04 powerpoint presentation of natl strategy ssil

Joint Donor Technical Assistance FundDeveloping National Strategy for AMC

COMPLEMENTARY and ALTERNATIVE MEDICINE

(CAM)

in BANGLADESH

NATIONAL STRATEGY AND ACTION PLAN

(Draft)

AMC Division

DGHS

MoHFW

GoB

1


Introduction

• Delivery of services• Education and Training• Regulation of Education and Practice• Quality of drugs• Cultivation and Conservation of Medicinal Plants• Research• Programme Management

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Guiding Principles for developing strategies and action points:

• Wherever possible, preference be given to strengthening existing organizations instead of creating new ones; and

• Similarly, preference be given to scaling up and replicating models / arrangements which are known to have worked instead of a de-novo search or design.

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Delivery of Services

Expand availability of CAM services and medicines so that these are available at all levels of care in the public health system.

Medical College Hospitals: District Hospitals: Upazila Hospitals: Community / Village level: Urban Slums:

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Medical College Hospitals: Establish a CAM Unit in every medical college hospital

• Separate CAM-OPD registration counter in the registration area• 1 Medical Officer from each of the 3 disciplines –

– Unani, – Ayurvedic and – Homeopathy

– Shared support staff (1 pharmacist and 1 office attendant)

– The Gardener to be trained and re-deployed to manage the OPD registration counter

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District Hospitals: Set up a CAM Unit in every district hospital

• A separate CAM-OPD registration counter in the registration area

2 doctors only – 1 Medical Officer from either Unani or Ayurvedic and 1 Medical Officer from Homeopathy discipline

– Shared support staff (1 pharmacist and 1 office attendant)

– The Gardener to be trained and re-deployed to manage the OPD registration counter

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Upazila Hospitals• Two CAM doctors • – a Unani or Ayurvedic Medical Officer and • – a Homeopathic Medical Officer Forenoon

OPD clinics at the Upazila hospital Afternoon

visit Community Clinics• Every Community Clinic is visited by a CAM doctor twice a week

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• In addition to attending to the patients, the CAM doctors

• will also check the upkeep of the medicinal plants garden and

• interact with the members of the Management Committee / Community Support Group and members of local self government, etc.

• to propagate and promote the use of medicinal plants for prevention and treatment of ailments.

• The Gardener, where available, should be asked • to help Community Clinics in the Upazila area to set up their medicinal plant gardens and• provide help and assistance to such community people

– who may be interested in growing medicinal plants in their homestead – (this may be done through meetings arranged by the CHCP).

– Where not available, such post may be created and filled up for similar duties.

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• Adopt an Essential CAM Drug list (EDL-CAM) for 3 levels of public health facilities

– part of the supplies made to the Upazila health complex may be stored at the Community Clinics

• Authorize Essential Drug Company Limited (EDCL) to take up production of items on EDL-CAM.

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Community / Village level (1): Assist Union Parishads to engage trained traditional health practitioners as their own

‘village health practitioners’• Selection may be made by the Union Parishad from amongst the traditional practitioners, practicing

in the UP area, who are (a) less than 40 years of age and have the requisite qualification for the Diploma course.

• The nominee will have to secure admission on his/her own in a Degree College

• The course fee (tuition fee, course material and examination fee) shall be paid by the concerned Board to the college on behalf of the Government.

• For female candidates, opting for a residential course, hostel fee may also be paid by the Government.

After the successful completion of the course, the UPs may engage these persons as their

authorised Village Health Practitioners and may give them mutually agreed remuneration.

The scheme can be popularised by the Bangladesh Deshiyo Chikitsak Samiti who may be given a small grant to hold meetings with the UPs in remote areas to explain the scheme as well as to facilitate selection of candidates.

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Community / Village level (2): Use the Community Clinics network to train traditional health practitioners for better

primary health care• AMC doctors posted to the Upazila Health Complex (UHC) should be making a weekly

visit to the Community Clinics in the UHFC area. – orient the members of the Management Committee and Community Support Groups about good

practices for maintaining health and preventing diseases.

• Two of these – say, first and last visits in every month –

– (a) Traditional healers [following a seasonal calendar of topics (e.g. such as prevention of diarrhoea in summer months].

– (b) Traditional Birth Attendants (TBAs) practicing in the Community Clinic villages. [may focus on MCH care and how medicinal plant products and herbal preparations can be helpful in care of mothers and children.]

– AMC doctors should conduct these meetings

» traditional practitioners (TPs) and

» traditional birth attendants (TBAs)

CHCP would be in-charge of organizing the meetings

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Urban Slums: • Partner with BRAC to train their Swasthya Sebikas in the use of Medicinal

Plants for prevention and treatment of ailments

• BRAC has a network of more than 1 lakh ‘health entrepreneurs’ called Swasthya Sebikas.

• The network started with the rural areas but has since been expanded to cover the urban slums in the country.

• It is proposed that a partnership be established with BRAC (through a suitable MoU) for training and orientation of the SwasthyaSebikas in the use of medicinal plants and ‘over the counter’ CAM medicines for prevention and treatment of common illnesses.

• The training can be subsequently expanded to include SwasthyaSebikas working in the rural areas also.

• Note: Family Planning workers of the Family Planning Directorate, MoH&FW, may also be trained for educating the rural people to use medicinal plants for birth control, child and mother health and for treatment of common diseases.

12


Education and Training

• Establish “Bangladesh National Institute for CAM (B-NICAM)” as an autonomous institution under the BSMMU

• Strengthen and streamline hospital services at the Government CAM Degree Colleges,

Mirpur (Dhaka)

• Establish Schools of CAM in the existing Medical Colleges

• Phase out stand alone Diploma Colleges Phase out Diploma course for general students introduce bridge-course for Diploma holders

• Introduce scholarship scheme for financing CAM education of students from economically backward (poor) families

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“Bangladesh National Institute for CAM (B-NICAM)”

• The BSSMU mandate includes setting up a Centre for Post-graduate teaching in CAM disciplines.

• This should be operationalized.

• If necessary, sourcing the Faculty for this institute may be included as an item under the MoU between India and Bangladesh for the CAM.

• The research activities at the Institute may be predominantly academic.

• The applied research, on the other hand, may be conducted by both academic institutions as well as public and private laboratories, with

• Overall coordination of applied research being done by a new unit proposed to be created at the BCSIR headquarters .

• Design and implementation of orientation training courses for in-service modern system medical officers in CAM may also be entrusted to the National Institute at BSSMU.

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• Strengthen and streamline hospital services at the Government CAM Degree Colleges, Mirpur (Dhaka)

The hospitals attached to the two CAM hospitals may start • 24 x 7 MCH care Provide routine ante-natal or post natal Maternal and Child Health care

And also handling minor pregnancy complications

a Nursing School be established in the two colleges.

• a standard 3-year Diploma Nursing course approved by the Nursing Council

• with a special add-on orientation module on relevant CAM discipline.

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Establish Schools of CAM in the existing Medical Colleges

• CAM schools are established in the existing Medical Colleges in a phased manner.

• For the public sector, • to have a CAM school in at least one Medical College in every Division. • Gradually, the network of medical colleges with a CAM school should be expanded.

• The Armed Forces Medical Colleges may also be invited to set up a CAM school,

initially at Chittagong

• Private medical colleges should also be encouraged to set up a CAM school. For this, a onetime grant may be offered to them.

It will take require far less resources

than setting up stand alone CAM Colleges is an added advantage

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• Phase out stand alone Diploma Colleges

• Phase out Diploma course for general students

• Introduce bridge-course for Diploma holders

• Introduce scholarship scheme for financing CAM education of students from economically backward (poor) families

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Regulation of Education and Practice

• Interim Reform (1): Change the name of the two Boards to ‘Councils’Interim Reform (2): Declare Founders / Principals / Faculty members from the institutions

as ineligible to participate in the elections for the Board membership

• Establish a (common) Council for CAM

• Revise standards for CAM Degree Colleges

• Introduce Continuing Medical Education System with a mandatory of recertification system for practitioners

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Change the name of the two Boards to ‘Councils’

• It was learnt during the situational analysis phase that the DGHS had to take over the registration of graduate degree holders because they did not want to be registered by a “Board”; the fact that registration of the MBBS and BDS pass-outs is looked after by the Bangladesh Medical and Dental Council (BMDC) !

• The obvious response to the situation would have been to issue an amendment notification to the Ordinance changing the name from “Board” to “Council”.

• However, the DGHS started issuing registration certificates to the graduates which is a clear violation of the statute.

• In order to restore the authority assigned to the Boards under the Ordinance,

• it is proposed that an Executive Order may be issued by the Ministry of Health & Family Welfare to change the name from “Board” to “Council”.

• Fresh registration certificates may thereafter be issued by the “Council” to all graduates degree holders.

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Quality of drugs

• Establish a dedicated drug testing laboratory for CAM (DTL-CAM)

• Establish a dedicated CAM Division in the DGDA Headquarters

• Issue corrigendum to the Drug Act, allowing pharmacies in public hospitals to prepare medicines for dispensing it to their patients

• Develop Bangladesh Good Clinical Practice Guidelines for CAM (GCP-CAM)

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Establish a dedicated CAM Division in the DGDA Headquarters• Be the secretariat for

– (a) Drug Control Committee (CAM) and – (b) Task Force on Adverse Drug Reactions from CAM

• Compile / update national Formulary and Pharmacopoeia on CAM• Compile / update protocols for preparing medicines from medicinal plants• Compile and publish lists of Essential CAM drugs

– for primary, secondary and tertiary health care level facilities

• Prepare / issue guidelines for standardization of CAM drugs• Prepare / issue guidelines on Good Manufacturing Practices for CAM drugs and

– herbal preparations / products

• Design and implement training / orientation programmes for promoting standardization of drugs, GMP, protocols for preparing medicines from medicinal plants and other aspects related to safety and efficacy of CAM drugs and products.

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Cultivation, Conservation and Promotion of Medicinal Plants Medicinal Plant cultivation as part of commercial forestry: Medicinal Plant cultivation on marginal / fallow land by women self-help groups:

Establish Medicinal Plant Promotion Unit under

Horticultural Products Division in the Directorate of Agricultural Extension (DAE)

Set up Medicinal Plant Promotion Unit under Certification Marks Wing in the Bangladesh Standards and Testing Institution (BSTI)

Introduce knowledge and use of medicinal plants in secondary education Organize exhibitions to popularise medicinal plants

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Research• Set up a “Centre for Coordinating Applied Research in Complementary and Alternative

Medicine (CCAR-CAM)” in the BCSIR

• Strengthen BCSIR laboratories for expanding and intensifying research on medicinal plants

• Establish an integrated herbal garden cum research centre at Dhaka

• Establish “Bangladesh CAM Research Challenge Fund”

• Sponsor students to CAM institutes in India and other countries for post graduation studies and research

• Offer to set up SAARC Centre for research in CAM in Bangladesh

• Establish “National Ethics Committee for CAM Research”

23


Programme Management

Directorate of Complementary and Alternative Medicine (CAM)• Programme Coordinator (Mainstreaming)• Programme Coordinator (Education and Training)• Programme Coordinator (Regulation and regulatory bodies)• Programme Coordinator (Cultivation, conservation and promotion of

medicinal plants)• Programme Coordinator (Research)

Inter-Ministerial Steering Committee (IMSC)

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04 powerpoint presentation of natl strategy ssil

Healthcare