The Indian Experience of PSM Departments and the Teaching of Public Health
Item
- Title
- The Indian Experience of PSM Departments and the Teaching of Public Health
- Creator
- N S Deodhar
- Date
- 2007
- extracted text
-
THE INDIAN EXPERIENCE OF PSM DEPARTMETNS AND THE
TEACHING OF PUBLIC HEALTH
Dr. N.S. Deodhar, Pune
Prologue: Traditionally, the subjects of physiology
and hygiene, and hygiene and public health were
taught in secondary schools and medical colleges,
respectively, in Indian educational system. What
was the rationale in discontinuing this practice? In
late 1940s in the western world, there was a
paradoxical situation of the decline in the status
and fall of the discipline of public health as a result
of the successful control of communicable diseases,
improvement in environmental health, etc. Insights
& contributions ofProfessor Edward McGravran of
University of North Carolina, & Prof. Huge Leavell
of Harward School of Public Health, USA, in
regaining the lost ground resulted in broadening
the pure curative function of family physicians and
consultants to include the disease preventive and
health promotion aspects; this was the origin of
community health.1
With this back-drop, first International
Conference on Medical Education was held in
London, UK, in 1954. One of the recommenda
tions was to discontinue teaching of the subject of
public health and hygiene in the medical colleges
because it was considered as out-dated. It was
proposed to create a Department of Preventive &
Social Medicine (PSM), British equivalent of
community medicine, in every medical college.
The objective was to strengthen the prevalent
curative clinical medicine by supplementing it with
the preventive and social components. Idea was to
make practice of medicine, especially of the
general practitioners or family physicians more
health-oriented and community-focused. As it has
often happened in many efforts in reorientation of
medical education (on foreign ‘expert advice’), the
good intentions and objectives are lost during the
process of ‘advancement’. There are many reasons
for this, especially of lack of clarity and insight on
the implications such as provision of appropriate
and adequate inputs which are required to
effectively implement recommended measures or
reforms, apathy and tendency of the faculty
members and management to maintain status co,
and failure of the authorities to provide necessary
inputs adequately and in time. The aim of this
paper is to stimulate introspection on the part of
the authorities like Governments and Medical
Council of India, Faculty Members of the PSM
Departments and Indian Association of PSM for
in-depth evaluation of the current status of
teaching of the subject at the undergraduate and
postgraduate levels vis-a-vis the objectives with
which these special departments were established.
Hopefully, this will result in discovering their
present role in strengthening the moribund public
health services & system in India, and developing
a flexible plan of action for restructuring, design
ing & empowering the departments to play the new
envisaged role effectively and efficiently.
Take-off: Our Governments and authorities are
quick in accepting recommendations originating
from the international sources, but characteris
tically implement them half-heartedly and ineffec
tively. First two departments of Preventive and
Social Medicine in India were established in 1953
at B.J. Medical College, Pune, and S.S.G. Medical
College, Varodara (formerly called Baroda). ‘Very
imaginative’ staffing pattern provided by the
Government for this highly demanding task was a
professor, junior lecturer and a clerk put in a single
room. Dr. J.K. Adranvala at Pune and Dr. A.K.
Niyogi at Varodara, who initiated the discipline of
PSM were highly successful public health experts
and managers with insight for amalgamation of the
old subject of public health and hygiene
(discarding the non-essentials for a general
practitioner) into the teaching of new discipline of
PSM and making it meaningful to the students by
its practice in the community and hospital
situations. I happened to be the first junior lecturer
at BJMC, Pune. I was surprised for my selection
by Prof. J.K. Adranvala because in the interview I
had explicitly declared that my primary interest
was in surgery and getting M.S. degree. I also
vouched that my interest in surgery will not come
in the way of my discharging my duties fully and
efficiently. These two departments developed and
evolved different patterns for teaching PSM, but
both laid emphasis on epidemiology. Teaching of
biostatistics2, epidemiology and comprehensive
bed-side clinical sessions in Infectious Disease
Hospital, were initiated at Pune, and CPGP
(Curative Preventive General Practice) Units at
Varodara, were some of the items of variation.
2
r
In 1955, the Government of India decided
to create a department of preventive and social
medicine in each medical college’’. In due course
more departments of PSM were established.
Persons, who were in charge teaching of preventive
arid social medicine, had different background,
vision, capabilities & vision. The concept of
preventive & social medicine was rather nebulous.
The scope and potential for development of PSM
was so wide that various ideas - some of them
vague - were tried out and teaching of this subject
at different colleges in India disclosed amazing
variety of content and method. This teaching "was
not a smooth task. There was no recognition of the
new discipline by many clinicians. Early phase up
to 1970 constituted transition period when there
was philosophical talk on positive health when
illness was rampant. Transformation of ‘public
health’ to ‘preventive medicine’ was hampered by
a shortage of qualified and suitable teachers, and
teaching was also affected by the fact that students
were, admitted in progressively increasing
numbers. Administratively, there was more of
hindrance than support, more of ridicule than help,
and much unrewarding paper work. While these
conditions still prevail to a varying extent at some
places, there is a general improvement. The new
discipline is, however, still far from mature. There
were unwarranted moves for empty educational
reforms such as for change oi the name from
Preventive and Social Medicine to Community
Medicine4.
Emergence of the new Departments PSM
in many divergent ways was, in fact, healthy trait,
Like Pune and Varodara, PSM Departments at
Banaras, Nagpur, Mumbai, Delhi, Lucknow,
Hyderabad Indoor, Vellore, etc., have their own
distinctiveness. For want of detailed information,
the purpose of this paper, and need of brevity and
objectivity, specific directions various PSM
Departments were developed was considered
inappropriate. Therefore, their performance has
been neither reviewed nor elaborated. The success
story' at B.J. Medical College, Pune, is given in
details so that some lessons can be drawn.
B.J. Medical College, Pune: The Department of
Preventive and Social Medicine at was established
in 1953. Dr. J.K. Adranvala, Mjt.c.p. dtm iH,DP.n.,
an eminent public health scientist and efficient
administrator, was the first full-time professor who
directed the department up to I960. At that time
the department was located in one big room, and
only one Jr. Lecturer, Dr. N.S. Dcodliar, and a
clerk were on the staff to assist the professor. The
teaching was limited to two academic terms for the
undergraduate students only. There was hardly
ally field programmes, and the separate examina
tion in the subject of preventive & social medicine
at the University of Pune, was just abolished. From
June 1961 to March 1974 I was in charge of the
department. The various aspects aild filial stages
of development are indicated below5.
Staff! (a) Full-time Staff at the College (H.Q.) -
1. Professors
2. Readers in PSM
3. Reader in Social Paediatrics
4. Reader in Social Obstetrics
5. Reader in Demography
6. Reader in Social Sciences
7. Epidemiologist
8. Statisticians
9. Lecturers
10. Medical Social Workers
11. Research Assistant (non-medical)
12. Public Health Nurse
13. Health Educator
14. Curator of Museum, Health Educator
15. Artist and Photographer
16. Projectionist
17. Stenographer
18. Nurse Midwives
19: Auxiliary Nurse Midwife
20. Basic Health Worker
21. Laboratory Technician
22. Laboratory Assistant
23. Clerk-cum-storekeepcr
24. Laboratory' Attendants and Peon
2
3
1
1
1
1
1
2
7
2
1
1
1
1
1
i
i
3
1
1
1
1
1
4
(b) Honorary staff at the college:
1. Hon. Lecturer in Infectious Diseases
2. Hon. Consultant in Occupational
Health
3. Hon. Consultant in Social Sciences
1
1
1
© Staff at the Urban Health Centre, Poona:
1. Reader in PSM I/C (from H.Q. staff)
2. Lecturer
3. Medical Officer, Dispensary
4. Hon. Dental Surgeons
5. Lecturer in Paediatrics
6. Tutor in Midwifery
7. Medicui Social Worker
1
1
1*
2*
1
1
1
3
(From H.Q. stall)
8. Public Health Nurse, Sister Tutor,
9. Sanitary Inspector
10. Laboratory Technician
11. Health Visitors
12. Vaccinator
13. Malaria Worker
14. Compounder
15. Statistical Assistant
16. Clerk
17. Dresser
18. Class IV staff
19. Driver (from H.Q. staff)
1
1*
1
2*
1*
1*
1*
1
1*
1*
2*
1
(d) Staff at the Rural Training Centre, Sinir:
1
1. Reader in PSM VC
1
2. Lady Medical Officer
1#
3. Medical Officer, I/C PHC
4. Medical Officer, VC Dispensary
1#
5. Medical Office VC Dispensary
1#
1
6. Dental Surgeon
2
7. Public Health Nurses
1
8. Health Educator
9. Health Inspector (Sanitary Inspector) 3+1**
10. Lab. Technician
1
4+8#
11. Nurse Midwives
8+r
12. Auxiliary Nurse Midwives
13. Basic Health
3** +2#+r
14. Clerical staff
4
4
15. Drivers
16. Class IV staff
9+8#+r
(e) Visiting Specialists from Sassoon General
Hospitals, Poona:
1.
2.
3.
4.
5.
6.
7.
8.
Professor of PSM, once a week.
Asso. Prof, of Medicine, twice a month.
Asso. Prof, of Mid. & Gynaec, twice a month.
Director of Paediatrics and 3 Hon. Prof. —
once a week by rotation
Asso. Prof, of Surgery, Once a month.
Hon. Dermatologist, Once a month.
Hon. Chest Specialist, Once a month.
Hon. General Practitioners from Poona, Four,
once a week by rotation.
Note: Post borne on: * - Poona Municipal Corporation, ** Director of Health Services, II - Zilla Parishad Poona, ♦ - Zitla
Parishad Ahmednagar.
Space and Locations: The main department was
located on the ground Hoot and the basement of the
college bu'lding and occupies over about 775 sq.
metres. Additional space in the basement of the
adjoining block of the hospital building with an
area of about 350 sq. metres was to be acquired.
Immunization Clinic, Family Planning and
Welfare Clinic, Antenatal Clinic, Postnatal Clinic,
Well Baby Clinic, Cancer Detection Centre,
Medical Social Service Department, Diabetes
Clinic, Genetic Clinic, etc., were located in the
Sassoon General Hospitals, Pune. Once establish
ed and stabilized the services were directly run by
the respective departments in the college and
hospital, not necessarily by the PSM Department.
Field Practice Areas: The Urban Health Centre
was located within 5 minutes walk from the
college. A two storied building with a paved open
space, garden and playing facilities for children,
was provided by the Poona Municipal Corporation.
The Rural Training Center was located at
Sirur, about 69 km from Pune, serving a popula
tion of 48,000 spread over an area of 663 sq. km.
Ample space was provided at the H.Q. with Clinic
Buildings, Administrative Block, Teaching Block,
Hostels for medical and other trainees, etc. At all
sector villages, Health Clinics were provided.
Undergraduate Training:
The teaching of
preventive and social medicine passed through
many phases of development and the following is
the account of the final stage of evolution. The
training extended throughout the M.B.B.S. course.
Besides, integrated clinics were conducted at a
near-by rural health unit, a subcentre, or a P.H.C.,
jointly in collaboration with Director of Paediatrics
and his staff, during the senior paediatric clinical
clerkship for one month.
Broad headings of the syllabus and the
distribution are given in table 1. A course of
lectures during pre-clinical period was designed to
point out the differences between the hospital &
general practice of medicine. The method used
was informal ‘interactive talks’ and discussion
with smaller batches of students. Students’ health
service was specially developed as a practical
demonstration in PSM item, i.e., health care by
doing it. This was a unique exercise of experience
of learning through participation.
Bed-side clinics on infectious diseases at
1DH were integrated with teaching of epidemiology
of communicable diseases.
These two hour
sessions were conducted exclusively by the PSM
department. Special feature was enidemiological
-exercises and application in clinical practice.
4
Our basic objective was to train a clinician
for comprehensive medical care of the community,
with a strong bias in preventive and social aspects
so that he identifies and practises its principles at
every opportunity as a family physician. We did
not deliver a diluted ‘Public Health’ course.
Tabic 1: Syllabus and Distribution oJ'Topics
Period
Topic
Time
I M.B.B.S. - Students Health Sen ice 2 hrAvk
Is1 term* and Health Check-up
I M.B.B.S. - Introduction to Practice 1 lirAvk
2"d term
of Medicine.
- Psychology
1 lirAvk
n MB.B.S - Principles of Environ4 hrAvk
1“ term mental Sanitation.
II M B B.S.- Biostatistics in
4 hrAvk
2'“'’ term Medicine.
II M B B.S.- General Epidemiology
2 hrAvk
3,J term
III M B B.S. - Communicable Diseases. 5 hrAvk
i Meim
Epidemiology & Clinical
HI M.B.B S. - Community Health
5 lirAvk
2nd term Practice.
m M.B.B S. - Tutorials and Group
2 to 3
HrAvk
3“' terra
discussions.
26 wk
Internship - Comprehensive
Medical Care. Family
Study. Rural Medicine.
At the III M.B.B.S. (final) examination of
the University of Pune, there was a separate paper
in PSM carrying 100 marks, viva voce, & clinical
examination at Infectious Diseases Hospital
Question papers and examinations were designed
so as to stimulate thinking and application of PSM
knowledge and technology.
Postgraduate Teaching: The Department was
recognized by MCI for conducting courses leading
to D.P.H., D.I.H. and M.D. (PSM) of the Pune
University. The Department was also recognized
by the college of Physicians & Surgeons, Mumbai.
Postgraduate students in other subjects also used
facilities of PSM set-up.
Most of the teaching was through partici
pation & involvement, guidance, attachments &
clerkships, visits, seminars and dissertation, guest
lectures, journal club, field work and discussions.
Action learning was important6. In addition to the
central college library and other medical libraries
in Pune, the department had an abstracts library,
some periodicals and reports, and ever 1,000 books
and other publications, complete with subject
index. It was rich in teaching aids and materials.
Eight road-worthy vehicles and mobile laboratory
van were available.
Hours of Teaching: Excluding the internship,
over 380 hours were devoted to teaching of
preventive and social medicine. Out of these hours,
130 were for the theory classes and 250 for the
practical work. The whole period of 26 weeks
during internship was used for practical experience
and the students were required to stay at Rural
Training Centre, Sirur, for 2 weeks for orientation
and at an upgraded Primary Health Centre for 24
weeks for comprehensive experience.
The postgraduate students participated in
training of the undergraduates. They had to select
and study a problem in details and write a
dissertation. The students were involved or even
held responsible for managing Rural Training
Centre at Sirur, investigating disease outbreaks,
reported epidemics, or other health problems as
and when occurred. Several other institutions and
authorities such as Armed Forces Medical College,
the Directorate of Public Health, Regional family
Planning Centre, Statistical Bureau, Central Public
Health Laboratory, Pune Municipal Corporation,
Infectious Diseases Hospital, University of Pune,
etc., provided their full co-operation in the training
programme.
Evaluation and Assessment: Evaluation and
assessment of the students were regularly done at
the end of each academic term, and in some
instances at the mid-term. Students maintained
complete record of the practical work in the
‘prescribed journals’ which were certified at the
end of the course. Both the content and methods of
training various topics were critically reviewed and
evaluated, and courses modified, if necessary.
Rural Health Centre, Sirur:
This was
established in 1939 by the Government of Bombay
with the aid of Rockefeller Foundation. Up to
1956, the centre and 8 sub-centres were serving a
population of 48,000 spread over an area of 663 sq.
km. From lanuary, 1968, Health Unit, Sirur, came
under the control of the Dean, B.J. Medical
College, Pune, and functioned as a part of PSM
department. Apart from the medical studer.ts, the
5
Unit trained postgraduate students for M.D. (PSM)
and D.P.H. from, both BJ. Medical and Armed
Forces Medical Colleges, the students for B.Sc.
(Nursing), and the nurses and midwives, etc., for
varied duration. Medical interns were trained
throughout the year and good residential facilities
are provided for this purpose.
The Centre was upgraded to train 40
interns at a time and to fulfill the requirements of
the Pune University. Establishment of a second
Health Centre at Khed (Manchar) to take up the
additional load of 35 interns was considered, but
the proposal was dropped in light of the scheme of
revised internship programme. From lsl April,
1968, a new syllabus came into force for the rural
internship. Interns maintained a Journal and
recorded the work done, a requirement for the
completion certificate.
Several authorities were working in the
field practice area of Rural Health Centre, Sirur.
Administrative agreement were reached and from
1st July 1970 all the health and medical staff from
various agencies was put under the control of the
Reader L/C of the rural Training Centre for day to
day work, supervision, etc.
One of the major defects in teaching of
Preventive and Social Medicine was the lack of
practice and demonstration of whatever is taught at
theoretical classes. It is a well-known fact that the
students learn and know what they do themselves,
they understand, try to retain what they see and
read, and tend to forget what they only hear.
Therefore, the solution to the effective education in
PSM obviously was to design and develop the rural
(Sirur) and urban field practice areas so as to
provide an effective instrument of teaching and
demonstrating practice of PSM & comprehensive
medicine. A lot was also done even in the Sassoon
hospitals. However, a teaching hospital, the well
established traditional institution of medical
education, provides only a limited opportunity for
the practice of PSM, especially communityoriented and at a level of general practitioners.
Health Clinics (comprehensive dispen
saries) at sector villages were developed so as to
demonstrate a desirable set-up of general practice
which ensures a high standard of rational and
scientific medicai practice, and brings about a
positive relationship and partnership with the local
health services for mutual benefit and welfare of
the people. Not only all the basic health needs
were satisfied, but also specialist and some
diagnostic services were provided. We successfully
secured support of the Sassoon General Hospitals,
and Senior General Practitioners from Pune.
Facilities such as clinical laboratory, 50 MA X-ray
machine, etc., were provided to help the
consultants who attended primarily to guide and
provide consultation to the interns’. General
practitioners and Paediatricians visited the sector
villages and conducted “community-side” clinics.
These speciality clinics were organized on all
Thursdays.
Is1 Thursday: 1. Prof, of PSM. 2. Asst. Prof. Mid.
& Gynaec. 3. Hon. Prof. Tuberculosis. 4. Hon.
Asst. Prof. Paediatrics. 5. General practitioner.
2nd Thursday: 1. Prof, of PSM. 2. Asst. Prof.
Medicine. 3. Lecturer in Paediatrics. 4. General
practitioner.
3rd Thursday: 1. Prof, of PSM. 2. Asst. Prof. Mid.
And Gynaec. 3. Hon. Asst. Prof. Dermatology. 4.
Hon. Prof. Paediatrics. 5. General practitioner.
4lh Thursday: 1. Prof, of PSM. 2. Director of
Paediatrics. 3. Asst. Prof. Medicine. 4. Asst. Prof.
Surgery. 5. General practitioner.
5lh Thursday: Prof, of PSM. Or Pharmacology or
Ophthalmology, etc., visited as required.
Rural Training Centre was considered as
an integral, part of Sassoon General Hospitals.
Patients could be admitted directly from the Centre
to the hospital, if necessary. Ambulance service
was also available. This rapidly developing wing
of the Department, recorded its full activities in its
annual reports. Further details are elaborated
elsewhere7.
Basic Health Services: Rapid expansion of the
medical and health services on ad hoc basis, etc.,
made the administration of health services a
complex problem. Thus, it was decided to plan an
alternative & establish Basic Health Service (BHS)
as an experiment at Sirur. For the first time in
Maharashtra, a nucleus was created to implement
B.H.S. in replacement of the classical vertical
pattern of the delivery of health care. Pooling the
staff of various agencies and unifying the authority
on purely voluntary basis on persuasion, it was
been possible to put the dream into action. One
basic health worker and one aNM were provided
for -a population of 4,000 to 5,000, with adequate
supervisory staff. These services were used for
demonstration and to train paramedical trainees8.
6
Revised Internship Programme: One of the
important problems we faced was 200 admissions
annually resulting in a large number of interns to
be posted in each term. While we organized
undergraduate training at college by sub-dividing
the big batches and at the same time maintaining
efficiency, this was not possible during internship.
In order to make the internship programme
meaningful, attractive and more effective, revised
plan was introduced. Initially, the intake was
limited to 20 scats, but it was expanded every year
to accommodate all the interns eventually. The
main features were: (a) Experience in one of the
district hospitals for six months instead of at a
teaching hospital. We realized that one of the
difficulties in teaching of comprehensive medical
care was what was seen, practised, and continu
ously experienced by the students for three years in
a teaching hospital, as was ours - an example of
overstrained hospital practice of medicine with its
high specialization and sophisticated grandiose.
An easy and practical way out was to discontinue
their posting at Sassoon Genera! Hospitals, Pune,
(b) More closely guided and supervised rural
medical experience at selected P.H.C. for six
months.
Initially, seven Primary Health Centres in
Pune District were upgraded. Later the number
was raised to 21 covering three districts. Items for
upgradation included provision of good residential
accommodation to two or four interns at one PHC,
satisfactory boarding facilities, suitably equipped
clinical laboratory, transport, experienced and
interested Medical Officer, PI-IC fully staffed with
an addition of a post of laboratory technician and
additional annual recurrent grant for extra
medicines, laboratory supplies, specialist visits, etc.
Unique success of this six month rural internship
resulted in its recognition by MCI as an alternative
and the Government of Maharashtra extending this
programme in all Medical Colleges in the State.
Urban Health Centre: The Urban Health Centre
was established for demonstration of community
health services, relevance and impact of social and
economic factors on health & disease, comprehendsive and integrated medical care, continued
care, etc., and covered population of about 25,000
consisting of all the socio-economic groups. The
area included small industries and ‘‘Gadital” slum
was near-by. The area was about 518 hectares (two
sq. miles). U.H.C. was developed as an urban field
practice area for undergraduates and postgra
duates from B.J. Medical College and for Karve
School of Social Work. Interns and Pubic Health
Nurses were also attached to the Centre for
training purposes. In addition to training and
research, the U.H.C. provided the following
services to the people through its various clinics:
(a) Medical care, (b) Antenatal care, (c) Family
planning, (d) Well baby clinic, including milk and
diet supplement, (e) Creche, (f) Immunization".
(g) School health service including mid-day meals.
(h) Dental care, (i) Follow-up and extension
services, (j) Health education. Senior students are
posted at the centre for case-studies and
presentations, participation in the health services
such as school health check-ups, counselling and
referral services, immunization, health education,
morbidity surveys, nutritional projects and
research, MCH, etc.
Other Activities: The PSM Department of BJMC
initiated and was involved in many other fields of
activities. Only some are enumerated:
For a selected population the interns were 1. Family Planning Centre: This was attached to
to provide comprehensive medical care with ‘total the hospital. This centre and field unit of the
coverage’. This was in addition to participation in regional family planning training centre was used
the normal functioning of the Centre. Experiment for training of medical students.
was successful with encouraging response of the 2. Immunization Clinic: This clinic for comprestudents and staff. Specialist regularly visited the hendsive immunization was established with the
P.I-LCs. A separate vehicles and allowances were help of the Immunization Committee of Pune.
provided for specialist visits to selected PHCs. This Centre promoted triple immunization and
Outline of a minimum programme for training of polio protection in Pune. Both the public and the
Medical Interns during six months of rural posting doctors were active resulting in couple of lakh of
is reported elsewhere’. The programme was ..'children fully immunized within a few years.
evaluated and in general, the work done by each../.. 3.. Cancer Detection Centre: This was cstablishintern was found more than the required minimum, ed With .the help of the Pqnc Branch of the Indian
The interns were enthusiastic, showed considerable Cancer Society. . .This, weekly activity was one of
interest and maintained fairly good- records10, the few sticb centres in India then. •.
7
4. University Students Health Service'. This was
established in 1962 as an activity of the University
Board of Students Welfare and run by the Medical
Advisory Committee on both of which PSM
professor was a member.
5. Health Education'. This was a permanent and
specialized activity at the O.P.D. of the hospital.
Many instructive charts and posters were specially
prepared and permanently displayed in the hospital
at suitable places. Once or twice a year, health
exhibitions were arranged on a large scale for the
public in and outside the hospital. Special days
and occasions such as World Health Day; anti-fly
week; smallpox, leprosy, tuberculosis and other
control programmes; voluntary blood donation
drives; etc., were scrupulously used for educating
the public. Health talks were given by the Curator
of the Museum to the in-patients at Sassoon — a
part of a project ‘Health Education in Hospital’.
6. Museum: A permanent health museum was
provided for the undergraduate medical students
and nurses for study. The department had its own
library, charts, posters, films, slides & other audio
visual aids, material, in good quantity & standard.
7. Health Exhibitions became characteristic and
well recognized expertise of the department which
acquired proficiency in this field by practice.
Several exhibitions, general medical, health or in
special topics such as cancer, food adulteration,
leprosy, family planning, smallpox, diabetes, etc.,
were very popular in Pune. The exhibits were
mostly prepared by artist section, & real specimens
from anatomy & pathology museums & energetic
explanations by the students made them live.
8. Medical Social Service Department of the
Sassoon General Hospital was reorganized and
guided by PSM Department from 1961. It became
one of the well developed of such departments, and
looked especially after many social and non
medical aspects of patient care, rehabilitation12 and
welfare. It was staffed by two experienced and
efficient medical social workers, a craft teacher,
clerks and other personnel. A band of voluntary
social workers from Pune assisted them. In due
course, it was given the status of a separate
department dealing with several hundred of cases
every month. The staff participated in teaching.
Of special significance was establishment of an
association of helping citizens of Pune, “Society of
Friends of Sassoon Hospitals”. Its primary concern
was the welfare of Sassoon patients. It raised
funds and worked closely with administration.
Consultations: The PSM Department provided
consultation services not only to the practising
doctors in the city and others on technical matters,
but assisted clinical and other departments in the
diagnosis and management of communicable
diseases, immunization, statistical advice and help,
and several other problem solving. It also assisted
the Health Department of the Pune Municipal Cor
poration, and Directorate of Health Services,
Maharashtra, Pune, in epidemic investigation and
dealing with other health problems.
Assistance was rendered in Out-patient
Department project to improve the services, and for
training medical students and interns in general
medical practice. Through planning, modification
and decentralization into multiple GP Clinics
remarkable results were achieved. General waiting
period in O.P.D. was reduced from couple of hours
to just half an hour.
Research: Many studies were carried out by the
department. Several papers and three books were
published. Some of the important works included,
(1) Early diagnosis of smallpox by skin-smear and
other tests. (2) Socio-economic study of medical
students. (3) Study of susceptibility to infection and
herd immunity against diphtheria. (4) Epidemio
logy of “Poona Disease” — a new discovery, a
polyuria and po'ydipsia syndrome, which was
earlier wrongly called epidemic diabetes incipidus.
On investigation, epidemiology was defined,
etiological factor was discovered and the disease
was reproduced in animals. (5) Intradermal
immunization against Typhoid. (6) Investigations
on outbreaks of smallpox, epidemic dropsy,
typhoid fever, infectious hepatitis, etc. (7) rural
pre-school children, studies on growth & nutrition.
(8) Long acting penicillin in prophylaxis of posttraumatic tetanus. (9) Study of General Practi
tioners in Pune. (10) Study of Calcium and Vit. D
on growth of pre-school children. (11) Students’
Health Service. (12) Polio project and entero-virus
study at Sirur Unit were some of the biggest. They
were jointly taken with the I-Iaflkine Institute,
Mumbai. Serological surveys and virus isolations
from stools were reported to the polio study group
of I.C.M.R. Over 4,00C paired-sera were collected
from immunized and unimmunized children
between 1 to 10 years in Pune, and serologically
tested as a follow-up study of efficacy of regular
polio programme. Prints are available on a CD.
8
Publications:
Medical education was one of the
major interests, and some of the publications
related to training of medical students. < The
financial difficulties were solved mostly through
improvisation and economy. Use has been made of
the regular resources available at the college and
other institutions in Pune. From time to time
research grants were also procured from sources
such as I.C.M.R., University of Pune,
pharmaceutical industries, etc.
UNICEF Support:
The department was
recognized by UNICEF and was strengthened by
supply of books, many vehicles, special laboratory
equipment such as spectrophotometer, etc.
Upgradation of the Department: With these
contributions and development, the Department of
Preventive and Social Medicine at B.J. Medical
College, Pune, was the first to be upgraded for
post-graduate training by the Government of India
during the IV Five-Year-Plan from March 1970.
Additional staff and special equipment were
sanctioned. A lot of equipment including 80
column data-processing equipment of I.C.L. was
installed. Bio-statistics, occupational health and
nutrition laboratories were in established. The
project was completed in four years.
Eye on future: For us what remains to be done
was always important. Dynamic approach was
necessary in developing discipline of preventive
and social medicine or Community medicine.
Newer perspectives in medical education were
needed, and newly acquired knowledge and
techniques of communication, environmental and
social sciences were to be passed on and made
meaningful to future medical practitioners. The
people were to be informed and organized in
constantly changing and divergent community
settings, environment, etc. Motivation remained
an important determinant for action — individual
and social. An average general practitioner may
not be able to employ the latest advances in
diagnosis and therapeutics owing to lack of
resources, but his/her failure to avail him/herself of
the opportunities for preventive actions, has been
often because he/she never thinks of it. How to
make them think of & realize these opportunities?
The ‘bed-side’ model of teaching and learning has
been singularly effective in clinical medicine and
surgery. For training of tomorrow’s basic doctor
“community” has to be the “ward” for future
students5. A new ‘community-side’ model for
educating medical students was to be perfected.
Serious efforts are necessary for institutionalizing
the approach.
Vision”: Major considerations were as below:
1. Much that was being taught in the traditional
‘Hygiene and Public Health’ to medical students
was outdated and not relevant for medical practice.
2. Specialization and overprofessionalization of
medicine weakened doctor-patient relationship and
human values were neglected.
3. Significance of social factors in the causation,
impact and management of ill-health, prevention
of disease and promotion of health in medicine was
recognized. Ryle introduced the term ‘Social
Medicine’ to describe a new discipline.
4. Preventive and Social Medicine is purely a
clinical subject with emphasis on comprehensive
community practice and epidemiology.
5. Aim of teaching PSM is development of
concepts and acquisition of skill and knowledge for
practice, not in isolation, but integrated with the
practice of general medicine or its specialities.
6. Students should be trained not only in class
room (this was inevitable), but also by making
them learn through demonstration & participation.
7. Development of ‘teaching communities’ where
PSM is practised regularly should be an essential
activity as a tool for training purpose. Objective is
to remove the notion from the mind of students
that this subject is to be studied only for passing
examinations; and that the principles of PSM are
good, but have no place in practice.
8. Aim of teaching undergraduate students is not to
supply out public health specialists, but to turn out
good practitioners of medicine, who are aware and
capable of providing comprehensive and integrated
medical care, duties towards the community, and
responsibilities in the national health programmes.
9. Preventive medicine is not the only important
subject; it has no existence without curative
medicine. Prevention is a part of medical care.
10. Students have a mental barrier in appreciating
the needs of rural population, role of environmen
tal sanitation, traditional customs and beliefs, and
inadequacy of medical and health facilities, etc.
Thus, special attention has to be given to make
PSM teaching meaningful and interesting.
11. Last but not the least, in teaching PSM, one
has to work closely with all other departments, viz.
paediatrics, medicine, midwifery, surgery, and
o
9
others, e.g. tuberculosis, dermatology, venereology,
dentistry, ophthalmology, etc. Good cooperation,
collaboration and informal relationship with the
Directorate of the Health Services and the local
health authorities - both municipal and rural - are
vitally important. Constant and effective contact
with the community is necessary; and this can be
ensured only through high quality & uninterrupted
sendees. Teaching of medicine in a community
can never be effective without winning the
confidence of the people and their active support
and participation.
This provided guidelines in designing the
curriculum, method and manner of its delivery.
With a continuous evaluation for over 15 years,
programme of teaching PSM was evolved at the
B.J. Medical College, Pune. Details are available
elsewhere14. On all courses, care was taken to
provide illustrative examples which had direct
bearing on real-life situations as related to medical
practice, people, socio-economic development,
sanitation, etc. For example, in the practical work
in statistics, data on physiological variations
collected from the students’ themselves is made use
of. Extramural teaching was done as much as
possible through field visits and demonstrations,
etc., e.g., most of the teaching in environmental
sanitation was through the visits and
demonstrations. In most of the courses the
proportion of class-room lectures to practical &
field work was 1 to 2 or 1 to 3.
Highlights: The success of our endeavour did not
lie in recognition & upgradation by the Govern
ment of India. It was not so much on acclamation
received nationally and internationally, as on the
exploratory and study visits by the national and
international experts, officials of the international
agencies and governments, students, etc. Real
contribution was expert manpower development
and practitioners. There are score of students who
are practicing community health in a variety of
fields such as comprehensive general practice;
environmental health; health education; clinical
specialities like paediatrics, orthopedics, obstetrics
& gynaecology, ear-nose-throat; epidemiology,
health administration and applied research. A
second line of command was in place.
Decline: The PSM Departments were neither
reviewed nor their functioning evaluated. Barring
a few exceptions, diffcremial in development of the
PSM Departments failed in the development of
expertise and proficiency in one or more of the
sub-topics and sub-disciplines, e.g., epidemiology,
biostatistics, communicable & non-communicable
diseases, environmental health, nutrition, lifestyle
and behaviour, health systems research, health
education and so on. This is reflected in paucity of
publications. Examinee Appendix Table A. Of the
several reasons, major ones were mediocrity, lack
of insight and research, lack of practice and
proficiency, etc. Statements by two of the highly
reputed personalities in India are revealing.
Late Dr. R.V. Sathe said, “Despite these
multiple developments, the impact of this
discipline of preventive and social medicine on the
medical college on the whole including their
various departments, in not a distinctive and
enduring as one would have hoped”.15 Late Col.
Amir Chand observed, “Has such teaching of PSM
which has been expected to have been going on for
several years, made any real impact on the
teaching and practice of ‘Medicine or Community
Medicine’, if you like to call it? No it has not”.16
Prof. D. Anand has deliberated on this
topic in an editorial, the title of which is selfexplanatory, “Community Medicine - The Never
Born - A Story of Two Decades”.17 Some of his
statements are note worthy, viz. “(1) ... attempting
to entrust so much to so few with so little. (2) ...
the faculty members in this department continue to
be second-class citizens. (3) To-day teachers lacked
enough field experience. (4) Faculty not respond
ing to the need for establishing out-of-the wall field
training sites. (5)...medical students got impresssion that community medicine is the name of a
mental concept that is to be talked and discussed,
but it is not seen in day-to-day practice”.17 Bhatia
provided a very long list of reasons for failure of
PSM Departments in India and classified them in 7
broad categories.18 Bir Singh supplemented.19
As I feel, initiation of post-graduate
course of six month’s duration leading to M.D.
(PSM) was a disaster and beginning of decline in
quality, etc. It was too premature when the newly
introduced discipline was far from mature
development. The duration was soon changed to
two years, but the quality left much to desire. For
want of quality, adequacy and high standard,
barring few exceptions, qualification M.D. (PSM)
is not synonymous with expertise, proficiency and
capability. I preferred to give up examinership
because of disgracefully low standard experienced.
10
Further, there is always a gap between the
syllabus, curricula and the actual teaching of the
subject.
In order to rectify this inevitable
limitation & to ensure to satisfy the educational
aims and objectives of the training courses, text
books were developed as an instrument to facilitate
self-learning by the students. In this respect, the
most popular current text-book was a disaster.
Basic Preventive and Social Medicine edited by me
and late Prof. IK. Adranvala was designed to
promote practice of PSM by general practitioners
and NOT to serve as a guide to pass examination.
It failed to survive for second edition. Some more
text-books have come up, but the popular book
predominates and forms basis even for the
postgraduate studies. Naturally, as the standard
has reached the very bottom. Efforts to persuade
the office bearers of the Indian Association of
Preventive and Social Medicine for taking up the
task of producing a text-book separately for the
under- and postgraduates have fallen on deaf ears.
One can get insight into any discipline
only after its application and practice which
promotes thinking and leads to proficiency.
Unfortunately, this has not happened. We can
imagine the flight of department of surgery, were it
without operation theatre and otherwise no surgery
is undertaken. Precisely, this is what has happened
to most of these departments in India. My personal
observation infers that the performance of health
care services was poorer, if any, that at the nearby
primary health centre. There may be couple of
exceptions that prove the rule.
Unfortunately, with lack of leadership and
direction, mediocrity, lack of interest and support
from the college and State authorities, PSM
Department, B.J. Medical College, Pune, also has
fully abandoned its special and unique characteris
tics and activities. Degree of deterioration is
unbelievable and all-round. The field practice
areas are defunct. Faculty totally lack clinical
background, interest and experience, and special
posts have been converted into 9 posts of Associate
Professors and 6 posts of Lecturers in Preventive
and Social Medicine. All of them are confined
within the four-walls of the much withered
department and have nothing to do even with the
Sassoon General Hospital, Internship, Public
Health, etc. It has fallen in line with the majority
of PSM Departments in India.
The Future: Since the First International
Conference on Medical Education held in London
in 1954, much has been said and repeated in many
conferences and seminars on reorientation of
medical education in this country. But in reality,
medical education continues, more or less, in the
same fashion as it was in the beginning of the 20th
Century. Necessary reforms in our teaching
hospitals are considered elsewhere.20 How to go
about PSM? It is best that some of the active and
progressive young faculty members deliberate this
endeavour and chart a flexible plan of action on
experimental basis. Some of my thoughts are
briefly given here. The case of B.J. Medical
College, Pune, is provided earlier. Although it has
been totally ruined, field practice areas are defunct
and the only activities are confined to class-room,
it is possible to draw some lessons.
Even if defunct internship is revived, this
programme for one year will certainly not provide
a remedy. It is our experience that this period
cannot be used for bridging the defects in the
training imparted at a medical college. One year is
too short a period to undo the wrong impressions,
habits and attitudes acquired in a teaching hospital
and then to train the interns in comprehensive
medial care. The experiments Colorado and
Tennessee schools of medicine in the USA have
shown that the set-up of a medical college hospital
can be changed by removing the restrictions and
making room in a big way for general practice
units. In Poona a beginning was made, but
discontinued. However, it is felt that this modify
cation is neither difficult, nor is it expensive.20
Nevertheless, very few, if any, of our medical
colleges will be willing to do this, and let us not
depend on this reform. The proposed adoption of
three primary health centres by each of the medical
colleges by the Medical Council of India, has not
found any takers.21 In fact, PSM Department have
failed even to manage one subcentre of PHC
efficiently. Some of the possible.methods that will
help to improve the pathetic situation are discussed
elsewhere and need to be considered seriously.22,23
The five levels of prevention, based on the
natural history of disease, form the pillars on
which the teaching of PSM/community health
should be based. This is what the curriculum
revised by MCI requires. Rest of the structure can
be provided by epidemiology and social medicine.
11
The students should be able to witness and
experience some of the social factors that may
initiate or influence the disease process, and may
determine the patient’s reaction to the disease. It
is also essential to expose them to the social
consequences of the disease and to demonstrate
what is the best compromise between the theore
tically ideal treatment and what is possible in the
patient’s social circumstances. The above will be
served only if there is a strong field programme
before internship.
The field programmes in
comprehensive medical care are, therefore, most
important in training of the future doctors whose
dual function is curative and preventive medicine.
Unless such an integrated practice becomes the
rule, there will be no worthwhile progress in the
promotion of health and long-lasting relief of
suffering.
It is unfortunate that this most
important facet of teaching is tire most neglected,
mostly because of the indifference and apathy in
providing the necessary staff, equipment, transport
and other facilities to the departments of preventive
and social medicine.
In light of the new redesigned PSM
curriculum by the MCI, it is essential to restructure
and reorganize PSM Departments. Qualification
and experience required for the faculty should be
revised.
In every major clinical speciality
department, there should be an associate professor
of PSM who has postgraduate degree in that
discipline and training in PSM. PSM Department
should be a part of Health Services Department
Professor of PSM should have post-graduate degree
in public health and five years experience in field
of public health at a level that of a deputy director
of health services. He/She should be responsible
for the delivery of health services in the relevant
district. The staff of PSM Department should be
exchangeable with that in the Health Services, e.g.
those of the clinical specialists who have worked
for two years at Community Health Centre should
be considered basis of their performance for the
post of Associate Professor (PSM) in appropriate
clinical department of a medical college.
The indispensable requirement, however,
is to improve expertise & capability. It is obligato
ry to demonstrate successfully advancement and/or
development in any of the wide field of PSM or
public health. This should be self-revealing and
need not be told or advertised. Late Prof. D.N. Pai
of G.S. Medical College, Mumbai did precisely this
in the field of family planning & brought not only
prestige and recognition to the discipline, but also
was awarded Padmashri by Government of India.
PUBLIC HEALTH
Background: There is big confusion in the use of
common terms such as public health, Community
Medicine, PSM, Health Care, Health Services, etc.
Often some of these terms are taken as synony
mous, e.g., PSM and Public Health, Health Care
and Medical Care, etc., although it is not at all
true. It is desirable that at least in the academic
and management circles, these scientific terms are
correctly used. Explicit definitions are available.25
It is vital to understand that PSM is only a part of
medicine and both are the part of public health.
See diagram I.
Diagram I: Relationships Health & Medicine
[ndixidua! Leve]
Community Level
z MEDICINE N PUBLIC HEALTH
General Practitioners
Epidemiology
Clinical Specialists
Environmental Health
N
PSM k/
Control of Diseases
Prevention of Diseases
Promotion offiealth Quality ofLife
PSM is a mechanism or instrument for adjusting
medical practice to subserve some of the objectives
of public health. PSM should serve as a functional
link between clinical and public health practices.
It is in this regards, the PSM specialist should be
primarily an expert in public health and related
sciences such as epidemiology. Unfortunately, the
story of postgraduate education in public health in
India, is as pathetic, if not worse, than that in the
case of PSM.
History of Education in Public Health in India:
High standards of environmental sanitation which
were manifested during the Indus Valley period in
Mohenjo Daro must have had a tremendous back
up of education and training. The essentials for
health care were neatly woven into the daily
activities of life or “dina charya". In fact, the
modern concept of primary health care for ail has
been aptly and beautifully expressed in an ancient
Sanskrit verse: “Sarve santu niramayaha, sarve
sukhinaha santu" Surgical procedures such as
reconstruction of the nose would never have been
12
successful long before days of Lister Pasteur
without sterilization (Pavitra) and unquestionably
high standard of aseptic techniques.25
With adoption of the western model of
‘health development’, the lopsided development of
the medical component of the health services has
significantly slowed the pace of providing essential
health care to the rural population and urban poor.
Never-the-less, the School of Tropical
Medicine was established in Calcutta in 1922 and
All India Institute of Hygiene and Public Health
was established also in Calcutta in 1932. The
purpose was to investigate methods of applying
knowledge for benefit of the community and to
train the health officers in the local settings rather
than train them in England. The Bhore Commit
tee furnished a blueprint for the health services in
India and recommended education and training of
public health specialists, including strengthening
of teaching of preventive medicine and public
health at the medical colleges. It stated that the
teachers of hygiene (now PSM) should be members
of the Public Health Department who are actively
engaged in public health work or who were till
recently so engaged. Very ambitiously, it envisaged
that the future basic medical practitioner’s training
in public health would be on par with that of the
then current curriculum for the Diploma in Public
Health at Calcutta.
Failed PSM:
PSM departments were expected
to do quite a lot, but, in practice very little
happened except for some notable exceptions. The
inputs were too meagre, while the expectations
were too high. Hardly any talented person joined
the discipline of PSM by first choice. With the
formation of a separate teaching cadre, PSM staff
stood fully insulated from the practice of public
health, & even that of preventive medicine. The
Departments have built cocoons around them.
Under these circumstances, it is not surprising that
PSM and public health training at undergraduate
level remained substandard & far from satisfactory.
Integrated medical care is not easy in practice.26
Notwithstanding the sad state of academic
accomplishment, developmental contributions and
proven tract of record quality training, etc., about
60 of the PSM Departments have been recognized
by the Medical Council of India for conducting a
post-graduate course leading to M.D. (PSM), and
about 20 of them for awarding a Diploma in Pubiic
Health. It is obvious that MCH has neither basic
expertise nor insight in post-graduate education in
health and related sciences. .In this connection, it
will be worth while to examine as to how many of
these departments satisfy the recommendations (for
undergraduate course) of the Bhore Committee
mentioned under Appendix 29, Volume III of its
report. Instead of improving it, MCI has helped to
lower the standards of training in ‘public health’.
Further, medical & public health services
were integrated. This resulted in a gradual, but
substantial erosion of the discipline of public
health. Public health, at one time, was not even
recognized by the Ministry of Health and Family
Welfare, Government of India as a discipline.
Now it has been equated with the narrower subjects
of PSM, community medicine, etc. Over a period
of time, the medical officers who were posted as
the health services administrators or managers at
different levels have had neither formal training in
public health nor familiarity with the developments
in modern management techniques, and more so in
planning and provision of health care to the poor.
In effect, the current health services are in
name only. In reality, they provide medical
services. Preventive and promotivc health services
have received a much lower priority in develop
ment in comparison with that for the curative
services. While resources were mobilized to open
over 200 medical colleges in India during the last
50 years, the only school of public health - the All
India Institute of Hygiene & Public Health - at
Calcutta suffered from almost total neglect. There
were no takers when the VII Plan provided funds
for opening schools of public health or equivalent.
The only ray of hope was establishment of
the National Institute of Health Administration and
Education (NIHAE) in New Delhi, in 1962, under
the directorship of Dr. T.R. Tiwari. Its courses
such as Staff College in Health Management of
three months’ duration were innovative. I was
fortunate to have under-gone and experienced the
quality and high standard of this excellent course.
In fact, this institution would have tremendously
contributed in promoting meaningful practice of
public health in India. However, this was to be.
National Institute of Health and Family Welfare
(NII-IFW)'was started by amalgamating NIHAE
and National Institute of Family Welfare. Salt was
added spoiling the milk. In the process, NIHFW
and the courses ran by it got aborted.
13
All India Institute of Hygiene & Public Health:
This was established in Calcutta in 1832 with an
objective of training public health officers locally
in India in preference to training them in the UK
It was in a key position and provided the country
most of its public health specialists including the
public health engineers. Its multi-disciplinary
departments included Public Health Administra
tion, Epidemiology, Biostatistics, Microbiology
including Parasitology & Entomology, Biochemis
try and Nutrition, Occupational Health including
Physiological Hygiene, Environmental Sanitation
and Sanitary Engineering, Maternal and Child
Welfare, Health Education, Preventive and Social
Medicine, Veterinary Public Health, Anthropology,
and the urban and rural field practice areas at
Chetla and Singur, respectively. It conducts
several post-graduate degree and diploma courses.
The total annual admissions are about 250. It has
contributed significantly in health services research
and many of the recommendations of the Bhore
Committee were based on the work done at this
Institute. The major course leads to D.P.H. Yet, it
has remained static and has become out-dated for
the current and future needs for health managers.
With general lack of interest, available seats arc
not fully utilized by State & Central Governments.
Few more institutions can be legitimately
deemed as centres for training in public health:
1. National Institute of Health & Family Welfare,
New Delhi: This Institute plays a complementary
role to AUH&PH, Calcutta. It has almost all the
components of a school of public health except
departments such as Environmental Sanitation,
Health Education, Occupational Health, Parasito
logy & microbiology. Apart from several orienta
tion training programmes, it conducts post
graduate courses leading to M.D. in Community
Health and Hospital Administration. It also
conducts health systems research.
2. National Institute of Communicable Diseases:
Located in Delhi, it was established by expanding
the scope of the famous Malaria Institute of India
which was universally known for its research and
contribution to epidemiology of malaria. Now the
NICD is engaged in research and training in the
•
control of communicable diseases.
3. School of Tropical Medicine: This was estab
lished in Calcutta in 1922. It has contributed
significantly in the clinical & epidemiological
aspects of tropical diseases. It offers post-graduate
diploma in Tropical Medicine and Hygiene.
4. There are several other Institutions and Centres
in India which are devoted to one or the other
aspect of research or training in public health
components. These are listed elsewhere.25
Prescription: If the training of public health
manpower is to be ensured, the following are the
minimum requirements: (1) In the first place,
public health shall have to be accorded the priority
it deserves. In order to attract talented persons and
those with a proven tract of success and leadership
qualities, it is essential to ensure professional
career development. Most feasible & best available
alternative in the current situation is to create a
new cadre of National Health Service (NHS)
which is on par with that of IAS and IPS.
(2) The very challenging task today is to
strengthen the key leadership positions within the
health services and within the various institutions
for education, training and research. This is a
fundamental prerequisite for providing Health For
All through primary health care approach. The
leadership will have several critical roles to play.
These include: (a) Organizational, in harmonizing
all activities at community level in all its
components, by decentralization and adequate
empowerment of the Panchayati Raj Institutions.
(b) Epidemiological & health systems research for
community diagnosis, decentralized planning and
implementation of the programmes, monitoring
and evaluation, (c) Managerial, to administer the
huge & complex health organization, including
meaningful and effective coordination with all
developmental sectors.
(d) Technological, in
developing appropriate, relevant and cost-effective
interventions to solve the varied national, regional
& local problems, (e) Social, in ensuring commu
nity involvement and participation, and promoting
self-reliance & initiative on the part of the people.
(3) Establishing new schools of Public Health with
whatever titles one desires to give them, and to
maintain high standards and excellence in
education and research, will be a right step. Even
with high standard of public health in USA, the
number of schools of public health has increased to
about 25 during the last forty years. Many are of
high repute in terms of the competence and
proficiency of their alumni. The Study Group of
ICSSR/ICMR in its report, “Health For All - An
Alternative Strategy (1981) recommends establish
ment of a chain of schools of public health in
14
India. Report of the Working Group of the
Planning Commission for the 7th Plan on Medical
Education, Training & Manpower Planning (1984)
provides the estimates for the number of public
health administrators I managers from 9,600 io
10,750 by 2000 A.D. It recommends establishment
of new Institutions for training and assessment of
training needs, and the qualitative requirements.
(4) As regards other types of health manpower,
issue was deliberated by Banerji.1 The issues are
real. Potential schemes such as MPWs and CITWs
(HGs) have failed. This question is not considered
here because it is felt that if the first three
suggestions given above are taken care of, the
questions such as health manpower development,
etc., will resolve automatically.
References:
Baneiji, D., Training of Public Health Workers, Proceedings of the Third International Congress of the World Federation of Public
Health Associations and 25th Annual Conference of the Indian Public Health Association, Calcutta, 1983, pp 288-296.
Deodhar, N.S., The Course Content of Postgraduate Training in Preventive and Social Medicine - Statistics, Annual Conference of
2.
Indian Association of Preventive and Social Medicine, Cuttak, 1974.
Government of India, Proceedings of the Medical Education Conference, 1956, Calcutta.
3.
Deodhar, N.S., The Practical Approach to Teaching of Preventive and Social Medicine to the Undergraduates - the Plan of Action of
4.
B J. Medial College, Poona, NIHAE Bulletin, J. of Health Administration, 30.39-44, 1970
Deodhar, N S., Growth and Development of the Department of Preventive and Social Medicine, B J Medical College, Poona, Indian
5.
Journal of Preventive and Social Medicine, 2 : 109, March-June 1971.
6
Deodhar, N.S., Introduction to Action Learning: on Methods of Training in Preventive and Social Medicine (With special reference
to the postgraduate education in India), Proceedings of the Conference on Postgraduate Medical Education, Indian Association for
Advancement of Medical Education, 7th February 1965. Also published as a book by Asia Publishing, pp 422, 1968.
Deodhar, N S., Field Practice and Demonstration Area - Philosophy and Objectives, Criteria for Choice, Journal of Indian
Association of Preventive and Social Medicine, 1:13, January 1974
8
Deodhar, N S., A Background Paper for Advisor}' Panel on Delivery of MCH/FP Services, GOI and WHO Project, India 0278, New
Delhi, March 1974.
9
Deodhar, N.S., Minimum Programme for Training of Interns during six months Rural Posting, WHO Seminar on Training in
Internship period, Pondicherry, 29th Jan. to 2nd Feb., WHO SE.ARO Document No. SEA/Med.Education/Intcm. Sem./37, 1974.
10. Deodhar, N S., Evaluation of the Revised Internship Programme at B. J. Medical College, Poona. Journal of Administration,
NIHAE Bulletin, 6 : 88, 1973.
11. Deodhar, N S., Organization of Comprehensive Immunization Programme at Urban Health Centre, Poona, Sukhi Sansar,
Government of Maharashtra, 2:19, June 1969.
12. Deodhar, N.S., Dravid M... Medical Social Work and Rehabilitation, The Journal of Rehabilitation in Asia, J : 27, January 1964.
13. Deodhar, N.S. The Practical Approach to the Teaching of PSM to the Undergraduates - the Plan of Action of the B.J Medical
College, Pune, NIHAE Bulletin, J. of Health Administration, 30: 39-44, 1970.
14. Deodhar, N.S., Interdisciplinary Teaching of Preventive and Social Medicine Indian Journal of PSM, 3.69, March 1972
15. Sathe, R.V., Teaching of Preventive and Social Medicine in Relation to Health Needs of the Country, Report and Recommendations
of Conference, National Institute of Health Administration and Education, New Delhi, 1966, p 41.
16. Amir Chand, Need for Operational Research, Souvenir, XI Annual Conference of Indian Association for the Advancement of
Medical Education, 1970, p 21.
17. Anand D., Guest Editorial, Indian Journal of Medical Education, XXII(l), Jan-April, 1983.
18. Bhatia, J.R_, Training of PSM, Reasons for Failure to Achieve Desired Results, Indian Journal of Medical Education, XII (1 &2),
1973, p 21-30.)
19 Bir Singh, what Ails Teaching of Community Medicine?, Indian J. of PSM, 25(2):97, April-June, 1994.
19. Deodhar, N.S., Present Role of Teaching Hospital in Community Health Care, Journal of Health Administration (NIHAE Bulletin),
9: 15-21,1976.
20. Deodhar, N.S., Utilization of three Primary Health Centres for Training Medical Students in Community Medicine, Report of
AIIH&PH/ICMR Workshop, 9-11 January 1980, AIIH&PH, Calcutta, pp 27
21. Deodhar, N.S., Newer Trends in Teaching Preventive Medicine, Souvenir, Annual Conference of Indian Public Health Association,
Pune, 1978.
22. Deodhar, N.S., Rationalizing Undergraduate Medical Education and Training of a General Medical Practitioner, and Restructuring
Postgraduate Education and Training in Public Health Management, Special Consultation on Medical Education, Planning
Commission, Government of India, New Delhi, 28-08-2001.
23. Last, J.M., A Dictionary of Epidemiology, International Epidemiology Association, Oxford Medical Publications, New York, 1983.
24. ‘ History of Education and Training of Public Health Specialities in India, Indian Journal of Community Medicine, 14 : 66-69, AprilJune 1989.
25 Yamall, KSH, Pollk KI, and others, Primary Health Care, is there enough Time for Prevention?, Am. J. Public Health, 93:635-641,
2003, reviewed in International Journal of Epidemiology, 32(3):483, June 2003.
1.
15
%
Appendix
Table A: Number of Papers published in Journal of PSM/Community Medicine by Broad Classification
Number of Papers Published by Year
Topic
1975-80 81-85
86-90
91-95
96-97 2000-02 Tolal
1. Health determinants, environmental
sanitation, nutrition, health education.
7
10
7
10
3
15
52
2. Epidemiology. research, health informa.
7
12
1
4
3
5
32
3. PSM teaching
3
1
1
2
1
4
12
4. General practice
5
1
0
0
2
0
8
5. Primary health care, social sciences.
MPW.CHW schemes, smoking, drugs.
alcohoL health economics
13
32
6
9
3
10
73
6. Urban and occupational health
1
6
2
5
1
4
19
7. Family welfare
5
6
5
4
1
5
26
8. MCH and immunization
24
26
13
17
8
30
118
9. Communicable diseases*
24
17
6
13
5
20
85
10. Non-communicable diseases
9
8
4
li
6
8
46
98
119
45
75
33
101
471
Total
Note: This is a qualitative analysis, but without consideration scientific qualities. Since there are
missing numbers and years, quantification may not be valid.
(*) Priorities distribution was Intestinal worms-15, HIV/AIDS-13, Diarrhoea & Malaria-5 each,
Tuberculosis & Leprosy-4 each, Poliomyclitis-3, Cholera-2, and Hepatitis & Rabies- 1 each.
Considering the number of medical colleges and faculty size, the number of publications appear
rather on low side for 25 years duration. There also appear to be distortion and fashion in the
topics selected. Readers may interpret and draw their conclusions as to what this data suggest.
Position: 3641 (2 views)