|Year : 2012 | Volume
| Issue : 2 | Page : 116-119
Capacity building of AYUSH practitioners to study the feasibility of their involvement in non-communicable disease prevention and control
Dinesh Kumar, Sunil Kumar Raina, AK Bhardwaj, Vishav Chander
Department of Community Medicine, Dr. R. P. Government Medical College, Tanda, Himachal Pradesh, India
|Date of Web Publication||20-Sep-2013|
Sunil Kumar Raina
Dr. R. P. Government Medical College, Tanda, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Background: Sharing of public health knowledge and skills by professionals in allopathic system of medicine with Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) professionals in India has always been considered as part of integrating the health system in India. But till date, a curriculum has not been framed for follow-up.
Materials and Methods: A training course was developed for AYUSH professionals in India on the public health principles for the prevention and control of non-communicable diseases (NCDs). Three course chairs interacted with international and national public health and AYUSH experts, and the curriculum for a 3-month course was developed.
Results: The curriculum comprised interactive lectures, problem-based exercise, field visits, and research protocol development. A total of four participants, nominated by the World Health Organization, India, were trained during the course, with significant ( P = 0.00) improvement in knowledge from 53.2 to 80.0 points.
Conclusion: A novel and feasible public health course for complementary and alternative medicine professionals on the public health principles for NCDs' prevention and control is needed to bridge the demand gap for public health professionals in India.
Keywords: AYUSH course, non-communicable disease, public health
|How to cite this article:|
Kumar D, Raina SK, Bhardwaj A K, Chander V. Capacity building of AYUSH practitioners to study the feasibility of their involvement in non-communicable disease prevention and control. Ancient Sci Life 2012;32:116-9
|How to cite this URL:|
Kumar D, Raina SK, Bhardwaj A K, Chander V. Capacity building of AYUSH practitioners to study the feasibility of their involvement in non-communicable disease prevention and control. Ancient Sci Life [serial online] 2012 [cited 2023 Feb 5];32:116-9. Available from: https://www.ancientscienceoflife.org/text.asp?2012/32/2/116/118552
| Introduction|| |
In India, one-half of the disease mortality occurs due to non-communicable diseases (NCDs) like cardiovascular diseases (CVDs), diabetes, hypertension, depression, and cancer, and control of their common risk factors remains an important public health strategy for their prevention and control. In resource-poor countries like India, the low doctor to population ratio (60 per 1000 population) has been posing difficulty for health care provision. It is important for all to note, however, that Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) practitioners have been providing health care to the people through 2860 hospitals across India., This probably has formed the basis for the use of AYUSH in the National Rural Health Mission (NRHM) with the main objective of improving the provision of health care services.
NRHM has identified the role of AYUSH in various national health programs. Their services can be utilized in both formulation as well as evaluation of public health interventions. But such an effort has not been tried in terms of developing a structured course/curriculum. Keeping this in view, a 3-month course was designed on the principles of public health for the prevention and control of NCDs.
| Materials and Methods|| |
Course concept and design
The course for AYUSH professionals was conceptualized by three course chairs at Dr. Rajendra Prasad Government Medical College (Dr. RPGMC), Himachal Pradesh in June 2011. During the serial meetings held with the content experts from AYUSH educational and training institutions like Dr. Rajiv Gandhi Post graduate Government Ayurvedic College; Government Homeopathic College, Himachal Pradesh; and Department of AYUSH, Ministry of Health and Family Welfare, Government of India, in July and August 2011, the course contents were finalized. Later, the course was structured and discussed with international experts in September 2011. After incorporating opinions from the national and international experts, the course was finalized and administered to four AYUSH professionals from October to December 2011 (3 months). From the interested AYUSH professionals who had applied to the World Health Organization (WHO), India, the eligible participants for the course were scrutinized and selected independently by the WHO and were nominated for the course at Dr. RPGMC.
Course evaluation and statistical analysis
Tests were undertaken before and at the end of the course to assess the improvement in knowledge of the course participants. Pre-course test was both objective and subjective and post-course test was subjective in nature, which was followed by viva voice conducted by independent public health experts (not involved during finalization of the course). The pre-course test was for 30 points (objectivity: 20; subjectivity: 10) and the post-course test was for 100 points. As the total points of the tests were different, the score of each participant for each of the tests was converted to a relative scale having maximum score of 100. For example, if the score of a participant was 10 out of a maximum score of 30, then the score of the participant on a common scale having maximum score of 100 would be 33.3, i.e., [(10/30)× 100]. Since there were only four study participants, Wilcoxon signed rank test for matched pairs was used to observe significant changes in the knowledge.
| Results|| |
Course description: Participative sessions
Didactic lectures were delivered in the forenoon and afternoon sessions and each lecture was followed by a problem-based practical exercise. Experienced public health professionals interacted with AYUSH professionals during the lectures focusing on epidemiology, biostatistics, surveillance, writing of study protocol, health promotion, standard treatment guidelines, health resources and finance management, health legislation, and equity.
Week 1: NCD epidemiology
It covered important topics like the burden of NCDs and the state of epidemiological transition in developing countries and India. The role of social, political, environmental, cultural, and economic factors in the development of NCDs was stressed. Genetic determinants of NCDs like thrifty gene hypothesis, along with novel risk factors of NCDs like C-reactive protein (CRP), homocysteine, serum amyloid A (SAA), fibrinogen, adhesion molecules, cytokines, lipoproteins such as lipoprotein (a), small dense lipoproteins, and apolipoproteins were also discussed.
Week 2: Epidemiology, biostatistics, and surveillance
Basic biostatistics methods like types of data, measures of central tendency and dispersion, and measure of disease were practiced. Techniques for NCDs' surveillance like (STEP wise approach to Surveillance) approach to assess the burden and trend, along with, its (STEPS) feasibility in AYUSH discipline was discussed with the participants.
Week 3: NCDs' prevention and control
The concepts of primordial, primary, secondary, and tertiary prevention for NCDs were discussed. Various methods to recognize and identify the role and responsibilities of global, regional, national, and local stakeholders in NCD management and prevention were studied. In addition, the worldwide experiences of various community-based NCDs interventions were shared.
Week 4: Behavioral and social sciences in health
Determinants of health including the global strategy for diet, physical activity, and health (DPAS) as also framework convention of tobacco control (FCTC) were deliberated upon. Principles of counseling for patients of substance abuse were discussed and its methods were demonstrated in the clinical and community settings.
Week 5: Public health interventions
Evidence-based public health interventions for NCD control with country wide experiences in India were studied.
After the discussion of each successful intervention, an assessment was done to identify the potential role of an AYUSH professional in the intervention.
Weeks 6 and 7: National health programs
National Program for Prevention and Control of CVDs, Diabetes Mellitus, Cancer, and Stroke (NPCDCS) along with the overview of the NRHM was discussed. National Program for Control of Blindness and Deafness was discussed and the role of AYUSH in the screening of patients with blindness and deafness was also identified. Other programs like National Mental Health Program, National Iodine Deficiency Disorder Control Program and Micronutrient Deficiency, and national nutritional programs were shared with the participants. Healthy aging and models of geriatric health care were also discussed.
Weeks 8-10: Health promotion
Important areas like health field concept and sickness carrier, along with explanatory models like empowerment model, health belief model, and health action model were explained and discussed. Participants were made aware about the values, beliefs, attitude, and normative system as the important factors influencing health. Various macro- and micro-level strategies that influence health behavior and their evaluation methods were discussed. The role of AYUSH in health promotion and evaluation was identified and discussed with the course participants. Research design issues in health promotion along with tale of three errors were shared with the participants.
Week 11: Occupational health, injury, and disaster management
The role of surveillance and Haddon's matrix to ascertain the determining factors for injury was emphasized. Various sources for injury surveillance and their limitations were also analyzed with the group.
Week 12: Financial management and advocacy
Financial management issues, costing and analytical techniques, along with cost-effectiveness analysis, utility, and benefit analysis were discussed. The role of evidence building and advocacy for NCD prevention and control was shared with the participants.
Participants interacted with the policy makers, administrators, and program managers to discuss the operational issues related to the program for NCDs' prevention and control during field visits. Focussed group discussions were arranged with the community members to assess the health needs of the community.
Each participant was assigned an independent supervisor for a research project during the second week of the course. Project protocol was prepared and approved by the departmental committee by the end of the first month of the course. During the second month of the course, 15 special afternoon sessions were assigned to each participant to collect and analyze the data.
Course test scores
The four participants - Homeopathy (2), Ayurveda (1), and Unani (1) - had an average 10 years of working experience after completion of their 5-year undergraduate training course of the respective discipline. Knowledge score of the participants increased significantly (P = 0.00) from 53.2 (range 40.0-70.0) to 80.0 (range 60.0-80.0) points.
| Discussion|| |
Human resource development is required for NCDs' control. One way of doing this is through capacity building of the available human resource. NRHM has emphasized the mainstreaming of Indian System of Medicine (ISM) and the potential role of AYUSH professionals in the field of health care. Transfer of technical public health knowledge and skills through organization of training courses for AYUSH professionals is needed.
In the present study, knowledge of the participants has shown improvement up to 30 points. No such experience is found in the medical literature. The other courses like a 2.5-day Evidence-Based Medicine course for surgeons and an 8-day Integrated Management of Neonatal and Childhood Illness (IMNCI) showed improvement up to 10 points and 40 points, respectively., Improvement of knowledge depends on the course contents, structure and quality of lecture, and effective communication.
Team-based learning (TBL) approach had been observed to be significantly efficient for the gain in knowledge of the study participants. It helped in acquisition of new knowledge and analytical reasoning skills among the participants. As WHO independently nominated the interested AYUSH professionals for the course, coincidentally, in the present course, presence of four participants itself constituted a team and, therefore, they learned through TBL approach. It made the communication effective during lectures and problem-based exercises. Problem-based learning (PBL) was also observed to be very effective in acquiring knowledge., Post lecture, problem-based exercise was rated very effective by the participants during feedback sessions.
Building human resource for health has been an important domain in resource-poor settings. With the background of low public health workforce, capacity building of the existing health workforce by organizing training courses of public health becomes important. The present study showed that the AYUSH professionals can be trained in public heath principles and methods for the prevention and control of NCDs in India.
Limited number of participants led to insufficient statistical evidence in the present study, but it did not stop us to introduce the feasibility of such a course.
Formal construct validation of the course and test was not undertaken, but the experiences of chairs and experts produced adequate face and content validity of the course, which was sufficient to enhance knowledge and skills.
| References|| |
|1.||Jha P, Gajalakshmi V, Gupta PC, Kumar R, Mony P, Dhingra N, et al. Prospective study of one million deaths in India: Rationale, design and validation results. PLoS Med 2006;3:e18. |
|2.||Mullan F. Doctors for the World: Indian Physician Emigration: The Market Rules. Health Affairs. 2006;25:380-93. Available from: http://www.india-reports.in/future-growth-global-transitions/economy-in-transition/doctors-per-one-hundred-thousand-people-in-india/. [Last updated 2009 Nov 7; cited 2012 Apr 24]. |
|3.||Debas HT, Ramanan LR, Straus SE. Complementary and Alternative Medicine. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, et al., editors. Disease Control Priorities in Developing Countries. 2 nd ed. New York. USA: Oxford University Press; 2006. |
|4.||Ministry of Health and Family Welfare, New Delhi. National rural health mission: Mission document. [document on the internet] 2005 Jun. Available from: http://www.mohfw.nic.in/NRHM/Documents/Mission_Document.pdf. [Last accessed on 2012 Apr 24]. |
|5.||Sprague S, Pozdinakova P, Kaempffer E, Saccone M, Schemitsch, EH, Bhandari M. Principles and practice of clinical research course for surgeons: An evaluation of knowledge transfer and perceptions. Can J Surg 2012;55:46-52. |
|6.||Kumar D, Aggarwal AK, Kumar R. Interrupted 5-day training on Integrated Management of Neonatal and Childhood Illness (IMNCI): Effect on the knowledge and skills of primary health. Health Policy Plan 2009;24:94-100. |
|7.||Okubo Y, Ishiguro N, Suganuma T, Nishikawa T, Takubo T, Kojimahara N, et al. Team-based learning, a learning strategy for clinical reasoning, in students with problem-based learning tutorial experiences. Tohoku J Exp Med 2012;227:23-9. |
|8.||Sangestani G, Khatiban M. Comparison of problem-based learning and lecture-based learning in midwifery. Nurse Educ Today 2012 [Epub ahead of print]. |
|9.||Dehkordi AH, Heydarnejad MS. The impact of problem-based learning and lecturing on the behavior and attitudes of Iranian nursing students. A randomised controlled trial. Dan Med Bull 2008;55:224-6. |
|10.||Ramachandran P. Human resources for health. Indian J Med Res 2006;123:485-8. |