

44 Tribal Health Initiative, Tamil Nadu

45 WHO

46 World Bank

***


SPEAKERS BACK GROUND (In alphabetical order)

Dr. P.H. Ananthanarayanan

Director-Professor and Head, Dept of Biochemistry

JIPMER, Puducherry

Dr. P.H.Ananthanarayanan, is an academician par excellence and an authority in the field of

Biochemistry. He has held several key appointments including that of Director, JIPMER,

Pondicherry (1999-2000) and Director, All India Institute of Hygiene and Public Health,

Kolkata. He is the Founder Professor and Head, Department of Biochemistry, B.P.Koirala

Institute of Health Sciences, Dharan, Nepal.

He is the member of numerous prestigious bodies including Fellow of Indian Public Health

Association and Member of the Advisory Committee, ICMR, New Delhi. He is also the Member

of the UG/PG studies in Medicine of West Bengal University of Health Sciences, Kolkata and

has been the Examiner and Question Paper Setter for UG and PG in Biochemistry, B.Sc in

Medical Laboratory Technology, MBBS, MD(Biochemistry), M.Sc(Medical Biochemistry) and

B.Pharm.

He has conducted Short Term workshops on “Systems Approach to Medical Education”,

“Evaluation Methods in Medical Education”, “Curriculum Development” for the Faculty

members of Medical Colleges and AIIH&PH, Kolkata

As an expert he has acted as a member of the Working Group of Experts on “Health” for the

Planning Commission of India.

He has authored several books and published over 30 papers in International and National

Indexed Journals.

***

Mr Basab Banerjee

Head Standards and QA at National Skill Development Corporation

Mr. Banerjee has worked in many disciplines, such as education, (Chief Operating Officer at

Teach For India), Training of human resources (at Reliance Retail Ltd) and many corporate

agencies.

Currently he holds position of Head in standards and quality assurance at skill Development

Corporation at New Delhi.

***


Dr. Bipin Batra

Executive Director, NBE

Dr. Bipin Batra is a Radiologists, Fellow, School of Public Health, University of Sydney, Post

Graduate diploma in health and hospital management (PGDHHM), Fellow- Medical Education

FAIMER, Visiting Fellow- Royal Tropical Institute, Netherlands.

Dr. Bipin Batra has extensive experience in assessment, regulatory aspects of health professions

education and is presently serving the National Board of Examinations as Executive Director.

His current pursuit includes ASPIRE, an Initiative for recognition of social accountability of

medical schools with AMEE (Association for Medical Education in Europe), Dundee UK;

Developing Distance Learning Courses on Accreditation and Assessment with OPEN

University, UK and Global Pediatrics Education Consortium GPEC) with American Board of

Pediatrics.

***

Dr. R. Chandrashekhar (PhD)

Chief Architect, Central Design Bureau for Medical and Health Buildings

Dte-GHS, MoHFW

Dr Chandrashekhar graduated in architecture from the prestigious Sir J.J. College of

Architecture Mumbai. He is a fellow of Medical Architecture Research Unit (MARU) South

Bank University, London, UK (WHO). As an alumnus of BITS Pilani, he is the first PhD holder

in Medical Architecture in India

He is a member of the Technical committee formed for setting up 6 AIIMS like institution and

Up gradation of 13 existing Medical colleges (under PMSSY) and Expert group consulting

designing of courses on “Health Facility Planning and Design and Healthcare Engineering”

He is also associated with various technical committees and organizations such as Indian

Institute of Architects (Northern Chapter) 2002-2006 (as a Vice Chairman), Academy of

Hospital Administrator and Architect Advisor (Fellow) and Delhi Urban Arts Commission

(adviser)

***

Lt. Gen. Narayan Chatterjee (Retd.)

Special Advisor – Government and NGO Relations

He has had a very distinguished career in the Indian Army for over 4 decades. A paratrooper and

most experienced pilot of the Army, he actively participated in 1965 and 1971 wars, Sri Lanka

Operation and Kargil conflict.

He held many key appointments in the Army and Ministry of Defence, notably, Additional

Director General Army Aviation Corps, Director General Resettlement and Director General

Manpower Planning and Personnel Services. As Director General Resettlement, he was

responsible for resettlement of ex- servicemen, war widows, disabled soldiers and other

casualties in the entire country. He was actively associated with the High Powered Committee


on Disaster Management, Govt. of India. Lt. General Chatterjee was also instrumental in the

conceptualization of Ex Servicemen Contributory Health Scheme (ECHS), which is fully

operational in the country. As Director General of Manpower Planning, he was responsible to

monitor the Health State of the Indian Army in conjunction with the Director General Medical

Services. He was Vice Chairman of the Army Group Insurance, a fund of Rs 7000 crores.

After retirement in 2003, he worked with an MNC as Head of Logistics and Training for 3 years,

when he was also actively associated with an NGO in Northern India. Widely travelled, Lt. Gen.

Chatterjee has been awarded on five occasions by the President of India for Distinguished and

Gallantry services.

***

Dr. Ameeta Joshi

Prof. and Head, Dept. of Microbiology, Grants Medical College

JJ group of hospitals, Mumbai

Dr.Ameeta Joshi is Prof. and Head, Dept. of Microbiology, Grants Medical College and

JJ group of hospitals since2008.For the past 2 years she has been on Board of Studies, Bachelor

of Paramedical Technology (BPMT), MUHS. From 2006-2008 she was on deputation to the

Directorate of Medical Education and Research (DMER) as OSD Medical Research Council of

Maharashtra. In addition to her teaching responsibilities, she was the Technical Co-ordinator

(DMER) Equipment Purchase to the Govt. Medical Colleges, Maharashtra.

Dr. Ameeta Joshi brings along with her clinical expertise, her passion for the cause enhancing

the Paramedical education in the country.

***

Mr. Sameer Mehta

Founder and CEO Everonn Medical Education

Director Mr Mehta Hospitals

Founding Director Atlas Advisory, Atlas Venturez and India Home Health Care

Mr. Sameer is the CEO of Everonn Medical Education, a subsidiary of Everonn. He is the

Director and former Chief Operating Officer of Dr Mehta Hospitals. He is also the founding

director of Atlas Advisory, a boutique business accelerator and Atlas Venturez, a family office

investment fund. He has over 15 years in management consulting, business development,

finance, strategy, operations and project management. A former management consultant with

McKinsey and Company (USA), Sam has served a number of global industrial and private

equity clients. Prior to McKinsey, Sam held multiple senior positions with Shell, BP, ICI and

Exxon in Europe and Latin America.

Mr. Sameer is a Chartered Chemical Engineer (CEng) with the Institute of Chemical Engineers,

a Professional European Engineer (EUR ING) with FEANI, a Chartered Scientist (CSci) with

the Science Council, a Chartered Environmentalist (CEnv) with the Society for the Environment

and a Sainsbury Management Fellow (SMF) with the Royal Academy of Engineering, UK. Sam


has an MBA from the Kellogg School of Management, a Masters in Engineering Management

from Northwestern University, USA and a Masters and Bachelors in Chemical Engineering from

the University of Bradford, UK. He is a Charter Member of TiE, The Indus Entrepreneurs, and

has served as an advisor, board or committee member to number of funds, associations and

enterprises.

***

Mr. Jwala Prasad Mishra

Executive Director,

State Health Resource Centre,

Chhattisgarh.

He has over 20 years‟ civil service experience and as worked closely with the Ministries

/Departments of Health , Statistics and Industrial Policy and promotion (3 years). Mr.J.P.Mishra

completed his Master degree in Statistics and thereafter pursued his M.Sc. (Macro-economic

Policy and Planning in Developing Countries) from Bradford University, UK (1995-96).

As Executive Director, SHRC, Chhattisgarh he has led a team of more than 50

professionals to managing the network of 60,000 community health volunteers called

„Mitanins‟ also provide technical assistance services to the State Health Department for

health systems reforms and development.

He has been an Independent consultant and Resource Pool Expert for Technical

Assistance Support Team in Madhya Pradesh [MPTAST] funded by the Department for

International Development (DFID), UK.

He has been a lead expert for the development of Health Sector Public-Private-

Partnership (PPP) Policy Framework in the State of Andhra Pradesh.

As Principal Specialist, Health Sector Support, German Technical Cooperation (GTZ),

India, he provided the Technical Assistance (TA) services to the Ministry of Health

and Family Welfare, and States for the implementation of National Rural Health

Mission.

As Program Adviser, European Commission Technical Assistance (ECTA) Team, India,

he was instrumental in the introduction and development of a Memorandum of

Understanding (MoU), a variant of performance-based funding system, establishment

of State Health Resource Centre in Chhattisgarh and Regional Resource Centre for

North-Eastern States.

***

Prof Deoki Nandan

Director

National Institute of Health and Family Welfare, New Delhi

He has been working in the field of public Health for more than 30 years and during this period

he has been an adviser and has provided consultancy to many international organizations e.g.

WHO-SEARO, UNICEF, CARE-India, EPOS, Population Council, MOST-India and USAID.

He is also a member of many state level committees and National Technical Expert Committees

specifically for AIDS, IMNCI and Child Health. He had been the National President of the

Indian Association of Preventive and Social Medicine from 1998 to 1999 and National President


of the Indian Public Health Association from 2005 to 2006. He has Drafted a Training Module

on Development of Health Workforce Strategic Plans for the South East Asian Region for the

WHO.

Presently he is the Chairman of the expert group namely Expert committee to promote research

in the various Human Reproduction Research Centres (HRRCs).

He has also been identified as National Trainer for ICDS, CSSM, RCH, RTI/STD, HIV/AIDS

and IMNCI. He has successfully undertaken more than 50 community based

studies/research/projects on issues related to EPI, RCH, RTI/STD, and HIV/AIDS, in

collaboration with national and international agencies, and has more than 150 research papers

published in national and international scientific journals.

He has been recipient of many awards rewarded with many awards in his distinguished career

with the highest accolade among them being the Uttar Pradesh Ratan award.

***

Dr Sita Naik _____________________________________________________________________________

MBBS, MD (Pathology), FAMS

Member, Board of Governors, Medical Council of India

Dr. Sita Naik, recently retired as Dean of Sanjay Gandhi Postgraduate Institute (SGPGI),

Lucknow where she was Professor and Head of the Department of Immunology. She is

currently Advisor to Apollo Hospital Educational and Research Foundation. She is also the

President of Indian Immunology Society. Dr. Sita Naik has been on the faculty of Seth GS

Medical College, Mumbai and at SGPGI, she was involved in conceptualizing, planning and

setting up of the first full-fledged department of Immunology in the country.

Dr Naik graduated from Maulana Azad Medical College and did her post-graduation in

Pathology at Postgraduate Institute of Medical Education and Research. She had post-doctoral

training in Immunology at the National Institutes of Health, USA.

Besides her research interests in the immunology of infectious diseases, she has also been active

in educating medical teachers on research methodology and scientific communication. Her

special interests are in issues related to quality in medical education and use of IT enabled

technologies in medical education.

***

Dr Subhash Salunke

Senior Adviser to Health Systems Support Unit

MBBS, DPH, DIH, M.D. (Medicine)

Dr. Salunke has been an effective and popular faculty in the subject of Preventive and Social

Medicine (Community Medicine) for eight years and a postgraduate guide. Also, he was an

adjunct Associate professor of Biological Sciences, human ecology at the University of Texas,


USA – School of Public Health – from 1994 to 2000. His 30 years‟ experience in the Public

Health Department spans from Deputy Director to Director General in the Health Services of

Maharashtra. Most of his illustrative examples of achievements in contemporary Public Health

emanate from his own personal experience. Being an achiever, he has experienced a meteoric

rise in the field of Public Health.

He has navigated various portfolios in Public Health not only by fulfilling goals and targets but

also by demonstrating innovative and rational ways. He has assisted State Governments to

initiate a number of schemes such as: “Jeevan Dai Arogya Yojana”, free blood supply to

Thalassemia patients, monitoring medical care in Trust-hospitals for poor, etc. mainly focusing

on health services to the poorer section of society. He was actively involved in formulating

projects like “Health System Development” for Maharashtra that was supported by the World

Bank. He has shown leadership in designing the HIV/AIDS Control special programme

(AVERT) with the assistance of USAID for Maharashtra State. He was one of the members of

designing National AIDS Control Programme Phase II during 1999-2000 that was a major step

in control of HIV/AIDS through the National Programme for Control of HIV/AIDS.

***

Dr. Sangeeta Sharma

Secretary, Medical Council of India

For the past 15 years, Dr Sangeeta Sharma worked in academics as a professor and Head,

Department of neuropsychopharmacology, Institute of Human Behaviour and Allied Sciences,

Delhi. She completed her MD (Pharmacology) in 1991 and also has a post-graduate certificate in

Quality Management and Accreditation of Healthcare Organization (QMAHO). Currently she is

also pursuing her MBA in Healthcare Administration.

Her areas of interest are clinical pharmacology and rational use of drugs. She has published

several papers in international and national journals. She has published several books and one of

the outstanding books has been “Standard Treatment Guideline” for doctors and “Good Store

Management Practices” for pharmacists. She has extensive experience in conducting national

and state level workshops for doctors, pharmacists and nurses. She has developed training

module for nurses on role of nurses in promotion of rational use of drugs. She has advised

several Indian states in developing drug policies, essential drugs tests, standard treatment

guidelines, standard operating procedures, quantification of drug needs, to name a few.

***

Col. K. Srikar

Colonel Training (Para Medical Training),AFMC

Col. Srikar brings with him an extensive experience of Pedagogy in standardization of allied

Services in the Army Medical Corps. He is presently posted as COLONEL TRAINING (PARA

MEDICAL TRAINING) and Associate Professor in the Dept of Hospital Administration at

AFMC. He has served for 25yrs in the ARMY MEDICAL CORPS as MEDICAL OFFICER and

has served in challenging fields such as Srinagar, Sri Lanka (Op-Pawan) and Somalia under the

UN mission.


Col. Srikar completed his MD Hospital Administration in 1999 from AFMC, Pune and during

his stint as Hospital Administrator in the military hospital was associated in making scales of

accommodation for Armed Forces Military Hospitals. He also developed Infrastructure for the

polyclinic and OPD, Accident and Emergency services, Trauma centre and ICU at 92 BH

(Srinagar) in 2002. He was Awarded Chief of Army Staff Commendation in 2002 for the work

done at 92 Base Hospitals. He has been affiliated with AFMC in starting 11 courses of Bachelor

of paramedic technology under the aegis of MUHS.

***

Dr Thamma Rao

Senior Adviser to Public Health Foundation of India

MBBS, M.D. (Medicine), F.A.G.E., D.H.A. (Post Graduate Diploma in Hospital

Administration), Masters in Social Sciences (Health Services Management)

Dr. D. Thamma Rao presently works as Senior Advisor at PHFI. He has over 23 years

experience in Public Health administration. He participated in International Conferences and

was deputed to Syrian Arab Republic by Government of India for 2 years (1978 to1980) and

deputation extended thrice annually for three additional years at the request of Government of

Syrian Arab Republic. During his tenure as Advisor, NHSRC, NRHM, Ministry of Health &

FW, New Delhi, at the country level, several strategies were conceived and implemented for

rapid progress in NRHM implementation across the States and development of Human

Resources for Health notably the NRHM approval of Rs. 915 crores for revival of Multipurpose

Health workers- male scheme including the training facilities and provision of 53,543 additional

male health workers at Sub-Health Centres in 235 High Focus districts, increase of nursing &

midwifery institutions from 1646 to 5222, revision of norms in medical colleges leading to 40%

enhancement of undergraduate seats (MBBS) from 24482 to 35533 and doubling of

postgraduate seats in three vital specialties (Obstretics, Paediatrics and Anaesthesia) for

enhanced availability of critical HRH for RCH and other programmes.

Apart from his tenure in NHSRC, he also served the government at various levels. His

understanding for health human resource is immense and exceptional.


ANNXURE-115

: SITUATIONAL ANALYSIS

Recommendations: Based on the plenary and group discussions, resulting from the terms of

Reference, the following recommendations were made to strengthen allied health services and

education in countries of the Region for Member States:

1) In the context of national human resources for health (HRH) policies,

develop/review/revise HRH policy for allied health services and education-based on

evidence (numbers, distribution, skills mix, career advancement structure, resource

allocation, educational programmes, etc.).

2) Standardize entry educational requirements for allied health personnel and provide

opportunities to meet the requirements.

3) Establish a focal point/body at the national level from among the allied health personnel

to be responsible for allied health services and education.

4) Ensure representation/inputs of allied health personnel in policy-making and planning

processes.

5) Increase accessibility of essential allied health services, particularly for disadvantaged

and underserved communities.

6) Create opportunities for advancement/development of allied health personnel.

7) Develop/strengthen and implement mechanisms (including regulatory bodies) for

quality assurance and accreditation of allied health services and education.

8) Support research to develop/strengthen allied health services and education.

9) Strengthen supervision and support systems for allied health personnel to function safely

and effectively.

10) Strengthen managerial capacities of allied health personnel in both education and

service sectors.

11) Identify and strengthen institutions as national centres for services and education, in

specific areas of expertise for allied health personnel.

12) Establish mechanisms for curriculum development, review and revision to respond to

health and professional needs.

13) Foster multi-professional education and innovative educational strategies (e.g., problem-

based learning, experiential learning, distance learning).

14) Ensure continuing education opportunities for allied health personnel.

15) Develop a network for sharing information, resources and expertise among allied health

within country.

16) Strengthen/encourage formation of professional body(ies) for allied health personnel to

facilitate development of the profession and protection of its members.

15

Report of an Inter country Consultation Bangkok, Thailand, 20-24 March 2000 “Health (Paramedical)

Services and Education” (December 2000 ); World Health Organization, Regional Office for South-East Asia,

New Delhi. Available at: < http://whqlibdoc.who.int/searo/2000/SEA_HMD_212.pdf>


ANNXURE-2 (Situational Analysis)

ALLIED HEALTH PROFESSIONALS IN UK ARE KEY PLAYERS IN THE HEALTHCARE

TEAM16

1. Arts therapies: Arts therapists use music, art or drama as a therapeutic intervention to help

people with physical, mental, social and emotional difficulties. Staff roles: Art therapist,

Drama therapist, Music therapist

2. Chiropody or Podiatry: Chiropodists, or Podiatrists, specialise in keeping feet in a healthy

condition. They play a particularly important role in helping older people to stay mobile and,

therefore, independent. Staff roles: Chiropodists/podiatrists, Footcare assistant

3. Dietetics: Dieticians translate the science of nutrition into practical information about food.

They work with people to promote nutritional wellbeing, prevent food-related problems and

treat disease. Staff roles: Dietician, Dietetic assistant

4. Operating department practice: Operating department practitioners (ODPs) are an

important part of the operating department team working with surgeons, anaesthetists and

theatre nurses to help ensure every operation is as safe and effective as possible). Staff roles:

Operating department practitioner

5. Orthoptists: They access and manage a range of eye problems, mainly those affecting the

way the eyes move, such as squint (strabismus) and lazy eye (amblyopia). Staff roles:

Orthoptist

6. Occupational therapy: Occupational therapists help people to overcome physical,

psychological or social problems arising from illness or disability, by concentrating on what

they are able to achieve, rather than on their disabilities. Staff roles: Occupational therapist,

Occupational therapy assistant, Rehabilitation assistant, Technical instructor

7. Physiotherapy: Physiotherapists treat the physical problems caused by accidents, illness

and ageing, particularly those that affect the muscles, bones, heart, circulation and lungs.

Staff roles: Physiotherapist, Physiotherapy assistant

8. Prosthetics and orthotics: Prosthetists design and fit artificial replacements - or prostheses

- for upper and lower limbs for patients who have lost or were born without a limb.

Orthotists provide braces, splints and special footwear to help patients' with movement

difficulties and to relieve discomfort. Staff roles: Prosthetist, Orthotist, Prosthetic technician,

Orthotic technician

9. Psychology: Psychologists bring psychological theory and practice to bear on solving

problems or bringing about improvements for individuals, groups and organisations. The

NHS employs psychologists in four main specialisms: clinical work, counselling, forensic

work and health psychology. Staff roles: Clinical Psychologist, Health Psychologist,

Counselling Psychologist, Forensic Psychologist

10. Psychotherapy: Psychotherapists use a psychological approach to treat adults and children

for a wide range of mental and physical difficulties. There are a number of different

approaches, including psychoanalysis. The NHS has designated posts for child

psychotherapists only. Staff roles: Psychotherapist

16 http://www.nhscareers.nhs.uk/ahp.shtml

Note: Exhaustive list of references will be furnished in the final report.

http://www.nhscareers.nhs.uk/details/Redirect.aspx?Id=4909



http://www.nhscareers.nhs.uk/ahp.shtml#a1


http://www.nhscareers.nhs.uk/details/Default.aspx?Id=1860



























http://www.nhscareers.nhs.uk/ahp.shtml


11. Radiography: Radiographers are involved in the planning and delivery of ionising radiation

treatment and in the examination of patients by means of x-rays, which are interpreted to aid

the identification of illness and disease Staff roles: Diagnostic radiographer, Therapeutic

radiographer, Radiographer assistant, Imaging support worker

12. Speech and language therapy: Speech and Language Therapists work with people who

have problems with communication, including speech defects, or with chewing or

swallowing. Staff roles: Speech and language therapist, Speech and language therapy

assistant











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