Society of Educators for Quality Update for Indian Physicians

PB No 8, Pondicherry India 605006

Introduction: This is about a core group of committed faculty members of a medical college in India. We belong to Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) a primier institute situated at Pondicherry.

1987-89: The beginning:
Initial objectives were to sensitize the young doctor-trainees to the need for Rational drug use(RDU), Essential / Personal-drug Concept(EDC) and Issues relating to Medical Promotion. It was soon apparent that it is necessary to spread the message to medical professional at all levels.

Spreading the Message: A cascade model was planned through which, we trained a core group of key trainers on RDU & EDC and they inturn train others in their locality. A national level workshop was conducted in 1988 and an international workshop in 1989. We linked up with a lot of opinion leaders and networks working on this area. The linkages with the PHARM group of Australia, Karolinska Instituet and Consumer International (then IOCU) were major gains for us. Our Training of Trainers(TOT) on RDU&EDC continued at Kerala in 1990 when we conducted four workshops. We were a key resource group in the national workshop at Vellore, funded by CI and organised by Christian Medical College. We also conduct RDU sessions for medical practitioners.

1990-93: Widening the Scope.
Meanwhile, it was felt by our group that Rationality should be promoted in other areas of medical practice like the usage of diagnostic aids because, misuse of diagnostics is financially more ruinous in the third world. So, we added these modules to our Interns' program. Then it was apparent that Ethical values and Communication skills were needed to practice rational manangement. We added these modules to make an integrated program on Quality Care. This is now a well standardized and structured program of 3 days adopted by many medical schools in India. We have brought out a trainer's manual called "Beyond Rational Therapy" to enable trainers conduct programs like we do.

1993-2000: Expanding the linkages.
It became apparent from our trainees that unless the public, the consumer and the health activists are taken along the path of the rationality and evidence based solutions, the demand for irrational management practices will continue. To facilitate linking with them, we founded an NGO - 'Educators for Quality Update for Indian Physicians(EQUIP), a registered non-profit society. With the help of Consumer International, we invited the health and consumer activists, the media, and legal and medical professionals from India, Malaysia and Australia for a workshop on 'Medicine, Media and Consumer Empowerment' in December 1993. It really opened our minds to different perspectives on complex health care issues. The physician of the group developed a 4-dimensional model of holistic health care which is useful to train junior doctors on holistic perspective. We released a model charter for health care rights called the Pondicherry Declaration which helped consumer groups to push for the Citizen's Charter of Healthcare Rights which has been released by the Indian Government recently.
We are medical resource persons for Federation of Consumer organisations and for Health activist groups like the Voluntary Health Association of India and All India Drug Action Network. The pediatrician in our group is very active in the promotion of rational infant feeding. We are now trying to develop quality indices to assess health care. In short, we have moved from mere rational therapy issue to holistic quality care.

Key for our success and sustained action: The first reason is committment to a worthy cause. People are generally surprised in India when they meet academicians - 'the ivory tower' intellectuals - in activists' meetings. But we believe that if one focusses on the common issue of providing quality health care, rather than on ideological or epistemological differences, then it is possible to climb down the 'ivory tower', interact productively with a mixed group of activists and work towards the common goal. Another reason for sustainance has been to expand our frontiers rather than be content with what we have already achieved. The third reason is to generate working capital by book sale and video sale to keep EQUIP going and also use the official and governmental support whenever feasible.

Lessons learnt: We have shown that a small core group of commited individuals can make big changes but it calls for a sustained effort over a long period of time; that if we work on common issues to achieve a common goal, it is possible to cooperate with many other groups with diverse interests and ideology; that with a little creative problem solving, it is possible to work on issues with a shoe-string budget; that as one achives the initial goal, one must widen the perspectives and identify worthier causes to promote.

Where do we go next? We will maintain leadership in our area of expertise viz., training on quality care for health professionals of different levels. We wish to get funding and other inputs to develop guidelines for Quality Assessment in Healthcare relevant to India. After that, we may move into 'Value Based Medical Education in the 21st century.'