Environmental Analysis

NATIONAL HEALTH POLICY - Main features

Objective 

• Achieve an acceptable standard of good health amongst the general population of the country.
• Approach would be to increase access to the decentralized public health system by establishing new infrastructure and upgrading the existing one, wherever necessary.
• Overriding importance to be given to ensuring a more equitable access to health services across the social and geographical expanse of the country.  

The state of public health infrastructure

• Revive primary health system by providing essential drugs under central government funding through a decentralized system.
• Have frequent in services training of public health medical personnel to update them on recent advancement in science.

Extending public health services

• Expand the pool of medical services.
• Examine increasing the scope of use of paramedical manpower of allopathic disciplines after adequate training and subject to monitoring of performance.
• Simplify state recruitment procedures and rules for contract employment.

Education of healthcare professionals.

• Setup a medical grant commission for funding new and upgrading existing Govt. Medical and dental colleges.
• Modify existing curriculum to make it need based and oriented.
• Expose UG students to geriatrics, frontier disciplines of medical research; create additional seats for deficient specialities.

Need for specialists in “Public Health” and “Family Medicine”

• Progressively raise the proportion of PG seats in “Public Health” and “Family medicine” disciplines to reach 1/4th of the total seats.
• Encourage specialization in public health both for medical doctors and non-medical graduates from allied fields.

Urban health 

• Setup an organized two-tired urban primary health care structure with appropriate population norms.
• Funding for the urban primary health care system to be jointly borne by local self government institutions, state and central government.
• Establish a fully equipped, trauma-care network in large urban settings.

Role of the private sector.

• Welcomes participation of the private sector in all areas of health activities- primary, secondary or tertiary.
• Enact suitable legislation for regulating minimum infrastructure and quality standards by 2003 in clinical/medical institutions.
• Develop statutory guidelines for the conduct of clinical practice and delivery of medical institutions.
• Setup private insurance instruments for increasing coverage under secondary and tertiary sectors.

Provide medical facilities to users from overseas.

• Provide health services on a commercial basis to overseas patients.
• Encourage service providers by providing fiscal incentives to all their earnings in foreign exchange.

NATIONAL MEDICAL EDUCATION POLICY 

• As of today the government of India is having an improved national policy on medical education. India’s national health policy does include medical education and much importance has been given to NGOs/Trust. The country now requires 6 lakhs nos. of qualified medical doctors to our ever increasing population, as per planning commission of India.
• The state government has also considered the need for private sector investment, particularly the health care facilities, augmentation of medical services by the private sector and health sector investment by NRIs.
•  In spite of the best of efforts on behalf of the government institutions, the people of the state are not satisfied and the health status, though improved from yesteryears, is far below when compared on the national scale as reflected by the health indicators.

MAIN FEATURES OF STATE MEDICAL EDUCATION POLICY

• The medical education in the state is imparted through 8 medical college colleges. The total annual intake of students for MBBS is 510 in 2007-08 and the detail of various medical colleges running in Bihar and their status is as here under:

• The total intake itself is far from satisfactory. Hence the state needs to increase the number of intake and allow more and more Medical Colleges / institutions in the state.

PRESENT HEALTHCARE SCENARIO OF THE STATE

• The state now has a fair network of medical and health institutions under NRHM both in rural and urban areas of the state for primary health care.
• Each district and sub district hospitals provide a wide range of curative medical care and diagnostic services but there are no provisions for secondary to tertiary level medical and clinical services in this district and sub-district level hospitals.
• These government hospitals provide basic medical services only to the scattered population but secondary and tertiary health care is yet to be introduced at the state level.

HEALTH CARE STATUS OF BIHAR

• Bihar, with a population of 83 million, is the third most populated state in India. The population density in the state is 880 persons per sqm. Km, which is more than double the national average of 324 people per sq km. The state has recorded the highest decadal growth during the nineties. While the all India decadal growth rate of population was 21.34%, the population of Bihar rose by 28.45% between 1991 and 2001. Around 40% of the population is below the poverty line. The major health and demographic indicators of the state like IMR, MMR, and TFR Etc are much higher than the all-India level and reflect a poor health status in the state. The human development Index (HDI), a composite index of literacy, life expectancy and per capita income, has increased for Bihar like the rest of India. But the state still lags at 0.367 compared to the Indian average of 0.472. Amongst the major states, the HDI of Bihar has been the lowest for the last three decades.
• Based on the indicators primarily related to health care infrastructure and reproductive and child health care, the state ranks 35^th in the country (DLHS 2002-04).
• The MMR in Bihar is 371 per 100000 live births, which is fourth highest in the country. The high level of MMR can be attributed to low level of institutional deliveries, high level of Anaemia among women, and low level of full ante-natal coverage etc.
• Though the infant and child mortality rates of Bihar are nearer the national figures, yet the state is amongst the states with high mortality rate (IMR) in the state is 61 per 1000 live births which is close to the national average of 58.0. The total fertility rate in the state is second highest in the country (4.2 compared to the national average of 3.0). Figures for the birth rate and death rate in the state are still higher than the national average with birth rate being 30.4 and death rate as 8.1 per thousand populations.
• The coverage under routine immunization and pulse polio is also very low as compared to the national figure. As per 2001 census, full immunization in the state was only 11% against the national average of 54%. Under nutrition among children and women is also much higher than the national level with 54.4% children being underweight and 81% anemic. The percentage of women with chronic energy deficiency (39.3%) is also higher than the national figure of 35.8%.
• However, the recent National Family Health Survey (NFHS-3) indicates some improvement since NFHS-2. It has shown an increase in immunization coverage from 12% to 33%, contraceptive use from 24% to 34%, institutional deliveries from 15% to 22%, but the figures are still far off from the national average. Malnutrition continues to be very high. In fact malnutrition among children has increased from 54% to 58%. Number of children showing wasting has gone up by 8%. Anaemia has gone up from 81% to 88% amongst children of 6.35 months and from 46% to 60% amongst pregnant women.
• The state has the largest number of kala-azar cases. The prevalence of other vector borne diseases like malaria, filariasis and communicable diseases like tuberculosis is quite high. The occurrence of water borne diseases is also high. In 2006-07, the second highest number of polio cases in the country was from Bihar.
• Available data on rural primary health care infrastructure indicate that, in Bihar, there are substantial gaps in sub-centre, primary health centres and community health centres, and also in essential requirements in terms of manpower, equipment, drugs in primary health care institutions. The state has a shortage of 1210 sub-centre, 13 primary health care centres. As per the 11^th plan approach paper of the government of Bihar, there is only one sub centre for 10,000 populations. However, according to the national norms there should be at least one sub-centre for 5000 population. Moreover, Bihar has one primary health centre for one lakh population where ideally there should be one PHC for every 30,000 population.
• In the district of SARAN, SIWAN & GOPALGANJ there is not a single health institution for tertiary level medical care and secondary level medical care. There is a lack of specialists at the community health centres in the above district.
• NSSO-60^th round (2004) reflected a drastic decline in the share of public health facilities in treatment of non-hospitalized ailments in both rural and urban areas. In rural areas, the share declined from 13% (1995-96) to 5% (2004). In urban areas, it declined from 33% to 11% during the corresponding period. The survey also showed that the number of hospitalized cases treated (per 1000) in public hospitals in rural areas is only 144 as compared to the all India average of 417. In urban areas, the figure is 215 as compared to the all-India average of 382.
• There is a shortage of 3376 medical officers and 19945 ANM. Percentage of PHCs adequately equipped with equipment stands at only 6.2 % compared to the national figure of 41.3%. There is a big shortage of gynaecologists and obstetricians to provide maternal health services in peripheral areas of the state.
• The status of training facilities in the state (both in terms of infrastructure and human resources) remains far from satisfactory at all levels. At the state level, there is only one training institute (SIHFW) that imparts training to health personnel. The SIHFW is facing a severe shortage of faculty and related facilities. At the regional level too there is an acute shortage of good training centres.
• Medical education and training- human resources development is the key to functioning/working of the health system. There are six government medical colleges in the state.
• There are two private medical college in the state and Reform international Consortium Trust is planning to establish another private medical college at the border of Saran dist and Siwan district in order to serve the people of three medically neglected district of Bihar i.e., Siwan, Saran and Gopalganj and one district of UP is Balia district and also some part of Deoria district.
• With continuous government funding in healthcare, the efficient and optimum utilization of infrastructure and resources assumes paramount importance. This could only be achieved through professional management and training and development of the manpower using these resources. Otherwise there is a need to allow the private sector to come into this health sector and create health care infrastructure to support the state health system.
• On review of statistical data it is observed that Bihar is definitely in need of more Medical college/ hospital beds to cater to the population. The pertinent observations are:-
• The number of beds is less than the recommendation of the planning commission as well as the WHO norms.
• There is gross-mal distribution in the availability of medical colleges and its bed between different geographic locations.
• Availability of trained medical manpower in the state, need for increase and gap analysis.

(Source: MCI 2010)

• In order to achieve the existing national level of number of Medical colleges in the state of Bihar for a population of 82878796 (2001 census) there should be at least 17 medical colleges in the state. On account of the paucity of medical colleges in Bihar, desirous students are forced to seek admission in medical colleges of the other states. Many meritorious students are unable to afford medical education outside the state. Thus, looking at the requirement of the Doctors in the state and education in the medical sciences, establishing a new medical college is not only feasible but also essential.
• The only hospital owned by the Government of Bihar, civil hospital Chapra and Siwan has a total in patient capacity of approx-108 and respectively.
• So the ratio of population and beds distribution comes to very less patients per bed. Saran and Siwan is lacking drastically in providing quality health care and still people are forced to go out to places like Patna, Banaras, Gorakhpur and Delhi etc for the treatment.
• When we compare the number of doctors possessing the recognized medical qualification under the IMC act and registered with the respective state Medical Council as given in the table the gap is very well viewed.
• The disparity or the gap between the distribution of doctors among the urban and rural areas are still unanswered questions. More and more trained Medical doctors are required for the rural areas in particular.
• The gap can be reduced and will be reduced in all the states of India if the number of medical colleges and number of annual intake to the medical colleges is subsequently increased.
• The improvement is not only required in the undergraduate course but also an urgent requirement for the improvement in the ever growing various postgraduate courses.
• Hence, there is an urgent need to improve the trained manpower and human resources development in the health care sector and according to the policy of various state governments of India, only autonomous bodies and other private sectors like Trust, NGO can improve and fulfil the demand of the health care sector of the state.
• Thus opening of BABA MAHENDRA NATH MEDICAL COLLEGE & HOSPITAL will give trained educated medical personnel to the state and society. Also the postgraduate program will give highly trained medical professionals who will contribute to serving the state and nation.
• In addition, the hospitals would also serve the growing population of SARAN, SIWAN & GOPALGANJ district of the state and Balia, Deoria district of UP. The people will get modern and tertiary level treatment under the roof.
• Thus, the opening of a medical college and hospital at the border of SARAN & SIWAN would not bridge the huge gap but will definitely contribute its part for the services of the population about 81, 14,688 in particular and state at large.
• In light of the above, it is clear that there is an urgent need for a medical college and hospital in the area where we have proposed the project.

2. AUGMENTATION OF MEDICAL HEALTH CARE-NGOS/VHOS INVOLVEMENT

From the above submission one can see the demand of medical colleges & hospitals with more no. of beds is. As SARAN division has become a modern suburb of Patna, the people are striving to get a better health facility. Above all, the Govt and some very much reputed private hospitals far away (100 to250 KMs) from the SARAN area. So one can understand the pathetic condition of a patient and his family members in the time of emergency.

• Moreover, as the colonies are developing very fast in the Saran vicinity, the availability of medical personnel and Para-medical staff will not be a problem. Once the medical college & hospital is established in the area, the market scenario will automatically change for the needs of students, medical personnel and patients. Hence the medical college and hospital is indeed a boon for the people of this area.
• In addition to this, though universal primary health care continues to be the highest priority of any government as a part of its commitment for “Health for all by 2000” (which could not be achieved) , development of secondary and tertiary healthcare level is also becoming increasingly important. This is mainly concerned with medical/ medical facilities.
• As far as the medical facilities are concerned no state in India is being able to provide even primary medical care. Talking about secondary and tertiary medical care will be beyond anybody's hope.
• Due to the epidemiological problem of medical disorders in the state it is now required and imperative to develop a good secondary level medical health care system and other speciality tertiary medical care services at the proposed new medical institutions at Saran.
• On the other hand the very high cost in getting medical treatment from private/ profit making hospitals is making it difficult for the common people to get the required medical care services.
• There is rising demand for good medical care which necessitates the involvement of the private health care sector particularly NGOs and VHOs to develop such secondary level medical care institutions.
• The involvement of the private sector , besides providing relief to the  fully stretched out public health care sector delivery system, would also improve the quality of services, due to its better location, easy accessibility and better patient service orientation.
• Even with the aforesaid objectives the state Govt. is encouraging the involvement of private sector in augmenting the health and medical services in the state, for which the government is assisting for the entire requirements to fulfil the qualifying criteria to establish a new medical college such as issue of NOC- essentiality certificate.
• Finally with the general easing of restrictions on private investments, many private investors including NRIs are looking forward to good investment opportunities in the healthcare industry. Both the central and most of the state governments and their policies are now a good attraction to private sector investment and involvement in health care projects, preferably states like Bihar.
• There is an utmost requirement for medical professionals in our country as well as in Bihar. Looking into this medical manpower requirement, it is necessary to establish another new medical college in Saran to provide a high standard of medical education as well as health services.
• A century ago the role of doctors was clear and simple, Sir William Osler; Regius Professor of medicine at Oxford noted that it was “to acquire facility in the art of diagnostic ……to grow in clinical judgement …to appreciate the relative value of symptoms and the physical sign …..To give the patient and his friends a forecast or prognosis …… [And] to conduct the treatment that the patient may be restored to health…or, failing that, be given the greatest possible measure of relief”. It was the age of acute care, and medicine’s knowledge base was contained in a single time- Osler’s principle and practice of medicine. Doctors accounted for about one in every three health professionals, and practised as general practitioners or consultant physicians and surgeons. The payment for health care was a contract between the patient and the doctor, and not the business of the government.
• One hundred years   on, how things have changed.
• Unprecedented advances in science and technology have splintered medicine into myriad specialist groups, and the information explosion has led to innumerable journals, textbooks and internet sites. Medicine’s focus has moved beyond acute care, to preventive health care and management of chronic diseases and aging. These require the skills not only of doctors and nurses, but of professionals in fields which have emerged in the last century, such as physiotherapy, occupational therapy, nutrition and social work. These professions have distinct educational programs, different emphases of practice and different professional aspirations.
• The demography of doctors has also changed. Women now account for one third of the medical workforce. They favour disciplines such as general practice, paediatrics, obstetrics and gynaecology, pathology, psychiatry and public health, where hours of work are reliable or can be structured around other commitments. Furthermore many doctors, in keeping with their generation, value matters beyond medicine: protected personal time, involvement with family and friends, and a balanced lifestyle.
• Considering the various factors of the market survey and doing environmental analysis ethically, including the national and state policies on medical education, which is not existing at present there is a definite need to improve the medical education and thus make availability of trained medical manpower seems to be quite mandatory.
• The study of present manpower in health services and the number of medical institutions, the gap is obviously visible and there is an urgent need to improve the available medical manpower.
• Considering the above factors the establishment of a new medical college at Saran is highly desirable and prima-facie feasible. This is possible only by the dedicated involvement by NGOs and VHOs like RIC Trust.
• Various committees have recommended that there should be one medical college and hospital for a population of 5 million, which means that the state would require about another 45000 more doctors. “This can be achieved only by establishing a new medical college & hospital in the private sector.”
• Bihar with the vast untapped resources and immense plan and prospects of population growth, has very few medical colleges in comparison to other states.
• The doctor: population ratio had touched one doctor for >15000 population, the state would need at least 12 more medical colleges to achieve the required ratio target of 1:1000 Aforesaid statistics justify the requirement of a new medical college at SARAN.
• The proposed medical college will be located at Rasulpur SARAN. The population of the district is about 35 lakhs. Moreover Saran is also emerging as a centre for advanced Medical and medical facilities not only in the state.
• Lack of facilities in government run hospitals and non availability of medical services in most of the government hospitals are compelling the public to utilize the services rendered by NGOs and VHOs.
• Presently the growth of medical / medical facilities is not keeping pace with the growth of Saran and its neighbouring districts and therefore exists ample scope of a new medical college and medical hospital at Saran. The proposed medical college and hospital will be of an international standard and will have state of the art instruments and equipment to provide quality medical care to all the needy.