Homoeopathy in Kerala Current Status and Future Plans document submitted to Govt of Kerala by Homoeopathy A Decade Movement
Homoeopathy which has completed only 200 years now occupies the status of second largest system of medicine used by the World population as assessed by the WHO. It has been made legalised medicine in 42 countries including India and enjoying the status of Complementary and Alternative Medicine (CAM) in 28 countries. It is still spreading in greater number of nations in the world. The prime reason for this fast spreading acceptance can be reasonably attributed to its salient features in being “safe, simple, scientific, economic and effective medicine for all”.
Though its origin may be traced back to Germany its growth and development is ostensibly found out in India. It is now 150 years when it became rooted in India. But it got the required deserving recognition as a system of medicine only after the dawn of independence. With in this short span of the years it has been enviously able to vie with the modern medicine which has got world patronage and ruling the roost of the firmament of traditionally blessed Ayurveda. Today India has become the “Super Power of Homoeopathy” in the World.
Even though Kolkatta stands to get the credit of the “.Cradle of Homoeopathy in India” Kerala is at its “pinnacle of prosperity.” since the last 30 years or so. It is worth to be noted here that a study conducted by the SPB in the year 2011 reveals that almost 25% of the people of Kerala fall back upon Homoeopathy for their health care needs. In Kerala Homoeopathy has begun to rule its roost in the earstwhile Travancore State during the reign of Sree Moolam Thirunal Maharajah. A resolution was got passed in the Sree Moolam Assembly in 1928 which it was that marked the first State to recognise Homoeopathy as a system of medicine in India. It’s Centenary Celebrations falls due in the year 2027.
Despite all these things, the first Govt. owned Homoeo Dispensary was established in Thiruvananthapuram, the capital city of erstwhile State of Travancore as well as Kerala in 1957. And it was the first Govt. owned Homoeopathy dispensary in India too. It is quite striking to note that the “Vajira Jubilee of Kerala does also synchronize with the “Vajra Jubilee” of the first public sector dispensary in Homoeopathy and ‘Navathy Celebrations’ of the first official recognition of Homoeopathy in India. The State of Kerala is set out to become 100% Homoeopathic State by providing Homoeopathic treatment facility in all LSGIs along with that of Ayurveda. Besides Kerala is already in the forefront in the case of recognition and acceptance of Homoeopathy in health care including the preventive medicine, education, research, medicine manufacturing, Homoeopathy in Veterinary and Plant Medicine etc. Kerala thus stands first in every aspect of Homoeopathy and the contributions of the State of Kerala are individually its own quite far from other systems of medicine. In this way, it may be seen that the celebrations of the “Vajra Jubilee of Kerala” serve to show that Homoeopathy has a significant role in the development of the State.
Our State has already formulated a ‘Perspective Plan by 2030’ for developing Kerala as a “World Hub of Education and Health”. It is perhaps with this view in mind the ruling State Govt. has visualised and launched an innovative scheme with ‘Sustainable Development Goals’ (SDGs) – “Nava Kerala Mission”, emphasising education and health also. Homoeopathy has a predominant role in being included in the health care particularly when the system relatively safe, simple, affordable and acceptable medicine for all. It causes no drain to the exchequer and less out of pocket (OOP) expenditure on the part of the people, besides guarding against harmful side effects of medicine. It is thus the inperative purpose on the part of the scheme makers to give optimum utilisation of Homoeopathy wherever it is found desirable and rewarding. It should be in this perspective the 13 FYP need to be designed and addressed in Homoeopathy.
- HEALTH CARE SERVICES
The Department of Homoeopathy, Kerala is currently setting a model for other States in India. Separate department which was formed in the year 1973 has been presently delivering the service of Homoeopathy for curative, preventive and palliative health care to the people.
There are 659 regular dispensaries, 416 NRHM dispensaries and 29 temporary dispensaries in scheduled caste dominant areas in the State. Over and above all these, there are 3 floating dispensaries functioning regularly in Alappuzha District. Apart from these 4 mobile dispensaries (1 each in the districts of Wayanad, Palakkad and Idukki and one more in Idukki dist. under NAM) are also functioning.
In order to attain 100% Homoeopathic treatment facilities provided under public sector, an additional 49 dispensaries may be opened in the remaining LSGIs. Though this requirement is known to have been included in current year, it is yet to be seen how far it will be met in this year itself. If it can not be met this year it may be ensured that this will be done in the next financial year.
All the NRHM dispensaries are temporary in nature running on the 60% financial assistance from the Central Govt. This assistance is liable to be reduced during the coming years. If the State does not regularize these dispensaries their future stake will be in peril. This warrant, urgent steps on the part of the State Govt. to regularize these dispensaries before the end of 13 FYP.
There are 34 hospitals with a total bed strength of 985. There is one dist. hospital each in all fourteen districts provided with 25 – 100 beds. There are 17 Taluk hospitals under Block Panchayats, 16 of them having a bed strength of 25-35, and the remaining one at Pallam block (Kottayam dist.) being titled “Homoeopathic Medical College Govt. Hospital” at Kurichi with 125 beds. In addition to that one speciality hospital for pain and palliative care for cancer patients with 10 beds at Vandoor (Malappuram Dist.) under Dist: Panchayat. Over and above these, there are two 10 bedded hospitals under Grama Panchyats.
The rest 46 Taluks have yet to be provided with hospitals during the 13 & 14 FYPs period themselves at least with 10 beds each.
Pay wards, Clinical labs, Medicine pharmacy etc. shall be streamlined in all Dist. hospitals under the KHRWs as in the case of Allopathic hospitals. All the Dist. hospitals may be developed and elated to attract NABH accreditation and this should be taken up as a phased programme in 13FYP.
2.3 Standardization of Existing Institutions
The deficiencies detected in the effective functioning of the above health care institutions though came into light for remedial action even during the XI FYP have not been attended to, except 83 dispensaries being raised as model ones. This does not mean that there are some achievements in the last FYPs under the Central assistance. But most of the gaps detected still remain to be rectified in the majority of institutions.
2.3.1 Physical Infrastructure
The institutions are deprived of necessary suitable buildings as per requirements for proper functioning along with other facilities, required manpower etc.
Out of the 14 District hospitals permanent buildings are available only in 11 while the remaining 3 are under construction. All the existing Taluk hospitals have their own buildings.
A number of 134 dispensaries are functioning in rented buildings out of the total 659.
2.3.2 Diagnostic and Accessory Management Facilities
The hospitals themselves are not fully equipped. There are facilities like Clinical lab and USS in the hospitals numbering about 23 and 5 respectively. ECG facilities are available only in certain institutions. Full time Lab technician post is available only in 14 hospitals. Inadequacy in staff and equipments in the above existing facilities and in institutions which are lacking in the above basic diagnostic facilities may be rectified during the 13 FYP.
A phased programme need to be prepared for making available these infrastructural facilities in all the hospitals and dispensaries in the State. To begin with necessary uniform model plan /sketch of the buildings along with the required landed area have to be finalized. Immediate follow up action for acquiring land from the LSGI concerned, the required funds for building construction from the Govt. through NAM and such other resources may be attempted. All necessary steps may be initiated in this direction urgently.
2.3.3 Uniform Staff Pattern
There are 25 to 100 beds are in each of the District hospitals, while there are 25-35 beds in the 16 Taluk hospitals. The medical staff pattern provided in the hospitals with 50 to 125 beds is one and the same. Similarly the medical staff pattern of 25 – 35 beds hospitals is also one and the same. The 10 bedded hospitals have posts of CMO, MO and RMO one each.
So far a uniform staff pattern could not be provided invariably in all regular dispensaries. The staff pattern taken for granted at present for each dispensary is one MO, one Pharmacist, one Attender and one PTS. This staff pattern is also not seen provided in 96 dispensaries. This is a set-back which is to be rectified at the earliest.
The Nurses and Nursing Assistants in the Homoeopathic hospitals are now doing 12 hrs. duty every day while their counterparts in other systems of medicine are doing 8 hrs. only. In Homoeopathy Nursing staff have to do their duty in 2 shifts whereas in other depts. they are doing it in 3 shifts. When viewed against humanitarian consideration and with the relations of other depts. these Nursing staff deserved to be regarded in parity in their duty hrs.
2.3.5 Formation of Kerala Public Health Standards (KPHS)
A uniform staff pattern has to be evolved for the smooth and effective functioning of the health care institutions. All these activities have to be codified in the analogy of the IPHS with particular reference to Kerala’s features / situation. Thus a KPHS my be formulated for implementation. It should contain the features mentioned in the IPHS like functions, essential services, physical infrastructure, manpower, equipments, diagnostic services, list of drugs, capacity building, quality assurance in services, hospital management committee, citizen’s charter etc. All the health institutions need to be developed following the KPHS norms. Then only, Kerala can be made the “World Hub of Health” as conceived in ‘Perspective Plan 2030’ by the Govt. for achieving its ‘Sustaining Development Goals’ (SDGs) for affordable and quality health care delivery for all.
- 1.4.. Speciality Clinics
Speciality Clinics / Centres have been developed with special reference to the potentialities of Homoeopathy in different fields of health care. As these activities have been found to be very effective and efficacious because of the unique features Homoeopathy being safe, simple, affordable and acceptable system of medicine. Such activities are being spread over more and more places. A detailed status as on date of these centres is furnished below :
|Sl. No.||Speciality||No. of Units||Commenced Year||Remarks|
|1.||Seethalayam||14||2010||Functioning only in Dist. Hospitals|
|3.||Mother & Child and Fertility Care Centre||04||2012||,,|
|7.||Pain & Palliative Care||14||2013||,,|
The manpower employed in these centres does not belong to any speciality cadre. No seperate course of study has been set up for moulding speciality medical manpower in Homoeopathy in the country except in Paediatrics and Psychiatry. The human resource working in the speciality clinics was selected with reference to their experience, interest and dedication in work. They are also drafted from regular service. Such being the case, this is additional service to them, without any additional benefits.
Because of dearth of staff, speciality clinics are conducted once in a week or in a fortnight. Some of the incumbents have to attend the speciality clinics at their own expense travelling from their far away parent institutions. On most occasions this has become inconvenient even going to the extent of dislocation of work in their regular duties. If it is to be corrected, separate manpower need to be created at the earliest. They need to be imparted training in Specialty concerned. The activities of speciality clinics should be assessed periodically to make necessary changes in functioning from time to time. Similarly newer and newer areas where Homoeopathy has its potential may be found out to arrange such speciality clinics also. These works may be entrusted with the R&D division of the proposed State Institute of Homoeopathy (SIH). In order to share the research and impressions of these works by the professionals and public, necessary effective dissemination of such things through IEC division of the SIH may also be caused to be arranged.
The speciality clinics are now being conducted in Dist. hospitals, at the behest of Dist. Panchayat Administration. Such clinics can be conducted in the institutions under Block Panchayats even in Grama Panchayats according as the need felt by such Panchayats. But it is up to them to bear the expenditure after providing necessary facilities thereof.
2.4.1 Pain and Palliative Clinic
A ten-bedded hospital was sanctioned in Vandoor, Malappuram Dist. in the year 2013 for providing pain and palliative care of the cancer patients titled ‘Chethana Clinic’. It is running exceptionally a good condition as more and more patients are attracted to this hospital. The necessity for developing it further was felt strongly. This matter may be studied in detail and all necessary developmental activities including the increase in bed strength with additional manpower need to be taken up urgently.
2.4.2 Infertility Clinics
It has been proved beyond doubt that Homoeopathy has better scope and results in infertility cases. It was first started in Dist. Homoeo hospital, Kannur and its results are found to be rewarding. Hence such speciality clinics have been introduced in Kozhicode, Kottayam and Thiruvananthapuram. As the clinic has been found to be very successful, to develop it further a landed area of 7.5 cents has been transferred to the dept. for constructing a speciality hospital at Kannur. The necessary buildings may be constructed at the earliest and all other required facilities with manpower may be deployed there.
2.4.3 School Health Programme
School Health programme titled ‘Jyothirgamaya’ was introduced in the State in 2005. It was found to be rewarding in results, following which it was introduced in 28 schools scattered all over the State. It is understood that this programme is not conducted regularly in selected schools. Now every year 2 new schools are selected in each Dists. for conducting this programme. This will not fetch the expected results from this programme. Allopathy and Ayurveda have also been conducting such programmes in schools. As at present varied systems of medicine conducts such programes for the same students, it has sparked a confusion as to which system of medicine should be followed on the part of the students, parents and teachers. Instead of separate school health programmes for each system of medicine as is done today, it may be done by integrating Allopathy and AYUSH systems of medicine considering the scope and potentialities of each system. Homoeopathy has proved itself to be efficacious in correcting and containing behavioural disorders, learning disabilities, prevention of substance abuse particularly tobacco, alcohol, drugs etc., besides minimizing the morbidity. As an effective compliment, Yoga practice is also recommended in this programme. If these things are done in an integrated manner one can easily look forward to forming a healthy generation.
2.4.4 Homoeopathy in Anganwadi Programme
Homoeopathy will find its best in Anganwadi were pre-school children and pregnant and breast feeding women are dealt with. It can render significance service in dealing with the complaints of recurrent attacks of URT infections, allergic manifestations, otitis media, tonsillitis, adenoids, diarrhoea, marasmus etc., ridding the tendency to such ailments in both preventive and curative spheres in children. It may not be lost sight of that Homoeopathy has also its significant role in anti-natal and post-natal care. It may also be noted that the care being given to the mother will definitely reflect favourably in children in their fetal and breast feeding stages by minimizing the internal dyscrasia. A special programme may be chalked out through conducting necessary workshops with experts for evolving a treatment protocol. It may also be propagated through IEC programme of the proposed SIH. In this way to be dream of moulding a healthy generation can be realized.
2.4.5 Prevention of both CDs and NCDs
Homoeopathy has already proved its efficaciousness in preventing communicable diseases especially of viral origin. Hectc efforts are continuously for the last 2 decades under the Dept. of Homoeopathy. The CCRH (GoI) also has conducted several preventive programmes and studies in this regard. It should be made standardised. Its whole success lies in finding out the genus epidemicus when epidemics breakout in the State. This can be scientifically and precisely done if the above task is delegated to the CRIH, Kottayam where there is a skilled team of researchers in Homoeopathy. What is more, it will be getting recognition, credibility and acceptability from all since it is an institution under the Research Council of Homoeopathy, Govt. of India. As it is handled by a particular team in a particular place regularly, it will naturally gain perfection in its results. Steps should also be taken to prepare the preventive medicines in blister / strip packings through HOMCO, Alappuzha. These medicines can be distributed to the epidemic-hit areas through Govt. institutions or other agencies. An arrangement to study and evaluate the efficacy and result of the above epidemic control programme should also be made in the University of Health Sciences / R&D division of the proposed SIH.
If the entire venture as mooted above is to become successful in a standardised way, the 4 agencies viz. CRIH, HOMCO, Hospitals and dispensaries and the Health University/SIH should work in tandem with each other in a co-relating and co-ordinating manner to contribute their whole mite.
In the case of NCDs one programme is being conducted under the title ‘Ayushman Bhava’ (in 7 Dists.) Now this is conducted involving AYUSH systems of medicine by giving using Homoeopathic medicines too. But there is no clarity as to the extent and involvement of Homoeopathic medicines. The system followed at national level integrating Yoga, a non medical management with Homoeopathy may be adopted here also.
2.4.6 Homoeopathy in ‘Vimukthi’
Now the State Govt. is all set out to launch a programme to rid the people of addiction to smoking, alcohol and drugs (SAD) titled ‘Vimukthi’. Homoeopathy has an envious role in this programme. Now a de-addiction programme is co-linked with the ‘Seethalayam’ project being run in Dist. hospitals. To make it cover the programme exhaustively in detail an independent stature need to be given and taken up accordingly being included in the proposed ‘Vimukthi’ programme. A scientific protocol may be developed after conducting a workshop with the professionals who are experienced in this field and other concerned experts (R&D of SIH). This deserves to be taken up as one of the major programmes in 13 FYP.
- Comprehensive Primary Health Care (CPHC) programme
The present Govt. aims at the State to set the Sustainable Development Goals (SDGs) on various health sectors by 2020 through “Ardram” initiative as part of “Nava Kerala Mission”. What this “Ardram” highlights is a Comprehensive Primary Health Care Programme (CPHCP) by changing the existing PHCs in Allopathy to Family Health Centres (FHCs). The programme will cover preventive, promotive and rehabilitative care apart from the curative. The PHCs will be restructured and its functions redefined with better infrastructure, trained health personnel, equipments and medicines, standard treatment guidelines and referral protocols will be developed for the essential care package that a FHC would have to deliver.
The concept of ‘Comprehensive Health Care’ does clearly involved the ploy of different systems of medicine hand in hand for all the health care needs of the people in an affordable and qualitative manner. It is here that the term medical pluralism strikes relevance. It is duly realizing this fact that the WHO has strongly endorsed this view, as a follow up of which the Central Govt. has adopted it in their national health policy. What is required when medical pluralism prevails is not merely the integration of systems of medicine but providing integrated facilities, by co-location of AYUSH with modern medicine, which provides people with option to avail treatments of their choice and help bridging the gaps in health care. This aspect should attract the serious attention of the Govt. to include AYUSH systems of medicine in the CPHCP and necessary action to this direction may also be initiated.
It is learnt that 170 PHCs are going to be converted into FHCs in the initial stage by providing with an additional infrastructural facilities and manpower. For co locating AYUSH services, what is required is an extra OPD facilities with an additional manpower i.e. one medical officer each in Ayurveda and Homoeopathy since it is these two systems of medicine that are seen more prevalent throughout the State. Sidha or Unani may also be provided along with theses if they are found to be more prevalent in such areas. Ayush OPD may be arranged in one and the same room on alternate days for Ayurveda and Homoeopathy (3 days in a week for each system). The Medical Officers will have to do field works such as School Health Programme, Anganwadi programme, medical / preventive camps, health awareness programmes etc on other days as scheduled in LSGI concerned. Only one Pharmacist is necessary for dispensing both systems of medicine as prevailing in the State of Tamil Nadu, as he has got training for dispensing in both systems of medicine. Separate room for storing and dispensing homoeo medicines is essential because they should not come in to contact with odour of other medicines. If this is followed the integrated school health programme suggested in Para 2.4.3 of this report can also be done effectively without any extra expenditure. The above manpower can be drafted from the dispensaries of the concerned system of medicine in that LSGI.
2.4 8 e-Health
Homoeopathy should also be included in the ongoing e-health programme under the Dept. of Health Services.
2.4.9 Service of ASHA Workers
At present ASHA workers are confined to only services rendered by the Directorate of Health Services. Their services should also be escalated and extended to the AYUSH systems of medicine.
3.1 Development of HOMCO
HOMCO (Alapuzha) is understood to be working profitably and so it should be developed as a full fledged one, so as to comply with the requirements of private practitioners besides the needs of the Govt. institutions by providing quality medicines at reasonable cost. It is desirable to open outlet medical stores at different parts of the State to enable the distribution of quality medicines and sundries to private practitioners and the public.
This being the lone public sector undertaking in this field in India, it would be better to make it more serviceable to institutions of other States and Central Govts. including Railways, ESI Corporation etc. by enlarging its network with the intention of augmenting its production. There is better prospect for exporting the quality medicines to foreign countries also, in the wake of increasing demand for Homoeopathic medicine in the World at present. This will feature an endeavour which would result in the capability of giving more employment thereby increasing the income of the State including the foreign exchange.
There were 2 developmental proposals in the 12 FYP, one at Alappuzha and other at Thiruvananthapuram. But nothing did take place apart from laying the foundation stones for the above proposed projects. Urgent steps may be taken to expedite the development activities by ear-marking sufficient funds in the State Budget. There are schemes for getting financial assistance from the Central Govt. too in this regard. Steps may also be taken to utilize this urgently.
3.2 Drug Testing Lab in Homoeopathy (DTL-H)
The only DTL-H in India is situated at Ghasiyabad in UP under the Central Govt. As it is far off at north the southern part of the country feels it very difficult to get the drugs tested because of the remoteness. It is, therefore, very urgent to see that a lab is setup in Kerala under the initiative of the State Govt. The most appropriate location is near to HOMCO in Alappuzha Dist. Central assistance can also be sought for.
3.3 Drug Standardization Unit (DSU)
A great number of new drugs can be developed from sources like plants, animals, minerals, metals etc. in Homoeopathy. Many sources of such drugs plentifully available in Kerala have not been tapped up so far. The setting up of a DSU closed to the HOMCO Pharmacy and proposed DTL-H would go a long way in their mutual benefit and convenience. Steps should also be taken to establish DSU, for this also feasibility of Central assistance can be attempted.
3.4 Homoeo Medical Stores
There are at present Homoeo Medical Stores under the Dept. of Homoeopathy at Thiruvananthapuram, Kottayam, Kozhicode and Kannur. They may be strengthened in complying with all requirements of the medicines for the Govt. institutions.
3.5 Drug Control Wing for Homoeopathy
As in the case of Ayurveda, a separate Drug Control Wing for Homoeopathy may be established under the State Dept. of Drug Control or it would be even better to have a separate Drug Control Dept. for AYUSH systems of medicine as a whole.
- EDUCATION AND TRAINING
4.1 UG Education
It was noticed that the annual intake for graduates for Ayurveda and Allopathy has increased manifold after 2002 whereas the UG seats for Homoeopathy have remained static at 250 per year in all the two government and three aided HMCs in the State. It was also noticed that the registration for Homoeopathic UGs passing out from outside States was almost equal to the registration by UGs passing from within the State every year and hence the intake capacity in the State may be increased considering the increasing popularity of Homoeopathy and the massive increase in the number of practitioners in Ayurveda and Allopathy as follows:
4.1.1 Enhancement of UG seats
i. It may here be considered that there is a feasibility of enhancing the existing 50 seats to 100 as per the MSR Regulations 2013 without any additional staff or extra hospital facilities. Hence necessary action may be initiated by April, 2017 itself to increase the UG seats to 100 for the academic year 2018-19 in both Govt. and aided colleges with judicious changes in the infrastructure, if required, with the consent of affiliation of the KUHS for obtaining the letter of permission (LoP) from the M/o AYUSH, GoI.
ii. A new college may be started as Constituent College of the University in KUHS campus at Thrissur as recommended in the report of the Homoeopathic Committee for the formation of the Health University.
iii. Considering the huge popularity of Homeopathy in the Malabar area and the large number of students migrating to other States like Karnataka, TamilNadu etc, for pursuing Homoeopathic education, a new HMC may be established in Kannur, taking the total number of HMCs in the State to 7 in place of the existing 5 – making 3 in government sector, 3 in aided sector and 1 in the University.
4.1.2 Ensuring the continuity of the existing courses
i. The Ayush Ministry has issued strict instructions for obtaining continuous permission for existing UG seats from 2017-18 onwards as per the MSR Regulations 2013, under which a functional operation theatre and labour room should be made available in the HMCs for teaching surgery and OBG. The last CCH inspection has pointed out along with certain minor deficiencies that in the GHMCs no functional operation theatres/labour rooms are available. This matter may be taken note of and urgent remedial action be taken before 31 December 2016.
ii. M/o of Ayush has also issued instructions that NABH accreditation for the collegiate hospital within one year and NAAC accreditation for the college within two years may be obtained for conducting UG/PG courses in all HMCs. Necessary action for complying with these instructions may be taken by both Government and private HMCs urgently.
iii. The State special rules for recruitment of teachers in HMCs are not in conformity with the existing amended MSR Regulations of the CCH and hence no recruitment of teachers has been taking place in GHMCs since 2006. This has resulted in crisis for starting new courses and for continuing existing courses which even may lead to closure of GHMCs in the near future. This issue may be taken up seriously to amend the special rules suitably at the earliest to start the recruiting process without delay.
4.2 . PG Education
i. It was noted that even though 4 new specialities were introduced in PG courses in 2001 Regulations, none of them could be started regularly in Kerala due to various reasons and at present there are only 3 existing specialities. It was also noted that the students of Kerala are compelled to go to outside colleges for PG courses. Hence it is felt desirable initial action may be completed by April 2017 itself for introducing PG courses in the new 4 specialities from 2018-19 onwards in the State.
ii. For the new subject Psychiatry the best institution would be the newly established ‘National Homoeopathy Research Institute in Mental Health’ at CRIH (GoI), Kottayam where it is that the only mental hospital in Homoeopathy in functioning not only in the State but in the National level.
iii. MD (Hom) in the subject of Pharmacy can be started either in the aided college in Kurichi, Kottayam or in the proposed ‘Institute of Paramedics in Homoeopathy’ at Kurichi, Kottayam, considering the proximity of HOMCO, whose facilities could be utilised for the purpose.
iv. For the new specialities of Practice of Medicine and Paediatrics, which are in great demand, action may be initiated by April 2017 itself to start them in the 2 GHMCs from 2018-19 onwards by upgrading their infrastructural facilities including faculty.
4.3 . Development of Collegiate Hospital
There are two GHMCs in the State with 100 bedded hospital in each. For providing more beds up to 200 to 250, necessary buildings have already been constructed in both colleges. It is in the absence of the academic complex in full shape, the buildings constructed for the hospital are being put into use for academic activities. In both these colleges there are sufficient paid medical manpower (42 faculties, 54 PG students and about 30 – 40 Interns in each college) which are now really under used. If their services are properly used in the Peripheral Health Centres more and more patients can be made to frequent the collegiate hospital for clinical studies. All the Maternity and Child Health (MCH) Centres under the City Corporation can be clubbed together under a tie-up programme for the PHCs. If this manpower is properly put into use, several speciality clinics, research programmes can also be undertaken besides the above PHCs.
4.3.1 Govt. Homoeopathic Medical College, Thiruvananthapuram (GHMCT)
At present most of the academic activities are being conducted in the buildings constructed for accommodating 250 bedded hospital. The bed strength of the hospital has to be enhanced to 150 at least from the existing 100 for introducing newer PG courses and PhD programmes during 13 FYP. This demands the construction of a well planned academic complex required for NAAC accreditation. This construction can be better made on the top of the existing hospital buildings. Necessary steps for the above may be urgently taken.
The existing academic and clinical facilities have necessarily to be broadened and enhanced when viewed against the new situation requiring the enhancement of 50 UG seats to 100, adequate tertiary care level hospital with more beds befitting the NABH accreditation, concomitant installation of students’ hostels , RMO quarters, Nurses quarters, Central Research Lab, Information and documentation Centre, Clinical and Communication Skills Development Centre, and associated infrastructural development for gaining NACC accreditation need to be accommodated in the present campus lying in 3 adjacent pieces of land at Iranimuttom.
4.3.2 Utilization of additional Acquired Land
It is in the newly acquired 5 ½ acres land foundation stones have already been laid for constructing “Homoeo Bhawan” for housing the Departments of Services and Education and for starting other unit of HOMCO, a medicine manufacturing unit. Again a proposal for establishing a Pharmacy College in that campus is also underway. Apart from the above, the proposed State Institute of Homoeopathy having Training division, R&D division, IEC division etc. has also to be provided here. For achieving the above goal, a strategy has to be evolved for utilizing the optimum level of available land. This necessitates the preparation of a master plan with a suitable landscape of the existing land initiating side by side necessary prudent action to acquire bits of land lying there in between the old and new campus. Necessary DPR may be urgently caused to be prepared leading to budgetary allotment in the 13 FYP itself.
There is at present a total landed area of almost 11 acres in GHMCT, which is the pivotal area in the capital city that can be made use of for the purpose of development of GHMCT into a “National Centre of Excellence in Education and Research in Homoeopathy” The chances of getting Central assistance are also brighter.
- Govt. Homoeopathic Medical College, Kozhicode (GHMCK)
All the essential requirements required in respect of GHMCT have to be afforded to the GHMC, Kozhicode also especially when NABH and NAAC accreditation for the hospital and the College respectively as mandatory for the continuance of existing courses and proposed higher courses. These developments have to be confined to within the 3 ½ acres of landed area left for the said developments. A new academic complex is under construction at a cost of 7 crores in the same campus. When the academic activities are shifted to the newly built academic complex, there is a scope for increasing the bed strength to 150 from the existing 100 as in the GHMCT during the 13 FYP. All the possibilities for developing this college need to be probed into with a view to making the college befitting the above accreditations. Necessary action directed towards making available the required fund may be taken urgently. Attempts should also be made to ascertain the availability of suitable land to accommodate men’s hostel, staff quarters, play grounds etc. in the near by site.
4.4. Paramedics in Homoeopathy
At present there are only 2 GHMCs for training the paramedics for filling up the posts of Pharmacists / Dispensers and Nurses in government institutions.– earlier there was Nurse-cum-Pharmacist course (NCP). At present Homoeopathic orientation course is provided to the Nurses having General Nursing certificates and for Pharmacists/Dispensers Certificate Course in Pharmacy (CCP) training is imparted in 2 GHMCs. However, they are not able to train sufficient numbers and provide effective training due to lack of hospital facilities and pharmacy (medicine manufacturing unit). The government had contemplated setting up a new Pharmacy College for this purpose at Thiruvananthapuram and even allocated funds, but it did not make much progress.
4.4.1 Institute of Paramedics in Homoeopathy
It is noted that Kurichi, Kottayam has got proximity to HOMCO, a medicine manufacturing unit under public sector, and a good number of hospitals – the 125 bedded Govt. hospital at Kurichi, 100 bedded CRIH hospital and 25 bedded ANSS HMC hospital nearby would be very helpful in providing training to the Pharmacists/Dispensers and Nurses in Homoeopathy. It was further noted that about 3 acres of land is available in the GHH campus, Kurichi . What this shows is that all these positive prospectus if taken together will certainly pave way for the establishment of a ‘Paramedical Institute in Homoeopathy’ at Kurichy which may be better than the one already under proposal for construction at GHMCT campus. It will be therefore be prudent if that fund is reallocated to the above proposed institute of Paramedics at Kurichi. The necessary DPR for the above Institute may be prepared and other follow up action to set up the Institute may be initiated immediately if, in-principle, approval is accorded by the Government. The institute could be temporarily located in the GHH buildings, Kurichi to start with and could commence functioning from 2017-18 onwards with the approval of the Government. For the time being, the services of the suitable staff of the Govt. hospital and nearby aided HMC can also be utilized. Availability of Central funds through NAM could also be explored for further development at appropriate time.
Training for the Human Resources in Homoeopathy (HRH) viz, teachers, medical officers, private practitioners, paramedics etc is highly essential for ensuring their efficiency in service by updating them in their respective spheres. It is highly relevant today in as much as no such regular institution in training is in vogue anywhere in the country. It is only through such an established institution with necessary paraphernalia that the imparting of systematic and monitored training could be expected. This is the spirit which is displayed in the present Govt’s election manifesto behind the proposal for establishing an SIH.
4.5.1 State Institute of Homoeopathy
It may be set up in the GHMC campus at Thiruvananthapuram. The said Institute could have three divisions – training, research & development and IEC. Necessary action for the preparation of DPR, budgetary provisions, etc for establishing the above Institute may be initiated urgently so that the Institute could be set up in the 13th FYP itself. The M/o AYUSH (GoI) provides lot of funds for training and efforts could be made to make available such funds for the project. If the Government approves, the proposed ‘State Institute of Homoeopathy’’ could be temporarily located on the vacant floor of the GHMCT till necessary infrastructure is put in place.
4.6 . Directorate of Homoeopathic Medical Education (DHME)
At present there is the Directorate of Homoeopathy in the State to look after the entire affairs of Homoeopathy except education. Homoeopathic education was separated from the Directorate in 1982. At that time there was only one college at Kozhikode. Thereafter another Govt. college was established at Thiruvananthapuram in 1983. Subsequently in both the colleges PG courses in 3 disciplines were started. Later on 3 private colleges were brought under direct payment. Then the activities increased manifold – new courses were introduced, research work started, speciality clinics established etc. All issues related to Homoeopathic education are being handled by the Principal & Controlling Officer (PCO) of GHMCT. He has to attend to all matters relating to medical education in Homoeopathy; all court cases and departmental cases are to be dealt by him; PCO is involved in preparation of all schemes including research proposals, schemes under NAM, etc; all queries on medical education in Homoeopathy are to be answered by him. It may be seen that over the last 16-17 years not much progress has been made in medical education – no progress on introduction of new PG courses as in other States, no efforts to increase the UG seats in government colleges, no enhancement of bed strength of collegiate hospital, no participation in the central sector schemes, etc, to mention a few. Ayurveda has made considerable development in all fields, but no efforts have been made to bring improvement in Homoeopathic medical education which is clearly due to lack of effective leadership and supervision. In view of the almost stagnant situation in the education front, there is urgent need to set up a separate Directorate of Medical Education in Homoeopathy. Necessary proposals were submitted to the Government by Homoeopathy and Ayurveda for setting up separate Directorates of Medical Education in respective systems as far back as 1997. But the Directorate of Education was set up for Ayurveda only and the requirement of Homoeopathy was overlooked. This necessity was strongly felt years ago especially during the time when the direct payment system was introduced in all the three HMCs under private sector. This was again brought to the notice of the Govt. through SPB in the XIth Plan proposals. But this was left unattended to so far. In view of the increasing activities in the Medical Education sector of Homoeopathy, the PCO is not able to effectively attend to all the institutional responsibilities in the GHMCT or provide effective supervision for Medical Education in Homoeopathy as his additional charge. As such there is urgent need of having a separate Directorate of Medical Education in Homoeopathy to attend to all matters related to medical education.
The proposed State Institute of Homoeopathy also could be brought under the supervisory responsibility of this Directorate. The proposed Directorate could be housed in the building being constructed in the GHMC campus at Thiruvananthapuram for Homoeo Bhavan where the Directorate of Homoeopathy would be housed, as has been done in the case of Ayurveda. Till that building is completed, the office could be housed in the GHMCT buildings and made operational with minimum support staff by upgrading some of the existing supervisory posts and within existing infrastructure of that college. If it is approved, necessary proposal with the DPR, budgetary and other related matters could be moved to the Government immediately.
Research and advanced studies are the basic things on which all medical sciences are veering round for the full and optimum development of them. This being the case necessary competant research activities need to be initiated. In the wake of PG courses being conducted in GHMCs and attempts are afoot for introducting PhD programmes in Homoeopathy, the relevance of starting research activities has to be recognized without any loss of time.
The ideal most place for conducting research activities especially clinical research is collegiate hospitals themselves. All the research facilities such as hospital, labs and category wise human resources in medical, paramedical and technical sections are already available in collegiate hospitals. It may be noted that the M/o of AYUSH, GoI has directed all the collegiate hospitals to ensure NABH accreditation within a period of one year for continuing their courses.
The Central Ministry has again a Central sector scheme titled ‘Extra Mural Research’ ear-marking Rs. 70 lakhs for a period of 3 years for a project. This situation has to be fully utilized by the teaching faculty of our colleges. Necessary effective steps to this direction may be taken urgently.
The SIH especially the R&D division should also seize this opportunity to conduct research activities in the departmental hospitals by deploying the above Central sector scheme of EMR to the maximum optimum level.
The R&D division of the SIH should take deligent action to issue necessary guidance to the dept. staff after assessing the quality of their routine work including related to speciality projects. Necessary improvement / modifications should also be made in the existing formats, registers etc. as and when required as per the assessment made from time to time.
5.1. Strengthening of Administration
In view of the increase in the number of institutions and activities, the existing Directorate and District offices of Homoeopathy need to be strengthened with additional man power and other attendant facilities resorting to modern technology like office automation etc.. There is imperative necessity in creating certain administrative posts such as those of Joint Director, Finance Officer, Law Officer at the Directorate. District offices need also to be developed as per requirements .
- State Public Health Cadre (SPHC)
Homoeopathy has proved its stake in health promotion and disease prevention. An SPHC may be formed in an integrated manner with members drawn from all the systems of medicine including Homoeopathy. Accordingly the Kerala State Public Health Act may be enacted unifying the existing Acts viz. Madras Public Health Act 1939 and the TC Public Health Act 1955. This has been referred to in the Working Group report of SPB on ‘Medical and Public Health’ for 12 FYP. It is understood that several discussions and deliberations have since been made towards this end. Stress may be taken to bring in the unified Act in the legislature and establish SPHC at the earliest.
- Comprehensive State Medical Practioners’ Act (CSMPA)
The prevalence of quacks in medical profession is on an appalling increase in the State and it is high time to curb them by enacting a CSMPA in lieu of TCMP Act 1953. The inevitability of this Act was also mentioned in the election manifesto of the ruling Govt. Immediate steps should be taken to formulate a comprehensive State Act on the basis of the Central Acts which are already enforced in the State in respect of all systems of medicine. While bringing the said comprehensive Act, it is better to include a provision for renewal of registration of medical practitioners once in every five year with insistence on having undergone a minimum of 50 hrs. CME programmes with a view to updating their knowledge on the trendy changes in medicine.
- 5.4.Clinical Establishment Act
With a view to maintaining standardization in medical practice, clinical establishments under both public and private sectors, a State Clinical Establishment Act may be enacted in the analogy of Central Clinical Establishment Act 2010. While formulating the above Act particular requirements/features of Homoeopathy should also be considered.
5.5 ‘World Homoeopathy Day’ Celebrations (WHDC)
It is to be observed in the analogy of other systems of medicine like Ayurveda, by conducting medical camps, medical exhibitions, seminars, conferences etc., giving awards to the best doctors in various spheres of Homoeopathy, releasing of books and other publications, starting of new projects for popularizing the salient features of Homoeopathy to the common man, regularly on Dr. Hahnemann’s Birthday (April 10) known otherwise as ‘World Homoeopathy Day’. Now this day is not properly observed except in 2015. State Govt. should therefore look in to the matter and see that it is conducted regularly. The category of research has not been included in the Best Doctor Award instituted by the State Govt. It should also be find a place in the State awards after making judicious amendments in the Rules concerned.
5.6 State Journal Publishing
With a view to making optimum propaganda and maximum publicity highlighting the salient features of Homoeopathy among the public and others, attempts should be made in Govt. level to utilize the social media in all its vigour and force. To keep the people and professionals abreast of all the trendy developments of Homoeopathy an official journal may also be brought in under the proposed SIH.