1. A Note on General Nursing and Midwifery course

"General Nursing and Midwifery course is a three and half years Diploma course inclusive of an internship programme. This programme is structured in a fashion that enables the course to impart knowledge and training that would essentially meet the health needs of the society. A minimum 100 bedded parent hospital is essential to start GNM programme. The institutionalization of this course in the various hospitals at the District and Sub-district level would go a long way in addressing the problem of shortage of nurses."

1. A Note on Diplomate of National Board
2. Minutes of the Meeting on DNB Course - 12^th January, 2015
3. List of Participants - 12^th January, 2015
4. Minutes of the Meeting on DNB Course - 6^th January, 2015
5. List of Participants - 6^th January, 2015

There is a serious shortage of qualified medical and health professionals particularly at the District and Sub-district level hospitals.
 
It is also well known that a number of private hospitals with a minimum of about 50-100 beds have been able to address this shortage through introduction of the courses which are offered through Diplomate of National Board (DNB), New Delhi. Diplomate of National Board (DNB) is a Post Graduate (PG) Degree (Masters – Duration of 3 years) programme equivalent to MS/MD recognized by the Government of India. This title is awarded by the National Board of Examinations (NBE), New Delhi an autonomous academic body equivalent to the Medical Council of India (MCI) under the Ministry of Health and Family Welfare. It is a full time course and is conducted in the premises of the hospital under the guidance of senior post graduate doctors. DNB offers different courses all of which are included in the first schedule of Indian Medical Council Act 1956.It has been noticed that very few public hospitals have so far taken advantage of the DNB Courses.The institutionalization of this course in the various hospitals at the District and Sub-district level would go a long way in addressing the needs of the PG students in medical/health sector.f the DNB Programme is initiated at the Govt. Hospitals with a bed strength of 100 and above, it would be beneficial not only from the point of view of certification of the professionals but would also help the hospitals to retain medical practitioners in hospitals without dislocation of medical and health services. Further, the DNB Courses do not need additional infrastructure. All that is required is a small library.West Bengal State Government has started the DNB Courses in 6 district hospitals viz., Howrah, Hooghly, Barasat, Krishna Nagar, Purulia and Asansol.CIPS has conducted two meetings one at Hyderabad on 6th January ,2015 and the other at Vijayawada on 12th of January 2015.The meeting at Hyderabad was attended among others by Prof. K Srinath Reddy, President, Public Health Foundation of India, New Delhi, Dr. Jayaprakash Narayan, Former IAS & President, Lok Satta Party, Dr. S K Rao, Director General, ASCI, Dr. G N Rao, Chairman, L V Prasad Eye Institute, Dr. S S Reddy, Former Director, Dr. Ravindran, Aravind Eye Care, Madurai, Dr. Chandrasekhar and Dr. Balaraj, Former Supdt., Osmania and Gandhi Hospitals, Sr. Doctors, who pioneered the programme at Nizamabad. The meeting at Vijayawada was addressed by Sri Kamineni Srinivas, Hon’ble Minister for Health & Medical Education, Govt. of Andhra Pradesh and attended by Dr Ravi Raj ,Vice Chancellor, NTR Health University, Dr Santa Rao ,Director of Medical Education, Andhra Pradesh among others.In continuation of the meeting held at Vijayawada on 12th January, 2015, Dr Kamineni Srinivas, Hon minister for Health and Medical Education [ a Medical Doctor himself!] ,Govt of AP has announced at Rajahmundry (AP) that the Govt. of Andhra Pradesh has decided to start DNB Courses in 10 select Area Hospitals including those at Rajahmundry, Machilipatnam, Proddatur and Nandyal. The relevant link is:

1. DO Secretary
2. Government Order Vision Centre Telangana
3. District Planning 2.0 - Report
4. Primary Eye Care in Telangana State
5. Vision Centre Proposal - Jharkhand

CIPS is exploring the possibility of institutionalizing the Vision Centres in Common Service Centres (CSCs) or Primary Health Centres (PHCs) in different states in association with Aravind Eye Care, Madurai and L V Prasad Eye Institute, Hyderabad. CIPS and Aravind Eye Care, Madurai have prepared a proposal on 27.08.14 for setting up of 15 IT embedded Primary Eye Care centres (Vision centres) on a pilot basis in three districts of Jharkhand. According to the proposal, these centres would be co-located in the Common Service Centers (CSC) with the technical assistance provided by Aravind Eye Care System (AECS) and the whole process will be facilitated by Centre for Innovation in Public systems (CIPS). 22nd September, 2014 - Ranchi, Uttar Pradesh -– To take this idea forward, Director, CIPS has undertaken a trip to Ranchi along with Mr. Thulsiraj, Executive Director, Aravind Eycare and Mr. Bhagwan Patil, COO, CSC PV, Govt. of India. At a meeting Chaired by Chief Secretary, it has been decided to initiate the pilot of 15 Vision centers with funds available through NRHM. Also, it was decided unanimously in the meeting on 22.09.14 to request the 14th Finance Commission for a grant to replicate this model throughout the state of Jharkhand. CIPS has helped the government of Jharkhand in preparing a supplementary memorandum, which was submitted on 24th September 2014. Through this supplementary memorandum, the Government of Jharkhand has requested the 14th FC for a sum of Rs. 80.71 Crores for setting up 454 vision centres across 24 districts of Jharkhand. This project, when fully operational will have a substantial impact in the health care and eye care indicators in Jharkhand.

CIPS has suggested to the Govts. of Telengana and Andhra Pradesh, the possibility of establishing Vision Centres with assistance from L V Prasad Eye Institute or Aravind Eye Care System. 13th October, 2014: CIPS has sent these proposals to all states. CIPS has further initiated the process of establishing Vision Centres at Endowment Institutions and Kalyanamandapams where there are enough resources for this purpose in the state of Andhra Pradesh. 25th September, 2014: CIPS has facilitated a meeting on this subject between Govt. of Telangana and L V Prasad Eye Institute. In pursuance of the efforts of CIPS, the Government of Telangana issued an Order (G.O.Ms.No.12) on 20.01.2015 sanctioning 4 Vision Centres to be set up at the PHCs in association with the L V Prasad Eye Institute at a cost of Rs. 28 lakhs. Out of this an amount Rs. 5.00 lakhs is the expenditure on infrastructure and Rs. 2.0 lakhs per year is the recurring cost of each Vision Centre. CIPS has also been looking at the possibility of establishing Vision Centres in different states on the lines of Jharkhand & Telangana.

16th & 17th of June, 12 – As a result of the process of dissemination of information and the visit undertaken by the Director, CIPS, senior health administrators who are in charge of Eye Care in different parts of the country were invited to Aravind Eye Hospital, Madurai, Tamil Nadu on 16th & 17th of June, 2012 for a study of the Best Practice of this institution. It is noticed that Aravind Eye Care has, among others, a very effective low cost treatment relating to cataract operation and manufacturing facility for (a) Intra ocular lenses (b) Sutures (c) Blades and (d) Medicines relating to eye care. The Aravind model of tracking diabetic patients for ensuring proper eye care has been commended by the Planning Commission. Directors of RIOs, NPCB & Department of Health & FW and also Health Experts from different parts of the country participated in the above Workshop. The Workshop was inaugurated by Shri. Keshav Desiraju, Spl. Secretary, Ministry of Health and Family Welfare, GoI, New Delhi, Ms. Sujaya Krishnan, Jt. Secretary, Health, GoI has also participated and shared her policy perspective. In continuation of the above, CIPS has conducted a Two Day Programme for 6 states for ensuring that the Cataract Surgical Rate in these 6 states substantially increase. These 6 under served states are Assam, Bihar, Chattisgarh, Jharkhand, Odisha and Rajasthan. The National average of the Cataract Surgical Rate as of 2012-13 is 5043 for million of population. In the programme that was conducted on 31st of October and 1st of November, 2014 all the 6 under served states have decided to take up an implementation programme for catching up with the national average of Cataract Surgical Rate. CIPS and Aravind Eye Care would be visiting these 6 states for a detailed micro plan exercise to be taken up at District level. Secretary, Health, Govt. of India commended this exercise to the states in a letter written on 14th January, 2015.

CIPS is also actively engaged in disseminating information relating to the 3 Year Rural Medical Practitioners Programme which has been successfully implemented in Assam. It has resulted in substantial improvement of Health Care at Sub Centres by increasing institutional deliveries and improving O P services. The following are the activities taken up: A number of presentations on the programme have been made in different states. CIPS has also conducted a number of Video Conferences on this practice. 24th September, 2014 – Bhopal, Madhya Pradesh: Director, CIPS has undertaken a trip to Bhopal for a focused discussion on the 3 Year Rural Medical Practitioners Course. He met the Commissioner (Health) in addition to the other Sr. officers emphasizing the importance of this programme. They have also discussed the possibility of incorporating nursing syllabus in the 3 year Rural Medical Practitioners Programme for enhancing service delivery at sub-centres / primary health centres. Lucknow, Uttar Pradesh – 21st August, 2014: Director, CIPS has undertaken a trip to Lucknow for a focused discussion on the 3 Year Rural Medical Practitioners Course. He met the Prl. Secretary (Health) in addition to the Director of Medical Education emphasizing the importance of this programme for a state like Uttar Pradesh which has a serious shortage of man power in the Health Sector. On the advice of the Secretary, DARPG, CIPS has completed the detailed documentation on 3 Year Rural Medical Practitioners Programme (Jorhat, Assam model) with the help of Medium Health Care Consulting, Hyderabad. 5th April, 2013: A meeting on 3 Year Rural Medical Practitioners Programme was organized by CIPS and the following members participated in this meeting: Sri Vinod K Paul, Professor, AIIMS, Dr. Meenakshi Gautam, Public Health Foundation of India, Dr. Krishna Rao, Public Health Foundation of India, Dr. K M Shyam Prasad, Executive Director, National Lutheran Health & Medical Board, Chennai, Shri. Dr. T. Sundararaman, Executive Director, National Health Systems Resource Centre & Shri Javid Chowdhury, Former Secretary, Health & Family Welfare, New Delhi. 4th December, 2012 -New Delhi Sri Sanjay Kothari, IAS, Secretary, DARPG, GoI, Sri Keshav Desiraju, IAS, Spl. Secretary, Shri Vishwas Mehta, IAS, Joint Secretary, Department of Health and Family Welfare, GoI reviewed the 3 Year Rural Medical Practitioner course. 9th March, 2012: A Brainstorming Session on “3 year – Rural Medical Practitioner Course” with Officials of Govt. of Andhra Pradesh.

Integration of Medical Education with Primary and Secondary Health Care – on the lines of CMC, Vellore and Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha. The following are the details of the above innovative practice how it has taken forward through series of meetings, video conferences, field visits and workshops: 20th & 21st January, 12: Presentation made by Dr. Anand Zachariah, Vice Principal, CMC, Vellore at Bangalore Workshop. This paved the way for the conduct of a major National Workshop on Integration of Medical Education with Primary, Secondary and Tertiary Health Care at CMC, Vellore, Tamil Nadu. April, 2012: The above theme was exhaustively discussed at the workshop held at Vellore, Tamil Nadu in April, 2012. About 44 Senior Heal Professionals from different States attended the Workshop. This paved the way for a series of meetings of officials of Govt. of India and State Governments.

• A policy document has been prepared for adoption at the National Level and has been sent to all the states as prelude to sending to the GoI and the ICMR & National Academy of Medical Sciences.

The proceedings of this workshop have been sent to all the states. October, 2012: CIPS has addressed all the Prl. Secretaries/ Secretaries/ Directors of Health & Medical Education, Secretary, Department of Health & FW, GoI, ICMR, MCI and the Principals of about 284 Medical Colleges all over India duly enclosing the proceedings of the CMC, Vellore. Communications have been received from Dr. V M Katoch, Secretary to the Govt. of India& Director General, ICMR and Sri Sanjay Kothari, Secretary, Ministry of Personnel, Public Grievances & Pensions, DARPG, New Delhi commending the model and expressing a desire to take it forward. 7th November, 2012: Director, CIPS made a presentation on this at a conference of Secretaries of Administrative Reofrms of the North Eastern States at Guwahati. 4th December, 2012 - New Delhi Meeting held by Sri Sanjay Kothari, IAS,Secretary, DARPG, GoI, Sri Keshav Desiraju, IAS, Spl. Secretary, Shri Vishwas Mehta, IAS, Joint Secretary, Department of Health and Family Welfare, GoI. 5th December, 2012 – Chandigarh This has also been discussed at Chandigarh with Mrs. Vini Mahajan, Prl. Secretary (Health), Govt. of Punjab, Mrs. Raji P Shrivastava, MD, Punjab Health Systems Corporation, Dr. Ashok Nayar, Director, Health and Family Welfare, Dr. Karanjit Singh, Director, Health Services Family Welfare and others. Dr. Anand Zacharaiah, Vice Principal, CMC, Vellore made a detailed presentation on the CMC, Vellore model. 28th of February, 2013: In continuation of the meeting of 4th December, 2012, a Brainstorming Session was held on this subject in the Chambers of Sri Keshav Desiraju, IAS, Secretary (Health) MoHFW, GoI on. This meeting was attended among others by Sri Sanjay Kothari, IAS, Secretary DARPG, GoI, Jt. Secretary Health, Secretaries & Heads of Department of some of the states, as also the representatives of CMC, Vellore, MGIMS, Wardha, Aravind Eye Care, Madurai and Sankara Netralaya, Chennai. As a result of the advocacy of CIPS, it has been decided by the Govt. of India to replicate the model of Integration of Medical Education with Primary and Secondary Health Care on a pilot basis in the following 5 Medical Colleges in different parts of the country.

1. Rangaraya Medical College, Kakinada, Andhra Pradesh
2. Agartala Government Medical College, Agartala, Tripura
3. Government Medical College, Patiala, Punjab
4. Jorhat Medical College, Jorhat, Assam
5. Vadodara Medical College, Gujarat

The following Video Conferences, Field Visits and Workshops have been conducted CIPS has conducted with CMC, Vellore, MGIMS, Sewagram and respective colleges on Integration of Medical Education with Primary, Secondary and Tertiary Health Care: Video Conferences & Field Visits

1. Video Conference on 21st March, 2013
2. Video Conference on 28th March, 2013
3. Video Conference on 8th April, 2013 (with Rangaraya Medical College, Kakinada, Andhra Pradesh)
4. Video Conference on 24th April, 2013 (with Patiala Medical College, Punjab).
5. Video Conference on 8th May, 2013 (with Government Medical College, Agartala, Tripura)
6. Video Conference on 27th May, 2013 (with 5 Medical Colleges)
7. Field Visit to Rangaraya Medical College, Kakinada, Andhra Pradesh on April 15th -17th , 2013
8. Field Visit to Government Medical College, Patiala, Punjab on April 29 – 1st May, 2013.
9. Field Visit to Agartala Government Medical College, Tripura on May 17th – 18th , 2013.
10. Field Visit to Jorhat Medical College, Assam on 30th May – 1st June, 2013.

Field Visit: The Field Visits were useful in the following manner:

1. Developing an awareness of the functioning of each one of the medical colleges and the peculiar health/disease profile of the people, who are served by the medical college and the attached hospitals.
2. Sensitising the faculty and students of the medical colleges on the good practices relating to the CMC, Vellore and MGIMS, Sewagram.
3. Developing the research orientation on the part of the faculty members of the respective institutions to carry out intensive studies which are relevant to their locale.
4. The distance education in medical and para medical programmes can be initiated by the respective medical colleges.
5. Sensitizing the medical education in different states of the need to bring on board the functionaries of the health systems in their respective areas.

Workshops

1. Workshop on Integration of Medical Education with Primary and Secondary Health Care at CMC, Vellore on 10th – 13th June, 2013. This was conducted for the core teams of 5 medical colleges all over the country.
2. Workshop on Integration of Medical Education with Primary and Secondary Health Care at Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha on 21st – 23rd October, 2013. This was conducted for the core teams of 4 medical colleges all over the country.

These efforts were included in the Annual Report of 2013-14 of MoHFW, GoI as follows: One of the report of the Task Force on Medical Education of the National Rural Health Mission had spelt out the need to draw upon MGIMS Sevagram’s initiatives and experience in curriculum innovations and rural placement of its graduates and had suggested launching a participatory exercise with MGIMS and other like-minded institutions, so that national guidelines could be formulated. As a result of that during current year the Ministry of Health & Family Welfare, Govt. of India has selected MGIMS and CMC Vellore in co-ordination with the Centre for Innovations in Public Services (CIPS), Hyderabad as co-coordinators to disseminate to other colleges the innovations conducted by the two Institutes. As an initial initiative, five medical colleges, one each in Kakinada (A.P), Vadodara (Gujarat), Patiala (Punjab), Jorhat (Assam) and Agartala (Tripura) have been selected and MGIMS and CMC are interacting with them in order to help them replicate the innovations introduced in the curriculum by the MGIMS, Sevagram and CMC, Vellore.

April & August, 2012: Ernakulam Hospital (Kerala) under the leadership of Dr. Junaid Rahman is one of the very few public hospitals to have received NABH Accreditation for the quality improvement measures institutionalized for enhancing patient care. This presentation was made at the workshops conducted by CIPS at Madurai (April, 2012) and Bangalore (August, 2012). The details of this initiative have also been circulated to all the States and UTs. At least Nine states viz., Andhra Pradesh, Madhya Pradesh, Himachal Pradesh, Punjab, Haryana, Meghalaya, Maharashtra, Karnataka & Jharkhand have strongly indicated that they would like the further handholding of the processes relating to NABH Accreditation. This resulted in the following initiatives: 5th January, 2013: Video Conference on (i) NABH & NABL Accreditation of Medical and Public Health Institutions: 23 health administrators and health professionals participated from Hyderabad in this video conference. Representatives, who participated in this through video conference, are from Kerala, Wardha, Maharashtra, Karnataka, Gujarat, Maharashtra, Punjab, Himachal Pradesh, Haryana, Chandigarh, Rothak, Faridabad and officers of NABH & NABL from New Delhi. (i) Dr. Gayatri, Director, NABH made a presentation on the objectives of NABH and highlighted the need for accreditation for a quality of service. The Director, CIPS stated that the Government General Hospital, Ernakulum is an important Govt. Institution in the country to have NABH Accreditation. The Director mentioned that Dr. Junaid Rahman (Superintendent of Hospital) has put in enormous efforts in attaining this distinction. Dr. Junaid Rahman in his presentation showed the status of infrastructure before and after accreditation of the hospital. Dr. Anil Reila, Director NABL briefed the participants of the objectives of NABL and Dr. Punam Bajaj made a presentation on the benefits of Accreditation in this video conference. (ii) Dr. Sunil Chandy, Director, CMC, Vellore has broadly outlined the functioning of CMC, Vellore and how the integration of medical education with primary and secondary health care got the priority from their hospital. Dr. Garg, MGIMS, Wardha, Maharashtra made a Presentation on the activities of their medical college and Kasturba Hospital. He outlined the manner in which the staff and students have to follow a code of conduct based on Gandhian Philosophy of thought and action. 3rd February, 2013: Field Visit to Ernakulam on NABH Accreditation On the basis of the Video Conference of 5th January, 2013, CIPS has facilitated a Fiedl Visit to Ernakulam. A five member Haryana Team and one Doctor from Andhra Pradesh visited Ernakulam Hospital, Kerala on 1st & 2nd February, 2013. Director, CIPS and Admin. Officer, CIPS have also participated in this Field Visit. 11th March, 2013: CIPS has further arranged a sensitization and capacity building session of a number of public hospitals in Himachal Pradesh with the representatives of NABH at Shimla. Work Shop on NABH Accreditation in Public Hospitals – Programme on Implementation (POI) in associationNational Accreditation Board for Hospitals & Healthcare Providers (NABH –QCI), Govt. of India, New Delhi at the Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, Maharashtra on 24th – 26th of October, 2013.

25th May, 2013: CIPS has facilitated a meeting with Health Officials Govt. of Andhra Pradesh and Dr. Arun Singh.
CIPS has entrusted the detailed documentation on "Samarpan" to Medium Health Care, Hyderabad.
6th March, 2013: Video Conference on SAMARPAN: CIPS has conducted a Programme on this initiative at the Auditorium of L V Prasad Eye Institute, Hyderabad on Wednesday the 6th of March, 2013.
Sri Nishant Warwade, IAS (through video conferencing mode from New Delhi), Dr. Amar Jyothi Persha, Innovator of Early Intervention Services, Hyderabad, Dr. Arun Singh, Adviser, Health, Govt. of India and Dr. Om Sai Ramesh, NIMHANS, Hyderbad made presentations on "Samarpan" at this programme.
A total of 32 health professionals from different organizations in Hyderabad participated in this conference. There was also participation from 23 Districts from 14 states through the video conferencing mode. It is learnt that the Govt. of India has agreed to include this as one of the items in the NRHM programme all over the country.
30th April, 2013: CIPS has received a response from Dr. Indu Malhotra, IAS, Dy. Commissioner, Barnala of Punjab state, who intends to take forward the Samarpan Programme.
CIPS has facilitated a meeting at Patiala with the officials of Govt. of Punjab, Officials of Barnala dist., and Dr. Arun Singh, Advisor, Ministry of Health and Family Welfare, Govt. of India (who has been associated with the institutionalization of Samarpan in Hoshangabad District, Madhya Pradesh).
11th January, 2013: At the suggestion of the Secretary, DARPG Director, CIPS attended the National Level Collectors Conference at New Delhi.
CIPS noticed the good model of early identification "Development Delay" among children. This is called "Samarpan". This has been implemented in Hoshangabad of Madhya Pradesh by Sri Nishant Warwade, former Collector and presently Dy. Secretary to Chief Minister, Govt of Madhya Pradesh.
CIPS considers that "Samarpan" is a worthy model for replication and implementation all over the country. Accordingly, letters were sent to District Collectors all over the country (numbering 666) in January/February, 2013.

CIPS has facilitated the diffusion of information relating to KIDROP. This is an initiative of NRHM, Karnataka and Narayana Netralaya, Bangalore. This initiative aimms to eliminate Blindness among prematurely born children on account of Retinopathy. It is now understood that Government of India are contemplating the introduction of KIDROP in about 10 states. It is further learnt that this initiative together with other measures of eye care are being considered for integration with universal access to health care.
In the meanwhile, on the basis of the advocacy of CIPS, steps have been taken by states like Rajasthan for integrating this into their NRHM programmes. It is further learnt that states like Bihar are planning to include this into their NRHM programmes. During the discussions of Director, CIPS with Sri Vidyasagar, Prl. Secretary (Health) Jarkhand on 29th December, 2012, the latter indicated that his state would like to include this in the NRHM programmes.

The presentation on Club Foot was made at the workshops conducted by CIPS both at Thiruvananthapuram (February, 2012) and Bangalore (August, 2012). The presentation along with the salient features was circulated to all the States and UTs. At least 5 states have subsequently communicated their desire to include this in their health care programmes.

CIPS has communicated a presentation on Palliative Care which has been made at the workshops conducted at Trivandrum and Bangalore. Four states viz., Maharashtra, Gujarat, Andhra Pradesh and Karnataka have so far communicated their desire to include this in their health care programmes.

As a result of the advocacy of this innovative programme, the state of Haryana sought a meeting on this with representatives of CIPS and NHSRC in Chandigarh on 3rd December, 2012. This meeting was held. A task force has since been constituted for replication of this in the state of Haryana.

A presentation on Early screening of Cervical Cancer of Tamil Nadu was made at the Workshop on Innovations in Goa (December, 2011)and Bangalore (August, 2012). Three states viz., West Bengal, Himachal Pradesh and Jharkhand have shown interest in this model.