Vision 2025
Government of Rajasthan
Department of Medical Education
Health Vision 2025
1. Preamble
The Government of India recognizes “Health for all” as a national goal and expects medical training to produce competent “Physicians of First Contact” towards meeting this goal. However, the medical education and health care in India are facing serious challenges in content and competencies.
The burden of diseases in India is still large. Though there has been some improvement, national statistics reveal wide disparities between different states as also rural/urban areas with regard to access to basic medical services and quality health care. These are generally attributed to inadequate infrastructure and lack of resources. However, physician shortage, both generalist and specialist, inequitable distribution of manpower and resources, and deficiencies in the quality of medical education also need careful and critical analysis and improvement.
Rajasthan, with a population of 68.6 million accounts for 5.7 percent of the share of India’s population. It has a higher decadal growth rate than India - 21.3 percent as compared to 17.7 percent. Three fourth of the population in Rajasthan lives in rural areas and is spread across over 44,672 villages. Rajasthan has one of the highest proportions of scheduled castes and scheduled tribes population among Indian states - at 17.8 percent and 13.5 percent respectively. Rajasthan has a youth bulge, with over 45 percent of the population under the age of 19 years and only 7.4 percent aged 60 years and above. As the structure of the population consists of such a large number of young people who are at childbearing ages, there is a population momentum and the population of Rajasthan will continue to grow. In terms of geographical area, Rajasthan is the largest state in India and has a low population density of 200 persons per square kilometer as compared with the population density of 382 persons per square kilometer for India (Census 2011).
1.1 Rajasthan - General Profile
State of Rajasthan is situated in western part of India and is the largest State of country in terms of geographical spread (342,239 sqkm. i.e. 10.4% of India's total area).
The State shares its north-western and western boundary with Pakistan, has the international border of about 1,070 Kms that touches Barmer, Bikaner, Sri Ganganagar and Jaisalmer districts. The State of Gujarat lies in south-west, Madhya Pradesh in south-east, Uttar Pradesh and Haryana in north-east and Punjab in north.
The huge portion of the state of Rajasthan is desiccated and houses the biggest Indian desert the ‘Thar’ and the oldest chain of fold mountains -- the ‘Aravali Range’ that splits the State into two geographical zones: Desert at one side and Greener areas on the other.
The Mount-Abu is the only hill-station that houses the Guru Shikhar Peak which is the highest peak of the Aravali-range with an elevation of 1,722 meters. Mount Abu lies at the south-western end of the range, separated from the main ranges by the West Banas River, although a series of broken ridges continues into Haryana in the direction of Delhi where it can be seen as outcrops in the form of the Raisina Hill and the ridges farther north.
About three-fifths (3/5th) area of the State lies north-west of the Aravallis, leaving two-fifths (2/5th) on the east and south directions. The north-western portion is generally sandy and dry. Most of this region is covered by the Thar Desert which extends into adjoining portions of Pakistan.
As per 2011 census the State of Rajasthan has a total population of 6.85 Crores that makes 5.66% of India's total population (121.01 Crore). The State ranks 8th across the States in terms of population.
S. N. |
Particulars |
Rajasthan |
India |
1 |
Total Population |
6.85 Crore |
121.02 Crore |
|
- Male |
3.55 Crore |
|
- Female |
3.30 Crore |
|
|
2 |
Urban/Rural Population |
|
|
|
- Urban Population |
1.32 Crore |
|
- Rural Population |
4.33 Crore |
|
|
3 |
Sex Ratio |
928 |
943 |
4 |
Literacy |
66.11 |
73 |
5 |
Population Density/KM2 |
201 |
382 |
Source: - Directorate of Census Operations Rajasthan
1.4 Decadal Growth
According to the Census 2011 the decadal growth rate of the population in Rajasthan was 21.44 percent compared to 28.41 percent in the previous decennial period between year 1991-2001. It is still higher than the decadal growth rate of India, which was 17.64 percent between 2001 and 2011, and has declined from a high of 21.54 percent during 1991 and 2001. Though the pace of growth has slowed down, still it is higher than the national average. Across districts the decadal growth rate varies from 32.55 percent in Barmer as the highest to 10.06 percent in Ganganagar the lowest.
Table ‑2: Decadal Growth Rate (2001-2011): Rajasthan
|
Urban |
Rural |
Total |
Male |
27.4% |
18.8% |
20.8% |
Female |
30.8% |
19.1% |
21.8% |
Total |
21.3% |
19.0% |
29.0% |
Source: - Directorate of Census Operations Rajasthan
1.5 Population Density
Population density in Rajasthan has increased from 165 per sq.km. During Census 2001 to a corresponding number of 201 in the recent Census 2011. In last 110 years it has increased from 30 in year 1901 to 201 in year 2011. Density varies between 598 in Jaipur (highest) to 17 in Jaisalmer (lowest).
1.6 Sex-Ratio
Average sex-ratio in Rajasthan in terms of number of females per thousand males is 926 which is lower when compared with 940 in case of India. There is a slight increase of five females per thousand males between 2001 to 2011. In last 110 years, between 1901 and 2011, the average sex-ratio in the State has increased from 905 to 926 compared to a decline from 972 to 940 at the national level. The ratio varies across districts between 990 in Dungarpur (highest) to 845 in Dholpur (lowest). The State ranked 20th among the States during Census 2001 and has slide to 21st position in Census 2011.
Child sex-ratio (0-6 years of age) varies between 926 in Pratapgarh to 831 in Jhunjhunu. Except for Sri Ganganagar, there is a decline in the child-sex ratio for all districts. Comparing with other States Rajasthan ranked 28 during Census 2001 and has declined to 29 position during recent census of year 2011.
As per Census 2011 overall literacy rate in the state was 67.06 percent, 80.51 percent among males and 52.66 among females. The corresponding figures for national average are 74.04 percent, 82.14 and 65.46 percent respectively for overall, males and females.
Across Districts in Rajasthan, overall literacy rate varies between 77.48 percent in Kota district (highest) to 55.58 percent in Jalore district (lowest). The male literacy varies between 87.88 percent in Jhunjhunu district to 70.13 percent in Pratapgarh district.
In last one decade the literacy-rate in Churu and Barmer districts has declined both for males and females. The female literacy-rate varies between 66.32 percent in Kota district to 38.73 percent in Jalore district.
In terms of total literacy Rajasthan ranks 33rd amongst 36 States/Union Territories while in case of male and female literacy the State ranks 27th and 35th respectively.
2. Rajasthan - Healthcare Profile
2.1 Human Development Index (HDI)
According to the Annual Health Survey (AHS) 2012-13 Rajasthan had and HDI of 0.434, which was comparatively higher than HDI of 0.387 as per the HDR 1999. And Rajasthan ranked (in India) 17 and 14 in HD 2007 update and HDR 1999 respectively. India reported HDI of 0.467 as per the HD report 2011 and according to HDR (United Nations) 2014 India has HDI of 0.586.
2.2 Infant Mortality Rate (IMR)
According to the Annual Health Survey (AHS) 2012-13 Rajasthan reported IMR at 55 at total. IMR was 59 and 38 in rural sector and urban sector respectively for Rajasthan.
IMR recorded is minimum at 19 in Rudraprayag (Uttarkhand) while in Shrawasti (Uttar Pradesh) was maximum at 103 exhibiting a variation of 5 times. IMR in rural areas of districts is significantly higher than in urban areas.
Also, neo-natal mortality rate and pre-natal mortality rate stood at 37 and 18 for Rajasthan as per the AHS 2012-13.
2.3 Maternal Mortality Ratio (MMR)
As per AHS 2012-13 MMR reported in Rajasthan is 208 and the Maternal Mortality Rate is 20 with a lifetime risk of 0.68% whereas India has MMR at 190 (WHO Report 2013).
CBR refers to the number of live births per thousand mid-year populations. Rajasthan had 24.1 CBR as per the AHS 2012-13, of which the rural sector and Urban Sector constituted of 25.2 and 20.8 CBR. Bageshwar (Uttarakhand) reported minimum Crude Birth Rate (CBR) of 14.7 and maximum reported is at 40.9 in Shrawasti (Uttar Pradesh).
Rajasthan had 6.4 CDR as per the AHS 2012-13, of which the rural sector and urban sector constituted of 6.7 and 5.4 CDR. According to the World Bank report India has CDR of 8. Dhemaji (Assam) has the minimum CDR of 4.5 and maximum is in Shrawasti (Uttar Pradesh) at 12.6.
2.6 Total Fertility Rate (TFR)
According to the Sample Registration System (SRS) Report 2012, TFR for Rajasthan recorded is 2.9, which constitutes 3.1 and 2.3 for the rural and urban sector respectively. Also, India has a TFR of 2.4 as per SRS 2012.
According to Sample Registration System (SRS) in the period 1991-95, life expectancy in Rajasthan was 59.1 years (58.3 for men and 59.4 years for women), 57 and 64.2 years in rural and urban areas respectively. During the same period of time, all India life expectancy figures (60.3 years - 59.7 years for men and 60.9 years for women; 58.9 in rural areas and 65.9 in urban areas) were higher.
During the past five decades, Rajasthan has witnessed some improvement in life expectancy and related measures. According to the Census of India’s estimates, life expectancy in Rajasthan increased from 46.8 years for the period 1951-61 to 53 years for the period 1971-81
2.8 Government Healthcare Infrastructure
At present there are 35 district hospitals, 5 satellite hospitals, 16 sub-divisional hospitals, 551 community health centres, 2066 primary health centres and 13227 sub centres in the State. The healthcare delivery system in Rajasthan comprises of a mix of public and private providers. The public healthcare delivery system is mainly a three-tiered system comprising of a vast network of 14,408 Sub-centers and 2080 Primary Health Centers at the primary level, 571 Community Health Centers, 19 sub-district hospitals and 34 district hospitals at the secondary level, and 8 teaching hospitals and healthcare institutions at the tertiary level (Rural Health Statistics, 2016 and National Health Profile, 2016). The average population served per government hospital bed is 1521 for Rajasthan as compared to 1678 for India (National Health Profile, 2016). The private healthcare delivery system comprises of individual practitioners, small clinics and hospitals and is highly fragmented, with a vast majority of it being serviced by the unorganized sector.
S. N. |
Health Facility |
Nos. |
1 |
District Hospital |
34 |
2 |
Satellite Hospital |
5 |
3 |
Sub-Divisional Hospital (SDH) |
19 |
4 |
Community Health Centres (CHC) |
571 |
5 |
Primary Health Centres |
2080 |
6 |
Sub Centres (SC) |
14408 |
7 |
City Dispensaries |
195 |
8 |
Block |
249 |
9 |
High Focus Blocks |
50 |
10 |
Government Blood Bank |
44 |
11 |
Identified Delivery Point |
1665 |
12 |
Trauma Centres |
58 |
13 |
108 Ambulances |
649 |
2.9 Government Medical Colleges
State has total 8 governments medical colleges of which 2 are situated in Jaipur, 1 each at Jodhpur, Ajmer, Udaipur, Kota, Bikaner, and Jhalawar.
S. N. |
Medical College / Institution |
Location |
Annual Intake (Seats) of MBBS Course |
1 |
Dr. S. N. Medical College |
Jodhpur |
250 |
2 |
Sardar Patel Medical College |
Bikaner |
250 |
3 |
S. M. S. Medical College |
Jaipur |
250 |
4 |
Government Medical College |
Kota |
150 |
5 |
Jawaharlal Nehru Medical College |
Ajmer |
150 |
6 |
R. N. T. Medical College |
Udaipur |
150 |
7 |
Jhalawar Medical College |
Jhalawar |
150 |
8 |
RUHS College of Medical Sciences |
RUHS |
100 |
Total |
|
1450 |
2.10 Medical Colleges under Rajasthan Medical Education Society (RajMES)
The following five medical colleges have been permitted each for 100 MBBS seats from the academic year 2018-19:-
S. N. |
Medical College / Institution |
Location |
Annual Intake (Seats) of MBBS Course |
1 |
Medical College, Bharatpur |
Bharatpur |
100 |
2 |
Rajmata Vijaya RajeScindia Medical College, Bhilwara |
Bhilwara |
100 |
3 |
Pandit Deendayal Upadhyaya Medical College, Churu |
Churu |
100 |
4 |
Medical College, Dungarpur |
Dungarpur |
100 |
5 |
Medical College, Pali |
Pali |
100 |
|
Total |
|
500 |
2.11-Proposed new Medical Colleges under Rajasthan Medical Education Society (RajMES)
S. N. |
Medical College / Institution |
Location |
Proposed Annual Intake (Seats) of MBBS Course |
1 |
Medical College, Barmer |
Barmer |
100 |
2 |
Medical College, Sikar |
Sikar |
100 |
Total |
|
200 |
2.12-Proposed new Medical Colleges at Dholpur under Phase-II
S. N. |
Medical College / Institution |
Location |
Proposed Annual Intake (Seats) of MBBS Course |
1 |
Medical College, Dholpur |
Dholpur |
100 |
2.13-Private Medical College
State has total 8 Private Medical colleges
S. N. |
Medical College / Institution |
Location |
Annual Intake (Seats) of MBBS Course |
1 |
M.G.Medical College |
Jaipur |
150 |
2 |
NIMS Medical College |
Jaipur |
100 |
3 |
Geetanjali Medical College |
Udaipur |
150 |
4 |
Pacific Medical College |
Udaipur |
150 |
5 |
Jaipur National University Medical College Jaipur |
Jaipur |
150 |
6 |
Ananta Institute of Medical Sciences |
Rajsamand |
150 |
7 |
Pacific Institute of Medical Sciences |
Udaipur |
150 |
8 |
American Institute of Medical Sciences |
Udaipur |
150 |
Total |
|
1150 |
3. Scope
· State faces a challenge of a double burden of diseases, where communicable disease burden still accounts for significant proportion of disease burden. In 2012 out of total number of DALYs lost 33% were attributed to this disease. There is rising morbidity and mortality cost attributable to non-communicable diseases. They are collectively responsible for an estimated 60% of premature deaths. The most of treatment part is being dealt at medical college attached and private hospitals while prevention is basically related to State Health System ( Medical and Health Department in Rajasthan)
· The Department of Medical and Health is going to strengthen Primary and Secondary level health care facilities in State and implement Vertical Health Programs effectively in field through district level institutions and peripheral health beneficiaries.
· The Department of Medical Education is basically key agency for providing Health Human Resource to the State Health System in terms of doctors, nursing staff, paramedical and other allied areas.
· The Medical College attached hospitals are the Tertiary Health Care providers in the State Health System dealing with referred and complicated cases.
· The Department also have got main objective of providing training, skill development to the health manpower and also work for research and development in the field of medicine and health.
3.1 Goal
Specific Health Goals
Reduce MMR to less than 120/per lack live Births
Reduce IMR to less than 30 per thousand live births
Reduce Under Five Mortality to less than 38 per thousand live births
Reduce Total Fertility Rate to 2.1
Reduce Incidence of TB to 130 per lac
Reduce API for Malaria to less than One
Reduce premature mortality from cardio-vascular diseases, cancer, diabetes or chronic respiratory disease by ¼ of NFHS-4 level.
Reduce out of Pocket Spending from 62.4% to 50% of total expenditure.
Medical College in all districts and 250 UG seats in all Government Medical Colleges.
PG seats 75% of UG seats and Nursing and paramedical courses in all medical colleges.
To ensure adequate number of highly skilled doctors equitably distributed in rural and urban areas across the State of Rajasthan.
To develop Medical College Hospitals as centers of excellence for training, research and referral centers for State Health System.
"Public health and minimum essential clinical interventions require about 1 physician per 1000 population (1993 World Development Report, the World Bank) (GOI target) It may be achieved by 2028. Planning Commission High Level Expert Group (HLEG). To achieve all district hospitals to be developed in to medical colleges with nursing and paramedical training.
Country has to attain the minimum 23 doctors, nurses and mid-wife per 10,000 inhabitants recommended by WHO under MDG. The population Ratio of State is 0.41 per 1000 as compared with 0.61 of National level. 1:1722
4. Achievement of the expected health outcomes will require.
a. Adequate investment of Public financial resources in health
b. Efficient prioritization of spending with greater emphasis given to Preventive health care rather than the curative care.
c. Adequate attention by the Government to the stewardship of organizing the health sector in its entirety without focusing exclusively on the provisioning of health care.
d. Addressing challenges in human resource for health in terms of numbers, distribution, quality and skill mix.
e. Sufficient focus on the convergence with programmes addressing the key social determinants of health (nutrition, drinking water and sanitation)
5. Vision:
While the context is complex, the vision of healthy State calls for re-prioritization of our goals. We also need to re-deliberate the usefulness of our long-term strategies. Over the course of next three years the health care system in country must prioritize the public health and shift from being curative to preventive. Public health is the science of protecting and improving health of families, communities through promoting healthy life-style, and research for disease and injury prevention and detection and control of infectious diseases. Overall the public health is concerned with protecting the health of entire population.
6. Need for more doctors and medical colleges
The current estimated doctor population ratio in India is 1:1722 as compared to a world average of 1.5:1000. It was communicated that the targeted doctor population ratio would be 1:1000 and achievable by the year 2031. For achieving this target & considering the number of existing Medical Colleges in the country, it was felt that the current intake by Medical Colleges and the critical mass of doctors would be rationally enhanced. However, the medium and long-term goals, the need for more medical colleges need to be met, primarily through the Govt. support.
The State of Rajasthan needs minimum of 16-18 Medical Colleges as per norms (one college for 50 lacs, Mudaliar committee 1962) but to achieve the standard doctor population ratio we need to have medical colleges in each district by developing district hospitals in to medical colleges. Apart from this the UG seats in all Government Medical colleges need to be increased to 250.
State of Rajasthan is not only facing challenges in terms of high maternal and child mortality indicators but is also staggering with poor manpower resources like poor doctor population ratio. State has 16 Medical Colleges including 8 Medical Colleges from Private Sector.
7. New Medical College attached to district hospitals.
With a view to utilize existing resources for developing new medical colleges in short period all district hospitals with more than 300 beds can be developed in to medical college. In long term all district hospitals to be developed as medical colleges.
State has to develop dedicated Medical Education Society with a view to have flexibility in getting additional revenue generation and also facilitate PPP mode wherever possible with leveraging States Budgetary resources and providing attachments with District Hospitals with more than 300 bed capacity. The cabinet decision has been taken to have Rajasthan Medical Education Society (Raj-MES) and run new medical colleges through the society to help the process.
The State entered in to MoU with GOI for 7 new medical colleges attached to existing district hospitals in July 2014. Out of these 5 medical colleges have been started at Bharatpur, Churu, Pali, Bhilwara, Dungarpur with intake capacity of 100 MBBS seats each total increase in 500 MBBS seats.
Running of these medical colleges will pose a great challenge before the State Government including deployment of medical teachers especially in remote areas like Dungarpur, Barmer. To take care Rajasthan Medical Education Societyhas been established for running these colleges and deploying the faculty and other staff, going for fast recruitment and procurement by having flexibility in time consuming office procedures. Society shall also help developing a financially viable model to operate on a no-profit, no-loss / minimal profit basis so that these colleges centre run smoothly and its sustainability is ensured.
8. Running Medical Colleges on PPP Mode:
As per MCI norms a fully functional 300 bedded (later to be upgraded to 500 beds) Hospital with Bed Occupancy Rate of more than 70% (Initially 60%) is first requisite to start a new college for first year. Recently MCI has permitted that the Government hospitals can be attached with Private Medical Colleges through an agreement of 33 years. Private Partner can be invited to procure land within 10 kms of existing District Hospital and submit proposals for running district hospital on PPP by attaching it with Medical College. There are 15 District Hospitals in State with bed strength of 300 or more than300 which can be utilized to start a new Medical College. We are in process of formulating a policy to invite autonomous society/Trust/ Company who can run a Medical College if the institution is attached with the existing Government Hospitals. Later PSP may be allowed to develop his own hospital also and the PPP can be on ROMT (Repair, Renovate, upgrade, operate, maintain and transfer) basis.
9. Increase in UG seats:
With a view to have more doctors with existing medical colleges and promote meritorious students of low socio-economic group all existing State Medical college can be up graded in terms of increasing UG seats to have maximum intake capacity. All existing Government Medical Colleges can be developed to 250 seated Medical Colleges which can enhance UG capacity of Government Medical Colleges substantially. CSS for strengthening of State Medical Colleges shall not only be restricted to increase in PG seats it should also include strengthening and capacity building for UG seats. The state requires central assistance for strengthening of infrastructure like hostel facilities and Lecture theatres. Government has also requested separate funds for strengthening of Hostel facilities under CSS.
There are 1150 MBBS seats in private medical colleges in 3 private medical colleges situated at Jaipur and 5 at Udaipur but in view of the high cost of education in these medical colleges the students passing out of these colleges intends to join private sector which is mainly concentrated in urban areas. But in case if number of medical colleges are also increased by liberating the policies for establishment of private colleges the cost of education in private sector can also be reduced to certain extent.
10. Increase in PG seats and new certificate courses to take care of demand of specialists in peripheral health system:
State Health System also has shortage of specialists in referral units, apart from the number of posts sanctioned the vacancy percentage is more than 50% which is an important factor as far as maternal and child mortality is concerned most of the referred complicated cases do not get specialist care within a manageable inter-health centre distance and patients succumb to their complication. These include specially gynaecology, paediatrics, anaesthesia, orthopaedics, radiology especially for the cases requiring critical care treatment. At many places, manpower is not there to take care of special instruments and for treatment and diagnosis of complicated cases.
The number of PG seats in Government Medical Colleges has been increased in recent years from about 415 to 1105 but it still needs to be increased to take care of existing demand and for providing opportunities to the state university MBBS students this is also important looking to the upcoming new government medical colleges in the State.
Starting equivalent PG diploma courses. CPS (College of Physicians and Surgeons), DNB(Diplomat National Boards) courses can be started in district hospitals especially where work of up-gradation is already going on. This can provide additional manpower for the State Health System.
11. Strengthening Tertiary Care in Medical College attached Hospitals:
Looking to the rapid advancements in modern medicine, more importance is to be paid to training and research and decongesting medical college attached hospitals by minimizing unwanted patient load by developing a good referral system
The system of Primary, Secondary and Tertiary health care system and referral system is skewed in state resulting in distorted pyramid of health care. The patient load in tertiary health care system is heavy and the occupancy in medical college attached hospitals is more than 100% whereas the average occupancy in peripheral hospitals and health centres is less than 50% this is resulting in increasing expenditure of tertiary health care system are out of about 46000 beds. 1/3are with medical college attached hospitals but as the occupancy is high the patient load may be larger than the peripheral beds. Strengthening of tertiary care regularly with provision of free drugs and diagnostics the patient load on tertiary health care system is further increasing. The issue needs to be addressed specifically through electronic management system in OPD using online registration, display boards in OPD and large waiting areas in OPD and investigation areas.
12. Integrated Hospital Management & Information System
The Medical College hospitals in Rajasthan are catering to major chunk of indoors in state IPD in health system. The influx of patient is not only from within the state but patients from neighboring states are also coming to these hospitals in a significant number. Today the annual OPD of SMS Hospital has crossed 30 lacs and is largest in country. Looking to the increasing patient load and disease burden on tertiary care centers i.e. medical college attached hospitals it is very important to manage for the security, cleanliness, sanitation, waste management and infection control practices. Local arrangements with routine tender process and involving manpower are causing multiple problems in managing the medical college hospitals. The problems of resident strike due to disturbed security arrangements also add to the problem. In view of this it is essential to outsource the services to a professional agency that has good experience in managing big hospitals in terms of security and cleanliness; they also use mechanized systems for cleanliness which is cost saving in big establishments.
As a side effect with increasing trends of Non- Communicable Diseases along with other socio-economic factors due to increasing urbanization and industrialization generating stress and other factors responsible for psychiatric illnessesare producing increasing burden of Psychiatric morbidity which isof great concern in State.
Psychiatric Centre of SMS Medical College Jaipur has got adequate land and infrastructure for development as Centre of excellence under National Mental Health Programme. State Government is willing to provide necessary manpower support for starting PG courses in Psychiatric Social, Psychiatric Nursing, and Clinical Psychology. Psychiatric Centre has adequate number of Medical Teachers in Psychiatry. State needs central assistance for developing the centre.
13. Promoting Research: Multidisciplinary Research Units in all Medical colleges, Rural Health Research and re-orientation of Medical Education.
There is a dire need to promote research at tertiary level institutions. Indian Council Medical Research (ICMR) is supporting establishment of Multidisciplinary Research Units (MDRU) including up gradation of virology laboratories for research and other purposes like dealing with resurging and emerging viral infections causing epidemics and pandemics in State. The laboratory will help in identify newer strains and estimation of load of disease in state. This will help in improving laboratory disease surveillance in the state and will prove a boon to the integrated disease surveillance program (IDSP). Apart from this Model Rural Health Research Unit (MDRU) shall be established in all medical colleges presently the Unit has been established at Jaipur only. This will help in identifying the disease pattern in the rural areas of the state which is more than 70% of the population of Rajasthan.
Apart from this the existing curriculum needs to be oriented in context of need of the community for actual prevention of diseases and promotion of health so that the burden of diseases and load on tertiary level health care facilities is reduced.
14. Fighting Non-Communicable Diseases-Super-speciality facility in all hospitals
With a view to take care of complications resulting in high mortality due to increasing burden of non-communicable disease. Super-speciality facilities are underdeveloped in all medical colleges except SMS Medical College Jaipur. 90% of the DM/MCh seats are at Jaipur. (Out of about 93 seats more than 80 are at Jaipur) Other medical colleges need attention for development of major super-speciality including Cardiology, Cardiovascular and Thoracic Surgery, Neurology, Neurosurgery, Urology, Nephrology, Paediatric Surgery, Plastic Surgery, endocrinology etc. Apart from this up-gradation of all existing hospitals by getting NABH and NABL accreditation is also required looking to the future needs and improving quality of services.
Government of India under PMSSY-III has initially planned to establish super speciality blocks at Udaipur, Kota and Bikaner. The Project Cost is Rs.150 Cr. with 25% State Share. This will take care of civil works and equipment but the problem of super specialist needs to be addresses on priority. We need these facilities in all existing medical colleges. The State will have to plan for inviting super specialists from say open market by lucrative packages this will require policy decision to have flexibility in recruitment process or make necessary amendments in existing recruitment rules (Rajasthan Medical Services (collegiate branch Rules, 1962) to take care of the and decentralizing recruitment process through newly created Directorate of Medical Education.
Consultancy Agency for concept to commissioning has been engaged by the Government of India for this project. Gap analysis and detailed project report has been prepared and presented before GOI. Construction is going on the Project may take about 12 months for completion as regards civil works and procurement of equipment and deployment of faculty is concerned.
After completion of this project or simultaneously Jodhpur and Ajmer may also be included for that either we may request GOI to extend the provisions or to create provision in state budget for planning such blocks in other medical colleges.
15. Strengthening of teaching and training in medical colleges for improving quality.
Following steps may be initiated in all Government Medical Colleges
1. Collaboration with national and international institutions of repute for technical support and knowledge exchange programs.
2. Development of paramedical sciences in all medical colleges.
3. Use of modern gadgets and equipment for teaching and training.
4. With a view to improve surgical skills and increasing quality of training without involving trainees in live surgical procedures modern surgical teaching needs simulators. Looking to the financial constraints we also need central assistance in terms of funding support or equipment.
5. Establishment of State-of-The-Art e-class rooms and e-library in all Medical Colleges.
6. Tele-medicine centres in all Medical Colleges.
7. Establishment of Multidisciplinary Research Units in all Medical Colleges.
8. Development of information and data centre in each medical college.
9. 24x7 Control rooms in all medical colleges.
10. The teaching in training in medical colleges should be re-oriented in such a manner that the students PG/UG get exposure to the public health problems and become aware of the national health programs. The training period and internship should be made fruitful so that the student graduating from the system become more useful to State Health System
16. Development of Cancer Centres
Cancer has emerged as important morbidity and mortality contributor out of major Non-Communicable diseases. The Government of India is promoting establishment of Tertiary Care Cancer Centres (TCCC) and State Cancer Institute (SCI) in Rajasthan under National Program for Prevention and Control of Cancer, Diabetes and Cardio-vascular Diseases and Stroke. Cancer patients from within the State and from neighbouring States are continuously increasing and it may reach to a tune of about 20000 patients per year. The patients from other states are also coming to S.M.S. as Jaipur is having good connectivity and transport facilities available. Looking to the limited medical and surgical facilities already available at S.M.S. Hospital facilities may be upgraded and extended by having a State Cancer Institute at RUHS as extension of these facilities as adequate land is not available in SMS Medical College and a separate Cancer Centre of excellence can be established with 500 bed capacity. We have adequate space available at Rajasthan University of Health Sciences campus.
The vision of Government of Rajasthan is to establish one SCI as a State-Of-The-Art Centre of Excellence for management of cancer patients in the State. Because of the challenge of availability of land under SMS Hospital, Jaipur, the State decided to establish SCI under RUHS College of Medical Sciences. This would also help decongest SMS Hospital, Jaipur of cancer patient load. The nomenclature should be frozen as State Cancer Institute and as Tertiary Care Cancer Centres and that the words State-Of-The-Art Centre of Excellence may be used separately for describing the centres but not in nomenclature.
The State Government desires to provide beautiful landscaping and greenery for SCI and segregation of services for cancer management based on time and payment capacity, with free services provided to BP patients and premium charges for services from APL patients, based on which the services would be cross-subsidized to BPL patients.
A Charitable Foundation shall be established for running the SCI which shall operate on a no-profit, no-loss / minimal profit basis so that the centre runs smoothly and its sustainability is ensured.
Establishing SCI may take about 24 months once the work starts and TCCCs may take about 12 months after start of work for its completion. The work of establishing these centres should be allotted on turnkey basis, and the construction work should be given preferably to private agencies having capacity of executing large projects.
With regard to construction of proposed centres, the prototype of Tata Memorial Centre should be followed – which recommends a constructed area of 3,000 ft2 per bed and estimated construction cost of Rs. 3,500 / ft2. For SCI the estimated constructed area for 200-bedded cancer centre would be about 6, 00,000 ft2 and an estimated cost of about Rs. 210 crores which would be about Rs. 234 crores on account of cost escalation @ 10% in second year.
For establishing SCI as a State-Of-The-Art Centre of Excellence, services of architects and technical experts of international repute, who have expertise in designing such a centre, should be hired by the Government.
A visit by a delegation from Government of Rajasthan should be made to other such institutes of national / international repute to learn the process of establishment of such centres and also to observe the processes for providing quality services to cancer patients.
Funding requirement for establishing SCI would be much in excess of Rs. 120.0 crores available under Centrally Sponsored Scheme – with an estimated Rs. 442.0 crores required for construction and equipments alone. Annual recurring liability for running SCI as a research oriented and client centred centre will be about Rs. 50-70 crores.
Alternative sources of funding would be required for establishing SCI – from Govt of India, Govt of Rajasthan, and Atomic Energy Regulatory Board (AERB), from Tata Atomic Energy, Rotary International and other philanthropic persons / organizations or by other means.
With regard to recruitment of service providers and managers for SCI, a Screening and Interview Committee comprising of renowned professionals of international repute should be constituted, and advertisement for the positions should be published nationally and internationally; good pay scales and incentives should be paid to the service providers recruited for the SCI. Professionals and specialists for SCI should be hired totally on a non-practicing basis – they should not be allowed to practice so they could exemplify their commitment to quality clinical care of patients to meet the standards of a Center of Excellence and also devote sufficient time and effort for basic and applied research. The professionals recruited for SCI through the Screening and Interview Committee should be such that they have a holistic approach towards patient care incorporating best clinical care of patients with commitment for which they should be non-practicing, research oriented and very good mentoring skills.
A Recruitment Committee / Board for recruitment of qualified, knowledgeable, skilled, competent and committed professionals of national / international repute who can help create a Centre of Excellence for patient care and research.
SCI should have sufficient focus on research, both basic and applied for cancer management and 10-20% of grant for SCI should be earmarked as incentive for Research Scholars / Investigators.
A State level Advisory Committee should be constituted which should also include eminent persons of national / international repute (both academic / non-academic professionals) and there must be provision of reimbursement / payment by State Government. Alternatively, they may be called as special invitees for the consultation meetings for which provision should be made for their travel, stay, per diem, etc. Other Specialists should also be included in the Advisory Committee – like Pathologist, Radio-diagnosis Expert, Blood Bank Expert, Radiation Physicist, Nuclear Medicine, etc. This Advisory Committee would guide on important technical matters for clinical care of cancer patients, for research and for mentoring of other institutions.
Revenue generation should be an integral part of SCI for sustainability and the ultimate decision will be left for policy decision and political will – whether it would provide gap funding on account of the deficit till the SCI becomes self-sustainable, or the Government would authorize the Society / Foundation constituted for SCI to charge from patients, including BPL patients; in such a case, if BPL Patients are to be treated free at SCI the government may be charged for their treatment by way of reimbursement.