ISM&H Facilities in Delhi

Directorate Of ISM&H, Govt. of NCT Delhi

Contents

• Overview • ISM&H institutions• Patient turnover of Dispensaries• Morbidity profile of patients• Case studies of Homoeopathy

• Established in August 1996

HQ at A&U Tibbia College campus, Karol Bagh, New Delhi.

Homoeopathic Wing at CSC-IIIrd, B Block, Preet Vihar .

Directorate of ISM & Homoeopathy

• Activities in respect of AYUSH stream

– Patient care– Education– Drug Control Cell (only of Ayurveda & Unani;

Homoeopathic part is still being looked after by allopathic drug control department)

– Coordination with GOI, MCD, NDMC and various NGOs.

– Research

Directorate of ISM & Homoeopathy

A & U Tibbia College and Hospital, Karol Bagh. New Delhi

Nehru Homoeopathic Medical College & Hospital, Defence Colony, New Delhi

Dr. B.R. Sur Homoeopathic Medical College & Hospital, Nanak Pura, New Delhi

Ch. Braham Prakash Ay Sansthan, Khera DaburJamia Hamdard, Jamia Nagar, New Delhi

Educational institutions

– Land 33.3acres– Intake capacity: 88 students (44 Ayurveda and 44

Unani) for Degree level & Six seats for P.G. level– Affiliation: Delhi University– Indoor capacity: 255 bedded IPD– Annual OPD patient turnover about 1.65 Lac

A&U Tibbia College

NEHRU HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,

–Land- 2.25 acres–Intake capacity: 100 students, 4

P.G. Seats–Affiliation: Delhi University–Indoor capacity: 100 bedded IPD–Annual Patient turnover 1.45 Lakh

DR BR SUR HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL

–Land : One acre–Intake capacity: 50 students–Affiliation: I.P. University–Indoor capacity: 50 bedded IPD–Annual patient turnover: 78389

pt

• Multiple agencies are providing Patient Care services of ISM&H in Delhi.

• Under the cafeteria approach to Health Care services, the Directorate of ISM & H is establishing regularly Ayurvedic, Unani and Homoeopathic dispensaries in existing Allopathic Hospitals and dispensaries.

Dispensaries

Year Homoeopathic (19)

Ayurvedic (9) Unani (13)

2006 72 21 0

2007 78 23 10

2008 80 24 10

2009 87 26 11

2010 91 30 13

Growth of Dispensaries of Directorate in Last Five Years

S. No. Agency Ayurvedic Unani Homoeo

1 GNCTD 30 13 91

2 MCD 126+14* 26 32

3 ESI 14 0 4

4 NDMC 12 0 13

5 CGHS 15+1 1 14

Total

*Speciality centres

194+15* 40 154

Agency Wise Dispensaries

There are two statutory bodies:• Board of Homoeopathic System of Medicine:

Board of Homoeopathic System of Medicine Act-1956

• Delhi Bhartiya Chikitsa Parishad:Constituted under Delhi Bhartiya Chikitsa Parishad Act 1996

REGISTRATION OF PRACTITIONERS

• Renewal of registration once every 5 years is undertaken in respect of Ayurveda, Unani and Homoeopathic practitioners.

• The state registers are periodically updated by these statutory bodies and the names of registered practitioners are notified in the gazette.

STATUS OF STATE REGISTERS

Specialty Registered

Homoeopathic 4319

Ayurvadic (9300) 3472

Unani 2013

Total 9804

Total Registered Practitioners

• The Deputy Director (ISM) is the notified Drug Controller cum Licensing Authority in respect of Ayurveda and Unani. There are 5 Drug Inspectors.

• The work related to Homoeopathy is being undertaken by the Drug Control department of Allopathy.

DRUG CONTROL & LICENSING

• There are 62 (40AY+14U+8H) manufacturing units.

• For the sale of A & U drugs no separate sale- license is required.

• However, for sale of Homoeopathic drugs, License is required: There are 293 Homoeopathic sale counters.

• All the manufacturing units of ISM are Good Manufacturing Practices (GMP)compliant.

DRUG CONTROL & LICENSING

Department Total Practitioners

Homoeopathic 103

Ayurvadic 28

Unani 8

Total 139

Human Resource

TEACHING FACULTYINSTITUTION CCIM/CCH

NORMSSANCTIONED POSTS

EXISTING STRENGTH

A & U TIBBIA COLLEGE

43 (AYURVEDA)46 (UNANI)

35(AYURVEDA)35 (UNANI)

AYURVEDARegular 06, Adhoc /Contract 10, Partime 03UNANIRegular 09,Adhoc/ Contract 12, Part time 025 Modern medicine

NEHRU HOMOEOPATHIC MEDICAL COLLEGE

43 43 33 regular teachers31 part time teachers

DR BR SUR HOMOEOPATHIC COLLEGE

43 29 19 regular teachers40 part time teachers

Patients turn over Homoeopathic Dispensaries

Patients turnover Ayurvedic Disp.

Patients turnover in Unani Dispensaries

Gender-differentiation Homeopathic dispensaries

Gender-differentiation Ayurvedic dispensaries

Gender-differentiation Unani dispensaries

2.88%

16.56%

29.6%

1.09%

23.06%

19.04%

1.13%6.18%

0.4% Fever 2.88%

J oint Disorder 16.56%

Digestive Disorder 29.6%

Diarrhea/ Dysentery 1.09%

Respiratory Disorder 23.06%

Allergic & Skin Disorder 19.04%

Piles, Fissures and Fistula-in-anus .02%

Diabetes, Hypertension,Cardiac Disorder 1.13%

Women Disorder 6.18%

EPI DEMI C DI SEASES- B .40%

Morbidity profile

Homeopathic Dispensaries

Morbidity Profile Ayurvedic Dispensaries

Morbidity ProfileUnani Dispensaries

Cost Effectiveness and Efficacy of Homeopathy in Primary Health Care Units of Government- A study

Dr. R. K. Manchanda, M. D. (Hom), Deputy Director (Homeopathy)

&Dr. Mukul Kulashreshtha, MD (CHA),

Chief Medical Officer (Allopathy)

Health and Family Welfare Department, Govt. of Delhi, India.

Abstract: Two studies presented at International Homoeopathic Congress

2005, LIGA at Berlin

29

• Government of Delhi has adopted a policy of cafeteria approach in primary health care units.

• The homeopathic clinics have been established in allopathic primary health care units.

• The patients have the option of availing treatment of their own choice.

30

• Aims and Objectives • To compare the expenditure incurred by

government towards running of allopathic and homeopathic clinics.

• To analyze the morbidity profile of patients coming to homeopathic clinics in comparison to allopathic clinics working under one roof.

31

Title – To assess the cost effectiveness of homeopathic clinic in Cafeteria approach

• The revenue expenditure incurred on both types of clinics during 1999-2000 have been taken from government records. The capital expenditure on the maintenance of these clinics have been excluded.

• The morbidity data has been complied using the disease classification system ICD- 9 of World Health Organization.

32

Method

Result- 1

Total Patients Attended During 1999-2000

No. of Clinics

No of Patients Attended

Annual Average Turnover OfPatients Per Clinic

Allopathic 139 3,823,689 27508 patients

Homeopathic 48 1,197,249 24943 patients

33

The patient’s attendance patterns revealed that homeopathic clinics were as popular as allopathic clinics at the primary health care level.

Result-2- Revenue Expenditure

Clinics Total Expenditure (in INR)

Total No of Patients Attended

Average Expenditure Per Patient Visit (in INR)

Allopathic 294,188,000

3,823,689

76.91.32 (€/Euro)

Homeopathic

18,472,000 1,197,249

15.430.26 (€/Euro)

34

Result-3 -Expenditure on Salaries

Clinics Total Expenditure (in INR)

Total No of Patients Attended

Average Expenditure Per Patient (in INR)

Allopathic 259,988,000

3,823,689 67.991.17 (€/Euro)

Homeopathic

16,272,000 1,197,249 13.590.23- (€/Euro)

35

Results- 4 Expenditure on Medicines

Clinics Total Expenditure (in INR)

Total No of Patients seen in a year

Average Expenditure Patient Visit (in INR)

Allopathic 34,200,000 38,23,689 8.94

0.15-(€/Euro)Homeopathic 2,200,000 1,197,249 1.84

0.031- (€/Euro)

36

• The expenditure in homeopathic clinics was one-fifth of the expenditure in allopathic clinics both in terms of salary as well as medicines. The reason for greater expenditure on salary indicates that the allopathic clinics require more supportive staff than homeopathic clinics.

37

S.No

ICD-9 codes

Group of diseases

1 001-139 Infections

2 140-239 Tumors, Malignant/Benign

3 240-359Endocrine, Deficiency, Blood, Mental & Nervous System Diseases

4 360-389 Diseases of Eyes and Ears

5 390-459 Diseases of Heart & Circulation

6 460-519 Diseases of Respiratory Tract

Morbidity Profile of Patients

38

7 520-579 Diseases of GIT

8 580-599 Diseases of Urinary system

9 600-679

Diseases of Genital Tract, Pregnancy and Child Birth

10 680-709 Diseases of Skin & Subcutaneous Tissue

11 710-779

Diseases of Connective Tissue, Joints, Congenital anomalies etc

12 780-799 Ill Defined Diseases

13 800-909 +Fractures, Injuries, Poisoning & Others etc

39

0.1

4.3 4.3 3.7

22.1

8.3

2

7

10.8

0.8

9.3

5.9

0.1

27.4

3.5

1.4

3.5

6.1

2.7

9.2

7.1

21.2

1.8

6.4

20.5

10.4

0

5

10

15

20

25

30

Homeopathic ClinicAllopathic Clinic

0.1

4.3 4.3 3.7

22.1

8.3

2

7

10.8

0.8

9.3

5.9

0.1

27.4

3.5

1.4

3.5

6.1

2.7

9.2

7.1

21.2

1.8

6.4

20.5

10.4

0

5

10

15

20

25

30

Homeopathic ClinicAllopathic Clinic

The morbidity profile of both types of clinics reveals that diseases of respiratory tract, infections, GIT diseases and skin diseases are the most common diseases at PHC level.

40

S.No Allopathic Clinic Homeopathic Clinic

1 Infections (001-009)

Amoebiasis TuberculosisSTD’sWorm infestations

DiarrhoeaViral fevers

Anamnesis of Disease Sub Groups

S.No Allopathic Clinic Homeopathic Clinic

6Diseases of Respiratory Tract (460-519)

PneumoniaAcute BronchitisAcute Respiratory infections

Allergic RhinitisCOPDSinusitis

41

7 GIT (520-579)

Acid peptic diseaseAcute colicAcute gastritis

Chronic dyspepsiaIrritable Bowel syndromeChronic Constipation

8 Urinary System (580-599)

Infections of Kidneys Nephrotic SyndromeNephritis

Urinary Calculus

42

S.No Allopathic Clinic Homeopathic Clinic

10 Skin and subcutaneous tissue (680- 709)

ScabiesFungal InfectionsPyoderma Pemphigus etc.

WartMolluscum ContagiosumAlopecia areataUrticariaVitiligoPsoriasis

43

• The patterns were not similar in both the types of clinics.

• These clinics complemented each other.• Allopathic had been found to be preferred by

patients with acute diseases and homeopathy by patients with sub-acute and chronic diseases.

• The above preference indicates the strengths and limitations of both the systems as per perception of the public.

44

• Title- Evaluation Study to assess the Effectiveness of Homeopathic Clinics running adjacent to Allopathic Clinics at Primary Health Care Level.

45

Study- II

• This study was conducted by an independent agency- Planning & Evaluation Department of Govt. of Delhi for deciding upon further expansion of homeopathy under the cafeteria approach at Primary Health Care Level.

46

• To assess the effectiveness of Homoeopathic dispensaries

• Patient satisfaction levels.• To assess the perceptions of

Allopathic doctors towards homeopathic clinic

47

Objectives

• The field survey of homeopathic clinics was conducted from 20.02.2003 to 25.03.2003.

• The study team interviewed 10 to 15 patients from each clinic and the staff working in homeopathic as well as allopathic clinics during the field visit.

• Separate structured questionnaires were used for both types of interviews.

• 57 homoeopathic clinics and 840 patients were covered during the survey.

48

Methods

49

Utilization of Homeopathic clinics

11

76

67

9

11

87

78

4

11

88

90

1

12

14

44

4

1150000

1160000

1170000

1180000

1190000

1200000

1210000

1220000

To

tal N

o. o

f P

atie

nts

2000 2001 2002 2003

Year

Patients Attended in Homeopathic Clinics, Govt. of Delhi

11

76

67

9

11

87

78

4

11

88

90

1

12

14

44

4

1150000

1160000

1170000

1180000

1190000

1200000

1210000

1220000

To

tal N

o. o

f P

atie

nts

2000 2001 2002 2003

Year

Patients Attended in Homeopathic Clinics, Govt. of Delhi

The number of patients in Homeopathic dispensaries is steadily increasing and indicates the growing popularity of the system.

Yes No

Whether it is beneficial to run Homeopathic clinic from the same premises

46(87%)

7(13%)

Whether the running of Homeopathic clinic create any problem

12(22%)

41(78%)

Whether the doctors of allopathic clinics refer patients to Homeopathic clinics

46(87%)

7(13%)

50

Majority of the doctors of allopathic clinics felt that homeopathic clinics within the same premises are beneficial for the patients.

The doctors expressed that they do not face any problems in running both the clinics and also refer the patients to homeopathic clinics for treatment.

The awareness among 383(45%) patients was through word of mouth (patient to patient contact). This indicates the acceptability of Homeopathy among general population.

Source of Awareness

627%

39547%

38345%

0

50

100

150

200

250

300

350

400

450

Word of Mouth (Patient toPatient)

Already aware because ofpast experience

Patients refered byAllopathic doctors

Source of Awareness

627%

39547%

38345%

0

50

100

150

200

250

300

350

400

450

Word of Mouth (Patient toPatient)

Already aware because ofpast experience

Patients refered byAllopathic doctors

51

162

81 78122

21

300

76

0

50

100

150

200

250

300

162

81 78122

21

300

76

0

50

100

150

200

250

300

The patients attending homeopathic clinics were from various occupations and all strata of society.

The timings of the clinics were suitable and popular in housewives also. 52

The patient satisfaction levels were very high and gratifying. Only 1% was dissatisfied with homoeopathic services.

Patient Satisfaction Levels (n= 750 patients)

1%

50%

39%

10%0%

10%

20%

30%

40%

50%

60%

Fully Satisfied Just Satisfied Neutral Dissatisfied

Tota

l Num

ber o

f Pat

ient

s

53

639 patients (85.2%) felt that homeopathic system of medicine is better than other systems of medicine.

The study showed that patients also visit the allopathic clinics and other clinics as per their requirements and preferred to use different systems of medicine as per their experience and advice of physicians.

127

639

26

632

9

1

Allopathic Ayurvedic Homeopathy Unani

Combination Not responded All of these

127

639

26

632

9

1

Allopathic Ayurvedic Homeopathy Unani

Combination Not responded All of these

54

134834077

437

189

Easy to take Faith No side effect Cost effective Past experience Others

134834077

437

189

Easy to take Faith No side effect Cost effective Past experience Others

Most of patients were of the opinion that homeopathy is safe, easy to take, cost effective and had faith in homeopathy due to their past experiences.

55

• Both the studies have established that homeopathy is popular, affordable and efficacious system of medicine at Primary Health Care Level.

• Homeopathy has the potential to minimize health care expenditure substantially if promoted in primary health care through the cafeteria approach, as is being adopted by Govt. of Delhi.

56

Conclusion

• This approach ensures patients participation, increases patient satisfaction in public health system and promotes cross system referrals.

57

I am thankful to Sh Mohan Lal, Director (ISM&H)

Thank you

Acknowledgements