Caring for a billion+ people: From problems to possibilities 0 for Allied Health Professionals Presentation on June 20th 2014 by Kavita Narayan, FACHE Head, Hospitals/Healthcare services Public Health Foundation of India Director, National Initiative for Allied Health Sciences Ministry of Health and Family Welfare, Government of India 1 Agenda for discussion Macro issues with India’s health system Health Human Resource challenges Specific issues pertaining to Allied Health Professions Exploring the possibilities for solutions to strengthen the system Partnership possibilities India’s Health Care Challenges Eliminate the diseases of under development and control the disorders of maladapted modernity Provide a wide range of needed health services to India’s 1.2 billion population with efficiency and equity CHALLENGES OF CARING FOR A BILLION + PEOPLE… 3 Mixed health system does not assure access or affordability to a large number We continue to battle maternal and infant mortality; over a third of all births are unattended by a skilled healthcare worker Universal Health Coverage? Public financing on health is only 1.2 % of GDP 70% of health expenditure is ‘Out Of Pocket’ Burden of infectious diseases and child under nutrition remains high; Rapidly rising burden of NCDs and Injuries Current scenario of Human Resources: DOCTORS 4 Doctor per 1000 population compared to CHINA 1.6 Sweden 3.3 India 0.6 U.S.A 2.6 U.K. 2.3 Additional Doctors required – 0.4 million by 2022 to reach 1:1000 Current scenario of Human Resources: NURSES 5 Nurse + ANM : Doctor Ratio Brazil 3:1 U.K. 5:1 India 1.6:1 South Africa 5:1 U.S.A 3:1 Additional Nurses required – 1.62 million by 2022 to reach 3:1 Allied Health Workforce shortfall- National estimate 6 Allied Health Workforce Category Demand Supply Gap Unadjusted EfficiencyAccess Adjusted Ophthalmology related 145236 17678 127558 136039 Rehabilitation /other related 1862584 40265 1822319 1841637 Surgical intervention technology 205088 7215 197873 208618 Medical lab technology 76884 15214 61670 70603 Radiography and imaging technology 23649 4352 19297 20971 Audiology/ speech language pathology 10599 3263 7336 8901 Medical technology 239657 3587 236070 237791 Dental assistance related technology 2048391 6243 2042148 2045143 Surgery and anesthesia related technology 862193 4050 858143 860086 1074473 181511 892962 980045 6265376 6409834 Miscellaneous Total The National Initiative for Allied Health Sciences Final report delivery in Feb 2012 Data analysis and final report writing Allied health workforce requirements modeling with GE,PHFI and IIPH-D experts’ guidance 40 students from six major specialties interviewed via focus group Full time secretariat of 7 staff including three senior experts since 9 months Extensive national and international desk review on five terms of reference Process Highlights 955 institutes researched over the web/telephonic conversations for matching specialties and institutions Over 300 national and international experts consulted within a 6-month timeframe over 14 workshops In-depth stakeholder consultations with 70+ allied health professionals & faculty Data collection from over 270 medical and allied health institutes in India (INPUTS) Site visits to eighteen national institutes of excellence 7 STUDENT SURVEY COMMENTS 8 9 Current Scenario - Structure of skill development and education governance in India Ministry of Human Resource Development Ministry of Labour and Employment and other ministries and government agencies Skill development and vocational training Education Primary Secondary Higher secondary Higher education State government and agencies ITIs Other vocational trainings (Modular/short term) Gaps and Issues to be addressed in Allied Health Education 10 in India Lack of a central regulatory authority or body Lack of standardization of Educational Methods: Range of the course and duration, Curriculum structure: Theory & Practical Training hours, including on job training Assessment system including examination Certificate issuing authority/ agency would ensure quality control No central database of the allied health training activities Selection process for admission remains ambiguous and disparate Pre-qualifications for admission for various courses is arbitrary TOT protocols continue to be ill-defined Internship/ Apprenticeship inadequate or absent 11 Defining Allied Health Professionals for India “Allied health professionals includes individuals involved with the delivery of health or related services, with expertise in therapeutic, diagnostic, curative, preventive and rehabilitative interventions. They work in interdisciplinary health teams including physicians, nurses and public health officials to promote, protect, treat and/or manage a person(‘s) physical, mental, social, emotional, environmental health and holistic well being. ” 12 Areas for implementation and action pathways Strategic Framework to augment skilled Allied Health Workforce Framework for Allied Health Regulation, reorganizing and development Framework for operationalization of the National and Regional Institutes of Allied Health Sciences Framework for educational methods Human Resources and Management issues of the national and regional institutes Strategic framework to augment skilled allied health workforce 13 • Standard and acceptable as Allied Health Professionals or AHP In lieu of ‘paramedics’ • Re-organization based on educational level, qualifications • Standardized nomenclature as part of promotions, cadre reform Establish overarching regulatory body to standardize quality for the profession and professionals Address and correct supply-demand gap Issues; work in partnership with private Sector to develop competency-based approach to training, skill-building Undertake overall cadre reform; Establish clear career paths for clinical practice, academics and management Build an Allied Health Knowledge Community (National Resource Network) responsible for all knowledge sharing, MIS management, innovation research Proposed interim umbrella structure to standardization allied health education 14 Existing Councils Medical Council of India Indian Nursing Council Dental Council of India Allied Health Council of India National Board for Allied Health Sciences Interim arrangement Proposed Umbrella model Pharmacy Council of India Proposed Council Healthcare related councils Rehabilitative and Therapeutic Services E.g. Physiotherapy, Speech therapy Diagnostic Technological Services E.g. Radiotherapy /Medical lab tech Curative Clinical Services E.g. Optometry , Dialysis technician Non-direct, ancillary & community services E.g. Sanitary inspector. 15 Framework for Allied Health Regulation, reorganizing and development Functions of the National Board for Allied Health Sciences (Precursor to Allied Health Council) Professional Conduct Standards Setting Creation and Maintenance of Live Registers Advising the Government Dispute Resolution Compliance Manager Growth and development of cadres 1. Strategic framework to augment skilled allied health workforce: (a) Change in Nomenclature Table 1: Recommended terminology Qualification of the Allied Health personnel Recommended Terminologies Degree holders Diploma holders Certificate holders Allied Health Professionals Allied health providers Allied health workers Table 2: Courses Duration proposed for Allied Health Personnel Type of Course Certificate courses Diploma courses Graduation courses PG Diploma MSc courses Duration 1 year 2 years 3 years 1 year 2 years Internship 3 months 6 months 1 year 6 months 6 Months Intern(Teaching/Research) 16 Strategic framework to augment skilled allied health work force – CADRE REFORM 17 Average promotion time in private sector: 3 yrs PRIVATE SECTOR suggested timeline for eligibility for promotion CLINICAL ROUTETherapist/ PUBLIC SECTOR Technologist Head Level 5: Doctorate 20 years+ Level 4: Post graduate degree 15 years + Level 3: Graduate degree 10 years + Associate Head Associate Senior Level 2: Diploma 6 years + Level 1: Certificate 2 years + Junior ACADEMIC ROUTE Management Route CXO Dean Vice President Head of Department Director Division Head Professor Manager Associate/ Additional Professor Assistant Manager Assistant Professor Lecturer Instructor Senior Technical expert Junior Technical expert Technical Associate 18 CADRE REFORM Define clear path for lateral moves, change in specialty or multi specialization. Define work norms , standards and job descriptions. Define Career Path Standardize HR Policies and recruitment rules Create more employment options through sanctioning of posts Set national floor salary for each level of training in the cadre. KNOWLEDGE NETWORK Establish of AHS Information and Resource Cell. Develop a dynamic online database for each Allied Health Personnel Earmark Research Funds for Improving Quality Standards for allied health professionals. 19 Framework for educational methods Constitute individual subject expert committees to review and Update syllabus and curriculum based on new standards Adopt modern teaching Methods such as SIM-based Training, e-learning, IT-enabled Tools, team-based training Invest in a robust Faculty Development program Develop courses and professionals in new and emerging allied Health cadres in keeping with international standards 20 Framework for the National Institute of Allied Health Sciences Best Practices Act as a lab for design, development and evaluation of best practices Academic Research Deliver courses in key emphasis areas Communications and Promotions Promote and advocate Careers in Allied Health Sciences including post graduate courses NIAHS Conduct state of the art research in allied health sciences Network Oversee network with other hospitals for higher end training and capacity building 21 Implementation plan: next steps Internal Review Situational Review Constitution of taskforce Sample Curricula circulated for inputs Develop skill & competency profile (Framework) Incorporate inputs Regional Workshop Prepare response draft Develop Curricula Submit to National Curricula Board External Review Response Draft posted on website (Public Review) Suggestions incorporated Consultation with HRD Final dissemination on concurrence The possibilities for allied health professions Molecular technologist Cytogenic Technologist Dermatology/STD /leprosy lab technician Phlebotomist Histopathologist Radiologic /Imaging technician Hemato Technologist Radiologic /imaging technologist Diagnostic medical sonographer Cytotechnologists Blood bank technician Medical and clinical lab technologists Medical and clinical lab technician Cardiovascular technologist Neuro lab technologist Diagnostic Sleep lab technician 22 The possibilities for allied health professions Respiratory Therapists Dialysis Technicians Critically ill children Technicians Medical Assistants Nursing Assistants ICU Technician Dental Assistants OT Technicians Dental Hygienists Critical Care Technicians ECG Technicians Emergency medical technicians and paramedics EEG Technicians Ophthalmic Assistants Curative Services EMG Technicians Optometrists PFT Technicians Neurophysiologist/END Technologists Ultrasound technologist technicians Perfusion technicians Medical dosimetrist Anaesthesia Assistants Endoscopy technician Anaesthesia technicians Nuclear Medicine Therapists Radiotherapists Urological technician Mental Health CounselorsPalliative nurse 23 The possibilities for allied health professions Physician Assistants Health Information Technicians Medical Record Technicians Medical Secretaries Medical and Health Service Managers Medical Transcriptionists Health and Hospital Administrators Pharmacy technicians Biomedical Technicians Medical social Workers Non direct Care Dark Room Assistant CSSD Technicians Medical appliance technicians Dieticians and Nutritionists Dental laboratory technicians Medical Physicists Hospital Hospitality Workers Epidemiologist Biostatistician Health Sanitary Inspector Mortuary technician Forensic technologist 24 The possibilities for allied health professions Audiometrician Prosthetist and Orthotist Prosthetist and Orthotist technician Speech-language therapists Occupational therapists Audiometry technician Physiotherapists Rehabilitative Hearing aid and ear mould technician 25 The possibilities for allied health professions Allied Health Professional Multipurpose Rehabilitation Worker Home based Care workers/Home Aides Community Based Rehabilitation Therapists Managers of Community based health programmes Community Related 26 PHFI’s CHARTER MANDATES BROAD CAPACITY 27 Working in three Core Mission Areas Developing the public health workforce and setting standards Through integrated set of activities Education Training Research Advancing public health research and technology Strengthening knowledge application and evidence-informed public health practice and policy Towards achieving our Vision Affordable Health Technologies Health Systems Support Communication and Advocacy Policy Development Strengthen India’s public health institutional and systems capability and provide knowledge to achieve better health outcomes for all LONG TERM OPPORTUNITIES FOR INDO-CANADIAN COLLABORATION 28 Investments through a Private Public Partnership mode Thematic areas Action Areas Maternal and Child Health • Training and education • Technology related partnerships Tobacco, Alcohol, Drugs • R&D • Training and education Infection control, patient safety and quality control • Capacity building • Technology related partnership • R&D Lifestyle diseases – Cancer, CVD, Obesity, Diabetes, Hypertension • R&D • Technology related partnerships • Capacity development Geriatric care • Capacity building • Technology related partnerships Students and Faculty exchange Research and Development investments Capacity Building Technology/ Innovation related partnerships 29 If we don’t create the future, the present extends itself -Toni Morrison 30
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