MAINSTREAMING OF ISM&H PRACTITIONERS AND BARE-FOOT DOCTORS

1. The National Population Policy (NPP) 2000 laid emphasis on mainstreaming of the ISM&H into the health system. This was meant to help cover the huge human resource gaps prevailing in the country in providing Health and Family Welfare services. The ISM&H and Private Medical Practitioners are available in large numbers and are spread throughout the nooks and corners of the country where often the normal health functionaries do not reach. The people have also faith in them as is evidenced by the large number of patients availing of their services. As these doctors are based in local communities and charge comparatively lower fees mostly poor people utilize their services.
2. The National Commission on Population (NCP) constituted a High Powered Advisory Group on Mainstreaming of ISM&H under the chairmanship of Shri K.C. Pant, Vice-Chairman, NCP. This Group has recommended that such practitioners should be given training and utilized for promotive, preventive and curative health care. Services of bare foot doctors could be used for IEC, counseling and social marketing of RCH products. The Group also recommended integration of knowledge of modern system of medicine and ISM&H.
3. With a view to operationalize the recommendation of the High Powered Advisory Group on ISM&H, the NCP has funded the State Institute for Health Management & Communication (SIHMC), Gwalior to undertake a pilot training programme for 300 Private Medical Practitioners (PMPs) of Gwalior Division in ten batches. The PMPs for the training have been registered with the Private Medical Practitioners Association, Gwalior and Active Medical Society of Madhya Pradesh. They were from Ayurvedic, Homeopathic and Electro-Homeopathic branches of medicine. The practitioners were selected from remote, unapproachable and areas which are out of reach of the field level government functionaries. The training programme at SIHMC was inaugurated by Smt. Krishna Singh, Member Secretary, th NCP on 28 December, 2001.

4. The curriculum for the two day orientation training programme included topics like Anatomy and Physiology of Reproduction, Vital Statistics, Health Indicators, Population Explosion, Temporary Family Planning Methods, Newer Methods Of Contraception, Permanent Family Planning Methods, NSVT, counseling in family planning, maintaining records and reporting and goals of the National Population Policy. The training programme was coordinated by the Commissioner Gwalior Division and the functionaries like the Chief Medical and Health Officer, Civil Surgeon and Faculty Members from the Medical College, Gwalior and other Specialists conducted the training programme.

5. This training programme was widely welcomed by the PMPs. The representatives of Panchayati Raj Institutions and the Associations of PMPs welcomed this initiative taken by the NCP in organizing such a training programme for the first time. The PMPs were of the view that the Workshop and the training has been very informative and has helped to clear confusion, myths and misconceptions.

6. The details of the training programme for five batches is given below for information.

 

Schedule of Training
 

In the last five batches a total of 174 participants have been trained. They were from Ayurvedic, Homeopathic, Unani and Electro homeopathic branches of Medicine. The practitioners from those areas have been selected that are remote, unapproachable and out of reach of the field workers and other Govt. staff.
 
The sessions were taken as per the following curriculum:
 

Curriculum

Day 1

10.30 A.M 12.00

Anatomy and Physiology of Reproduction

12.00-1.30 P.M.  

Vital statistics, Health indicators and population explosion

1.30-2.30 P.M.

Lunch

2.30-4.00 P.M.

Temporary Family Planning Methods

4.00-5.30 P.M.

Newer methods of Contraception

Day 2

10.30 A.M 12.00

National Population Policy

12.00-1.30 P.M.

Counseling in Family Planning

1.30-2.30 P.M.

Lunch

2.30-4.00 P.M.

Permanent Family Planning Methods

4.00-5.30 P.M.

NSVT

 

Maintaining records & Reporting

 
The resource persons are faculty/consultants of SIHMC Gwalior, Professors from Medical College, Gwalior, Civil Surgeon and CMO Gwalior. Mahila Bal Vikas Adhikari, Mrs. Qureshi is also being called to inform the participants about other health related schemes of the Government so that the Private Medical Practitioners can motivate their clients to utilize these services. All lectures were taken in Hindi. Use of overhead projector, Transparencies, Slides, Models etc. was done to make the topics more easily understandable to the participants. The sessions were more interactive rather than being only lectures.
 

Day One - Inaugural Session

The batches were inaugurated by Director SIHMC, Mr. Bimal Julka. A brief introduction of the participants was taken in the beginning. In his speech the Director strongly emphasized that the involvement of Private Medical Practitioners will be beneficial for the family welfare programme and also other health programmes of the government as the number of patients approaching the medical practitioners is very high and they have strong faith in these doctors. He pointed out that the involvement of the people in other programmes implemented by the government has shown good results. He hoped that this pilot study would be beneficial and this would be a base for involvement of private medical practitioners through out the state and the country in the family welfare programme.

1 Session

In the first session a detailed description of Anatomy and Physiology of Reproduction was given by Dr. Trikha. The process of reproduction i.e. ovulation, fertilization, nidation etc. was explained.

2 Session

In the 2 session topic of Temporary Family Planning Methods for Males/Females was taken by Dr. Mala Tiwari. She explained clearly the mechanism of action, side effect, Contra indications etc. of each of the available temporary methods. The participants had many queries which were answered.

3 Session

After lunch Dr. S.P. Sahni took the session on vital statistics, population issues and health indicators Recent data of health status in India were also discussed.

Last Session

The last session of day one was on newer methods of Contraception where in Dr.V.Joshi, Assist. Professor, Department of Gyn., Gwalior explained to participants about the recent and newer methods/Concepts in Family Planning.

Day Two - 1 Session

The 1 session of the 2 day was on National Population Policy. The objectives of N.P.P., National socio demographic goals etc. was taken by Dr. A.K. Saxena of SIHMC. Recent report of NFHS-2 on Infant Mortality and factors contributing to high IMR in M.P., were discussed.

2 Session

The 2 session was on Counselling by Dr. Mala Tiwari wherein the participants were told about how they can counsel a client for Family Planning. The objectives and benefits of counseling were discussed and Interpersonal Communication Skills were told.

3 Session

Dr. A. Trikha took session of Permanent methods of contraception and infertility. The reasons, methods of diagnosis and treatment of infertility were explained. The participants had many queries on tubectomy and vasectomy, which were clarified.

Last Session

Last session was on NSVT/Reporting and record keeping by Civil Surgeon of Gwalior Dr.R.P. Sharma and C.M.O., Gwalior Dr. Deenbandhu Diwedi. The participants were told about the New and recent method of male sterilization i.e. Non Scalpel Vasectomy. They were also explained, how they are supposed to keep records and reporting of the stock of Family Planning Methods which will be issued to them.

Conclusion

In the evening of the 2 day of all the batches the Director Mr. Julka interacted with the participants and asked them about their views and suggestions. The suggestion which have been put forward are given below:

  1. The Clinics of these trained PMPs should be made depot centres for distribution of contraceptives.

  2. Regular supply of contraceptives should be made available for their clinics so that the contraceptives can be distributed to the acceptors.

  3. Supply of cassettes, video films etc. about Family Planning.

  4. (iv) Supply of posters/Charts etc. regarding Family Planning Methods. These can be put on their clinics and this would help then to explain/counsel about a method.

  5. (v) Availability of a lady doctor at least once a week/month at the clinics of these trained practitioners for giving talks/lectures on important health related problems.

  6. (vi) Mass meeting/group meeting/baby shows etc. to be done by Government health functionaries in the clinics of these practitioners.

  7. They should be involved in all the health related Government activities.

  8. In every village a team of PMPs should be allowed to open a "Pariwar Kalyan Kendra". The Centre should be given one year to show its performance and if it is found satisfactory it should be given renewal for another year or else it should be stopped.

  9. Refresher training of this sort should be given to them again and again as this would help to increase their knowledge.

  10. Incentives should be given to acceptors of permanent method of Family Planning.

  11. Books related to Family Welfare Programme should be given to PMPs and library facility for PMPs should be started.

  12. Monthly meeting of these PMPs with Block Medical Officer and Chief Medical & Health Officer should be done for close coordination between the Government and Private Sector.

  13. Identity cards should be issued to these trained PMPs.

  14. Modules in Hindi should be given to PMPs for referral purposes.

  15. Some of the PMPs have offered to utilize their clinics by the government for purpose of opening a Family Planning Centre.

  16. Mobile Van should be utilized for creating awareness about family Welfare Programmme in the backward areas.

  17. Such types of training are so beneficial that PMPs are ready to attend them even if the government does not give as any TA/DA etc.

  18. Some PMPs should join together and form a working team. Creating awareness among the general public should be the aim of this team.

  19. Boards should be put on their clinics mentioning that this clinic is recognized by the Government for Family Welfare Programmes/ depot centers for distribution contraceptives.

  20. Referral slips should be given to the PMPs for referring clients from their clinics to the Government Hospitals. A client coming with the slip should be given proper care attention and behavior of doctors should be good. This will create a rapport of the PMPs among the general public.

  21. Vaccines should be made available to the PMPs for immunization.

  22. The trained PMPs should be given a target for Family Planning and if they meet the target, they should be given some incentives.

  23. Facility for free education of children of those couples who opt small family norm.

  24. Female PMPs should be given training on IUD insertion and MTP.

  25. Counselling camps should be organized at least once a month in backward areas.

  26. In the monthly meeting of the Government officials, representatives of PMPs should be called for suggestions.

  27. PMPs should be made members of the district/ block level Health Committee.

  28. Dates of Tubectomy Camps etc. in a particular area should be intimated to PMPs of that area so that they could also refer clients to avail these facilities

  29. Involvement of PMPs should be extended for making depot holders, refresher course, creating awareness, organizing camps etc.

  30. If PMPs are referring cases to a particular hospital then they should be allowed to accompany the patient to the O.T. so as to remove the fear in the minds of the client

7. The response of the medical practitioners to this training has been very encouraging and enthusiastic. A large number of Private Medical Practitioners are coming forward and are requesting to undergo this training at the SIHMC. Proposal for 10 more batches is being sent to National on Commission Population. Many of the above suggestions can be implemented. Apart from imparting training, it may also be necessary to introduce the required changes for removing regulatory handicaps and procedural difficulties to enable the PMPs to play a meaningful role. Adequate recognition and appreciation of the services given by such doctors may also be necessary. The training programme organized at SIHMC, Gwalior can be a model for undertaking similar programmes in other regions and States