ISM&H Facilities in Delhi
Directorate Of ISM&H, Govt. of NCT Delhi
Contents
• Overview • ISM&H institutions• Patient turnover of Dispensaries• Morbidity profile of patients• Case studies of Homoeopathy
• Established in August 1996
HQ at A&U Tibbia College campus, Karol Bagh, New Delhi.
Homoeopathic Wing at CSC-IIIrd, B Block, Preet Vihar .
Directorate of ISM & Homoeopathy
• Activities in respect of AYUSH stream– Patient care– Education– Drug Control Cell (only of Ayurveda & Unani;
Homoeopathic part is still being looked after by allopathic drug control department)
– Coordination with GOI, MCD, NDMC and various NGOs.
– Research
Directorate of ISM & Homoeopathy
A & U Tibbia College and Hospital, Karol Bagh. New Delhi
Nehru Homoeopathic Medical College & Hospital, Defence Colony, New Delhi
Dr. B.R. Sur Homoeopathic Medical College & Hospital, Nanak Pura, New Delhi
Ch. Braham Prakash Ay Sansthan, Khera DaburJamia Hamdard, Jamia Nagar, New Delhi
Educational institutions
– Land 33.3acres– Intake capacity: 88 students (44 Ayurveda and 44
Unani) for Degree level & Six seats for P.G. level– Affiliation: Delhi University– Indoor capacity: 255 bedded IPD– Annual OPD patient turnover about 1.65 Lac
A&U Tibbia College
NEHRU HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,
–Land- 2.25 acres–Intake capacity: 100 students, 4
P.G. Seats–Affiliation: Delhi University–Indoor capacity: 100 bedded IPD–Annual Patient turnover 1.45 Lakh
DR BR SUR HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL
–Land : One acre–Intake capacity: 50 students–Affiliation: I.P. University–Indoor capacity: 50 bedded IPD–Annual patient turnover: 78389
pt
• Multiple agencies are providing Patient Care services of ISM&H in Delhi.
• Under the cafeteria approach to Health Care services, the Directorate of ISM & H is establishing regularly Ayurvedic, Unani and Homoeopathic dispensaries in existing Allopathic Hospitals and dispensaries.
Dispensaries
Year Homoeopathic (19)
Ayurvedic (9) Unani (13)
2006 72 21 0
2007 78 23 10
2008 80 24 10
2009 87 26 11
2010 91 30 13
Growth of Dispensaries of Directorate in Last Five Years
S. No. Agency Ayurvedic Unani Homoeo1 GNCTD 30 13 912 MCD 126+14* 26 323 ESI 14 0 44 NDMC 12 0 135 CGHS 15+1 1 14
Total
*Speciality centres
194+15* 40 154
Agency Wise Dispensaries
There are two statutory bodies:• Board of Homoeopathic System of Medicine:
Board of Homoeopathic System of Medicine Act-1956
• Delhi Bhartiya Chikitsa Parishad:Constituted under Delhi Bhartiya Chikitsa Parishad Act 1996
REGISTRATION OF PRACTITIONERS
• Renewal of registration once every 5 years is undertaken in respect of Ayurveda, Unani and Homoeopathic practitioners.
• The state registers are periodically updated by these statutory bodies and the names of registered practitioners are notified in the gazette.
STATUS OF STATE REGISTERS
Specialty Registered
Homoeopathic 4319
Ayurvadic (9300) 3472
Unani 2013
Total 9804
Total Registered Practitioners
• The Deputy Director (ISM) is the notified Drug Controller cum Licensing Authority in respect of Ayurveda and Unani. There are 5 Drug Inspectors.
• The work related to Homoeopathy is being undertaken by the Drug Control department of Allopathy.
DRUG CONTROL & LICENSING
• There are 62 (40AY+14U+8H) manufacturing units.
• For the sale of A & U drugs no separate sale- license is required.
• However, for sale of Homoeopathic drugs, License is required: There are 293 Homoeopathic sale counters.
• All the manufacturing units of ISM are Good Manufacturing Practices (GMP)compliant.
DRUG CONTROL & LICENSING
Department Total Practitioners
Homoeopathic 103
Ayurvadic 28
Unani 8
Total 139
Human Resource
TEACHING FACULTYINSTITUTION CCIM/CCH
NORMSSANCTIONED POSTS
EXISTING STRENGTH
A & U TIBBIA COLLEGE
43 (AYURVEDA)46 (UNANI)
35(AYURVEDA)35 (UNANI)
AYURVEDARegular 06, Adhoc /Contract 10, Partime 03UNANIRegular 09,Adhoc/ Contract 12, Part time 025 Modern medicine
NEHRU HOMOEOPATHIC MEDICAL COLLEGE
43 43 33 regular teachers31 part time teachers
DR BR SUR HOMOEOPATHIC COLLEGE
43 29 19 regular teachers40 part time teachers
Patients turn over Homoeopathic Dispensaries
Patients turnover Ayurvedic Disp.
Patients turnover in Unani Dispensaries
Gender-differentiation Homeopathic dispensaries
Gender-differentiation Ayurvedic dispensaries
Gender-differentiation Unani dispensaries
2.88%
16.56%
29.6%
1.09%
23.06%
19.04%
1.13%6.18%
0.4% Fever 2.88%
J oint Disorder 16.56%
Digestive Disorder 29.6%
Diarrhea/ Dysentery 1.09%
Respiratory Disorder 23.06%
Allergic & Skin Disorder 19.04%
Piles, Fissures and Fistula-in-anus .02%
Diabetes, Hypertension,Cardiac Disorder 1.13%
Women Disorder 6.18%
EPI DEMI C DI SEASES- B .40%
Morbidity profile Homeopathic Dispensaries
Morbidity Profile Ayurvedic Dispensaries
Morbidity ProfileUnani Dispensaries
Cost Effectiveness and Efficacy of Homeopathy in Primary Health Care Units of Government- A study
Dr. R. K. Manchanda, M. D. (Hom), Deputy Director (Homeopathy)
&Dr. Mukul Kulashreshtha, MD (CHA),
Chief Medical Officer (Allopathy)
Health and Family Welfare Department, Govt. of Delhi, India.
Abstract: Two studies presented at International Homoeopathic Congress
2005, LIGA at Berlin
29
• Government of Delhi has adopted a policy of cafeteria approach in primary health care units.
• The homeopathic clinics have been established in allopathic primary health care units.
• The patients have the option of availing treatment of their own choice.
30
• Aims and Objectives • To compare the expenditure incurred by
government towards running of allopathic and homeopathic clinics.
• To analyze the morbidity profile of patients coming to homeopathic clinics in comparison to allopathic clinics working under one roof.
31
Title – To assess the cost effectiveness of homeopathic clinic in Cafeteria approach
• The revenue expenditure incurred on both types of clinics during 1999-2000 have been taken from government records. The capital expenditure on the maintenance of these clinics have been excluded.
• The morbidity data has been complied using the disease classification system ICD- 9 of World Health Organization.
32
Method
Result- 1
Total Patients Attended During 1999-2000
No. of Clinics
No of Patients Attended
Annual Average Turnover OfPatients Per Clinic
Allopathic 139 3,823,689 27508 patients
Homeopathic 48 1,197,249 24943 patients
33
The patient’s attendance patterns revealed that homeopathic clinics were as popular as allopathic clinics at the primary health care level.
Result-2- Revenue Expenditure
Clinics Total Expenditure (in INR)
Total No of Patients Attended
Average Expenditure Per Patient Visit (in INR)
Allopathic 294,188,000
3,823,689
76.91.32 (€/Euro)
Homeopathic
18,472,000 1,197,249
15.430.26 (€/Euro)
34
Result-3 -Expenditure on Salaries
Clinics Total Expenditure (in INR)
Total No of Patients Attended
Average Expenditure Per Patient (in INR)
Allopathic 259,988,000
3,823,689 67.991.17 (€/Euro)
Homeopathic
16,272,000 1,197,249 13.590.23- (€/Euro)
35
Results- 4 Expenditure on Medicines
Clinics Total Expenditure (in INR)
Total No of Patients seen in a year
Average Expenditure Patient Visit (in INR)
Allopathic 34,200,000 38,23,689 8.940.15-(€/Euro)
Homeopathic 2,200,000 1,197,249 1.840.031- (€/Euro)
36
• The expenditure in homeopathic clinics was one-fifth of the expenditure in allopathic clinics both in terms of salary as well as medicines. The reason for greater expenditure on salary indicates that the allopathic clinics require more supportive staff than homeopathic clinics.
37
S.No
ICD-9 codes Group of diseases
1 001-139 Infections2 140-239 Tumors, Malignant/Benign
3 240-359Endocrine, Deficiency, Blood, Mental & Nervous System Diseases
4 360-389 Diseases of Eyes and Ears5 390-459 Diseases of Heart & Circulation6 460-519 Diseases of Respiratory Tract
Morbidity Profile of Patients
38
7 520-579 Diseases of GIT
8 580-599 Diseases of Urinary system
9 600-679Diseases of Genital Tract, Pregnancy and Child Birth
10 680-709 Diseases of Skin & Subcutaneous Tissue
11 710-779Diseases of Connective Tissue, Joints, Congenital anomalies etc
12 780-799 Ill Defined Diseases
13 800-909 +Fractures, Injuries, Poisoning & Others etc
39
0.1
4.3 4.3 3.7
22.1
8.3
2
7
10.8
0.8
9.3
5.9
0.1
27.4
3.51.4
3.5
6.1
2.7
9.27.1
21.2
1.8
6.4
20.5
10.4
0
5
10
15
20
25
30
Homeopathic ClinicAllopathic Clinic
The morbidity profile of both types of clinics reveals that diseases of respiratory tract, infections, GIT diseases and skin diseases are the most common diseases at PHC level.
40
S.No Allopathic Clinic Homeopathic Clinic1 Infections (001-009)
Amoebiasis TuberculosisSTD’sWorm infestations
DiarrhoeaViral fevers
Anamnesis of Disease Sub Groups
S.No Allopathic Clinic Homeopathic Clinic
6Diseases of Respiratory Tract (460-519)
PneumoniaAcute BronchitisAcute Respiratory infections
Allergic RhinitisCOPDSinusitis
41
7 GIT (520-579)
Acid peptic diseaseAcute colicAcute gastritis
Chronic dyspepsiaIrritable Bowel syndromeChronic Constipation
8 Urinary System (580-599)
Infections of Kidneys Nephrotic SyndromeNephritis
Urinary Calculus
42
S.No Allopathic Clinic Homeopathic Clinic10 Skin and subcutaneous tissue (680- 709)
ScabiesFungal InfectionsPyoderma Pemphigus etc.
WartMolluscum ContagiosumAlopecia areataUrticariaVitiligoPsoriasis
43
• The patterns were not similar in both the types of clinics.
• These clinics complemented each other.• Allopathic had been found to be preferred by
patients with acute diseases and homeopathy by patients with sub-acute and chronic diseases.
• The above preference indicates the strengths and limitations of both the systems as per perception of the public.
44
• Title- Evaluation Study to assess the Effectiveness of Homeopathic Clinics running adjacent to Allopathic Clinics at Primary Health Care Level.
45
Study- II
• This study was conducted by an independent agency- Planning & Evaluation Department of Govt. of Delhi for deciding upon further expansion of homeopathy under the cafeteria approach at Primary Health Care Level.
46
• To assess the effectiveness of Homoeopathic dispensaries
• Patient satisfaction levels.• To assess the perceptions of
Allopathic doctors towards homeopathic clinic
47
Objectives
• The field survey of homeopathic clinics was conducted from 20.02.2003 to 25.03.2003.
• The study team interviewed 10 to 15 patients from each clinic and the staff working in homeopathic as well as allopathic clinics during the field visit.
• Separate structured questionnaires were used for both types of interviews.
• 57 homoeopathic clinics and 840 patients were covered during the survey.
48
Methods
49
Utilization of Homeopathic clinics
1176
679
1187
784
1188
901
1214
444
11500001160000117000011800001190000120000012100001220000
Tota
l No.
of P
atie
nts
2000 2001 2002 2003Year
Patients Attended in Homeopathic Clinics, Govt. of Delhi
The number of patients in Homeopathic dispensaries is steadily increasing and indicates the growing popularity of the system.
Yes No Whether it is beneficial to run Homeopathic clinic from the same premises
46(87%)
7(13%)
Whether the running of Homeopathic clinic create any problem
12(22%)
41(78%)
Whether the doctors of allopathic clinics refer patients to Homeopathic clinics
46(87%)
7(13%)
50
Majority of the doctors of allopathic clinics felt that homeopathic clinics within the same premises are beneficial for the patients.
The doctors expressed that they do not face any problems in running both the clinics and also refer the patients to homeopathic clinics for treatment.
The awareness among 383(45%) patients was through word of mouth (patient to patient contact). This indicates the acceptability of Homeopathy among general population.
Source of Awareness
627%
39547%
38345%
050
100150200250300350400450
Word of Mouth (Patient toPatient)
Already aware because ofpast experience
Patients refered byAllopathic doctors
51
162
81 78122
21
300
76
0
50
100
150
200
250
300
The patients attending homeopathic clinics were from various occupations and all strata of society.
The timings of the clinics were suitable and popular in housewives also. 52
The patient satisfaction levels were very high and gratifying. Only 1% was dissatisfied with homoeopathic services.
Patient Satisfaction Levels (n= 750 patients)
1%
50%
39%
10%0%
10%
20%
30%
40%
50%
60%
Fully Satisfied Just Satisfied Neutral Dissatisfied
Tota
l Num
ber o
f Pat
ient
s
53
639 patients (85.2%) felt that homeopathic system of medicine is better than other systems of medicine.
The study showed that patients also visit the allopathic clinics and other clinics as per their requirements and preferred to use different systems of medicine as per their experience and advice of physicians.
127
639
266
329
1
Allopathic Ayurvedic Homeopathy Unani Combination Not responded All of these
54
134834077
437
189
Easy to take Faith No side effect Cost effective Past experience Others
Most of patients were of the opinion that homeopathy is safe, easy to take, cost effective and had faith in homeopathy due to their past experiences.
55
• Both the studies have established that homeopathy is popular, affordable and efficacious system of medicine at Primary Health Care Level.
• Homeopathy has the potential to minimize health care expenditure substantially if promoted in primary health care through the cafeteria approach, as is being adopted by Govt. of Delhi.
56
Conclusion
• This approach ensures patients participation, increases patient satisfaction in public health system and promotes cross system referrals.
57
I am thankful to Sh Mohan Lal, Director (ISM&H)
Thank you
Acknowledgements
