Like many other developing countries, India did not realise the impact of population ageing till the 1970s. The need for geriatric medicine as a separate speciality was not appreciated, and it had a late beginning. In 1978, the outpatient service in geriatric medicine was started in Madras Medical College and Hospital, Chennai was started. The inpatient service was established in 1988, and the postgraduate program in geriatric medicine was formed in 1996, under the aegis of Dr MGR Medical University of Tamil Nadu. The National Policy on Older Persons (NPOP) (1999) mandated the establishment of geriatric medicine in all medical colleges. Responding to NPOP, the Medical Council of India developed the postgraduate training curriculum in geriatric medicine in 1999. Madras Medical College was the first medical college to establish postgraduate training in India. In 2004, a Postgraduate diploma in geriatric medicine was launched by the Indira Gandhi National Open University, Delhi, to equip the primary doctor with knowledge and skill in geriatrics and deal with older people's unique problems. After the initial enthusiasm, the program lost its importance due to a lack of hands-on training facilities and non-recognition by licensing authorities. Subsequently, Amrita Institute of Medical Science in Kochi, Kerala, Christian Medical College, Vellore, Tamil Nadu and Mahatma Gandhi Mission Medical College, New Mumbai, All India Institute of Medical Sciences, New Delhi have started a postgraduate (MD) training programme in geriatric medicine.
There is limited exposure to old-age
care in the undergraduate medical curriculum and nearly non-existent in nursing
and paraprofessional training. To address these issues, the Government of India
launched an intensive training programme with sponsorship from the World Health
Organization (WHO). The programme was managed by the All India Institute of
Medical Sciences, New Delhi and reached 100 medical colleges between 1998 and
2001. More than 200 primary care physicians were trained in workshops conducted
in medical colleges across the country. This initiative, with focused
operational inputs from WHO, led to creating a critical mass of teachers and specialists
trained in old age care and the evidence base required for more significant
initiative. The National Programme for Health Care of the Elderly (NPHCE) was
launched in 2010 by the Ministry of Health and Family Welfare, Government of
India. The programme has a two-pronged strategy: capacity building through PG
training in medical colleges and expansion of service from district hospitals
to the peripheral most dispensary.
During the 12th five
year plan, it was proposed that 12 medical colleges would be added for setting
up Regional Geriatric Centres. The Position paper by the Indian Academy of
Geriatric's states that we need 27,600 geriatricians for a 138 crore population(1).
Assuming that all the RGC'c become fully functional with adequate staff, we
would still have only 120 geriatricians, far below the minimum requirement. The
key measures enumerated to develop the health workforce included:
·
Training primary care physicians and internists
·
Mid-career training of family physicians and
general practitioners
·
Mandatory addition of geriatric medicine in the
medical curriculum
·
Incentives for institutes to implement geriatric
medicine postgraduation programmes
·
Making geriatric medicine a mandatory department
for medical colleges
Through these measures, we can
aspire to achieve the goal of healthy ageing and health for all in India.
Acknowledgement:
An extract from
a chapter titled "Evolution of Geriatric Medicine in India" by Dr A B
Dey
References
1. Rao
AR, Mathur A, Dey A B. Health workforce development for geriatric services in
India. J Indian Acad Geriatr 2020;16:176-9
