Objective="Create more specialists to give a better service to the rural community."
Details for Reform Option "Short Course training of Medical Officers, Assam"
During 1992, under the Child Survival and Safe Motherhood (CSSM) Programme, Community Health Centres (CHCs) were upgraded as First Referral Units (FRUs) to provide basic and comprehensive obstetric care. However, provision of equipment and improvement of infrastructure did not result in improvement of referral care throughout the country because specialists are limited in the State Health Services (SHS) and posting of available specialist manpower in FRUs was not possible because the state had no specialist cadre. For example, under CSSM/ RCH programme, 76 FRU kits were supplied in 1996-97 but these were unused till 2002.
During 2001, under the Sector Investment Programme (SIP), supported by the European Commission (EC), Government of Assam started to operationalise FRUs in Nagaon District. In April 2002, it was decided to have a Short course training for Medical Officers (MOs) to increase the number of specialists in the State ands allow the FRUs to function properly.
Considering the need for expertise, State Govt. decided to train non-postgraduate (non-PG) MOs in Medical Colleges of the State and then post them to FRUs.
Accordingly the Directorate of Medical Education (DME) was requested to direct the Medical colleges to conduct a six-month training for SHS doctors in the State using the SIP funds for the training courses. Initially, paediatrics and anaesthesia were selected. Later orthopaedics and then radiology were also added to the list.
The basic objective of the training is:
(i)Up gradation of theoretical knowledge and practical skills.
(ii)Expertise to deal with surgical, anaesthesia and other emergencies.
(iii)Ability to provide regular services in FRUs of rural areas.
The training is residential and MOs below 40 years of age were selected for the courses. Trainees have to attend theoretical classes by the faculty with the PG students as well as hands on practical training supervised by faculty/ senior staff. They are evaluated regularly and a certificate of expertise is issued only after satisfactory performance under supervision.
Results: Already 77 medical officers have been trained in anaesthesia (28), paediatrics (35), orthopaedics (7) and radiology (7).
Number of batches and numbers of MOs trained and posted to FRUs:
(i)Gauhati Medical College & Hospital, Guwahati: 4 batches.
Anaesthesia: 18; Paediatrics: 21; Orthopaedics: 6: Radiology: 4.
(ii)Assam Medical College & Hospital, Dibrugarh: 3 batches.
Anaesthesia: 8; Paediatrics: 12; Orthopaedics: 1: Radiology: 3.
(iii)Silchar Medical College & Hospital, Silchar: 1 batch.
Anaesthesia: 2; Paediatrics: 2.
Trained anaesthetists and paediatricians are also running District Hospitals.
Total expenditure so far: INR 18,48,000
Travelling Allowance and Dearness Allowance @ INR 24,000 per trainee per batch.
Three Medical Colleges in Assam
(i) Assam Medical College & Hospital, Dibrugarh
(ii) Gauhati Medical College & Hospital, Guwahati
(iii) Silchar Medical College & Hospital, Silchar
Three months (April 2002- July 2002)
Expanded referral care: FRUs can be operationalised through this trained manpower.
Increase of Specialists: Supplies more trained MOs.
Professional bodies are against this training.
Hesitation to perform: In a few instances, the trainees are hesitant to perform.
Community acceptance: The community is less likely to accept an MO who has taken a short course rather than a full post-graduate course.
Several rounds of meetings between the heads of departments and DME for finalisation of the course.
Who needs to be consulted
Director of Medical Education.
Sustainable.This training has been operational for three years and is expected to continue in future.
Chances of Replication
Replicable. It would enable other states to address the issues of shortage of specialists.
Dr Arti Bahl, Research Consultant, CBHI,New Delhi
October 2005. Last Updated: October 2006