Strengthening district level health care through involvement of medical colleges the cmc model
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Strengthening District Level Health Care through involvement of Medical Colleges The CMC Model. Dr. Rita Isaac M.D, MPH Professor& Head, RUHSA Department, CMCH.

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Strengthening district level health care through involvement of medical colleges the cmc model

Strengthening District Level Health Care through involvement of Medical CollegesThe CMC Model

Dr. Rita Isaac M.D, MPH

Professor& Head, RUHSA Department, CMCH

Reorienting Medical Education to Community Health Needs through models of primary, secondaryand tertiary level Health Care Programmes

Cmc s innovations in medical education
CMC’s Innovations in Medical Education

  • The story of CMC’S experiments in response to the emerging needs of our Nation dates back to the founding story of the young Dr. Ida's call in 1900 and her whole hearted, enthusiastic response to the dying young mothers in labour in our country.

  • I dedicate this presentation to all those stalwarts from our institution who toiled hard to put in place innovative models of medical education, community health outreach programme and family oriented health services and through it train young men and women to carry the torch forward.

Founder of CMC, Dr. Ida Scudder did her medical education at Cornell University, US, returned to India in 1900, when the average life expectancy was 24 years, and started a hospital with one bed

She being the only doctor, by 1902, Dr. Ida Scudder had only seen 12,000 patients

Frustrated at the thought of so many patients remaining outside the ambit of medical services, she began setting up road side clinics (1906) – taking services to villages and hamlets outside Vellore.

Dr. Ida Scudder going for one of the community visits

District l evel health c are models secondary and primary level c are programmes of cmc
District Level Health Care ModelsSecondary and Primary Level Care Programmes of CMC

Community Health and Development Programme (CHAD)-1rural block

Rural Unit for Health and Social Affairs

(RUHSA )-2nd rural block

Low Cost Effective Care Unit (LCECU)-Urban ward

College of Nursing Community Health

(CONCH)-urban ward

Strategies for strengthening health care
Strategies for strengthening health care

  • Established secondary and primary care level, affordable medical services for the rural, poor urban and tribal communities with tertiary care support at 2400-bed CMC Hospital

  • Develop all levels of health care personnel through relevant training programme

  • Identify and empower the most vulnerable groups in the communities through social and economic development programme and community education programme

  • Relevant, cutting edge research to improve services

Affordable medical services through a 3 tiered referral system
Affordable Medical Services (through a 3-tiered referral system)

2 rural blocks

Urban wards

Tribal area


Outreach clinics Govt. Linkage

CHAD -140 beds

RUHSA – 70 beds

LCECU- 40 beds


CMCH, Vellore


Medical services
Medical Services

  • Outreach Mobile Primary Care Clinics

  • Secondary Care Community Health Center

  • Tertiary Care - CMCH

    Secondary Level care

    • General medical care

    • Obstetrics

    • Paediatrics

    • Ophthal clinic- once a week

    • ENT- once a week

    • Dental Care

    • Orthopaedics clinic

    • Infectious disease clinic

    • Psychiatry clinic

    • Occupational and physio-therapy Care

  • Inpatient Services

    • Manage all common illnesses in adults &children

    • Obstetrics care with Caesarian sections

    • General surgeries

  • OPD

    ID Clinic

    OT/PT Center

    Primary care through mobile clinics by chad ruhsa
    Primary care through mobile clinics by CHAD & RUHSA

    • A peripheral health care team (Doctor, nurse, Rural community officer, health aides, Community health worker) visit each village once in 4 weeks

    • Nurses make home visits once in a week

    • Service focus: Antenatal care, NCD treatment, RHD prophylaxis, Seizure medications, Psychiatric medicines delivered at home (free or subsidized)

    • Referral to CHAD/RUHSA for further investigation/ treatment

    • Referral to CMC if needed

    • Feedback and follow up

    Mobile Clinic

    Socioeconomic community development programme
    Socioeconomic & Community development programme

    • 5 Elderly day care centres with noon meal programme

    • Youth clubs

    • Farmers clubs for marginal farmers

    • Play center for poor rural children

    • Self-help groups microfinance/microcredit scheme

    • Block-wide cervical cancer “Educate, Screen and treat” programme; IVR mobile technology to raise awareness

    Medical education community m edicine curriculum at cmc
    Medical EducationCommunity Medicine Curriculum at CMC

    Enables students to understand society and communities in

    India, culture and environment in which people live and

    acquire knowledge, attitude and skills required to deliver

    Effective patient care

    • Four phases

    • Each with special objectives

    • Designed to build on experience gained from the previous phase

    Practical Application of knowledge and Skills


    Community Based Research

    3rd Year

    CHP II

    Learn about Health systems

    Plan a health program

    2nd Year

    CHP I

    Live In Experience

    First Impression about rural community life

    1st Year


    Phase i first year of medical school
    PHASE I(First Year of Medical School)

    Community Orientation Programme (COP)


    • Socio-demographic survey

    • Community diagnosis

    • Study environmental, nutritional and social determinants of health

  • End of First Year

  • 3 weeks block posting

  • Multidisciplinary

    • MBBS, BOT, BPT, Dietarystudents

    • Determinants of health India’s rural folk

    • Existing health practices and beliefs about disease; its causes and prevention

    Students interaction with the community
    Students Interaction with the community assigned 10-12 households to study

    Working with the community
    Working with the community assigned 10-12 households to study

    Government officials interacting
    Government officials interacting assigned 10-12 households to study

    Role of Government and voluntary organizations and their programmes in improving the welfare of the rural community

    Involvement of other departments
    Involvement of other departments assigned 10-12 households to study

    • Preclinical departments – community studies

    • Clinical departments – take sessions at the camp site, make house visits

    Phase ii community health programme i first clinical year of medical school
    PHASE II assigned 10-12 households to study(Community Health Programme - I)First Clinical Year of Medical School

    2 weeks in the 1st clinical year


    • Study health systems(Public Health Sector)

    • Understand the morbidity profile

    • Plan and evaluate health programme

    Phase ii community health program i
    Phase II – Community Health Program I assigned 10-12 households to study

    • Cross-sectional survey to understand the morbidity profile in the community

    • Utilization of health services

    • Functioning of various types of health services

    • Health programme planning exercise in groups of 8-10 students

    Phase iii community health program ii
    Phase III assigned 10-12 households to studyCommunity Health program II

    Objective - Conduct a population based research in common areas like MCH, ENVIRONMENT, NUTRITION etc.

    • During the second clinical year, lasts 2-3 weeks

    • Design and carry out a epidemiological study

    • The pace and schedule of the work entirely dictated by the students

    • Staff serving as resource persons

    Phase iv internship 2 months posting in community medicine
    PHASE IV (Internship) assigned 10-12 households to study2 months posting in Community Medicine

    • Gains practical knowledge and experiences in primary health care and prepares them to be effective community physicians

    • Reinforce skills, knowledge and attitudes

    • community health practice

    • Plan community health education programmes

    • Learn to work as members of health care team including experts from other disciplines

    Interns’ Training Program assigned 10-12 households to study

    Emergency Management

    OPD & IP

    Mobile Clinics

    Major project-Population based Research

    Health Education

    Internship assigned 10-12 households to study

    • Trained in Quality Assurance through audits

      • Monthly meeting/review all services data

      • mortality Audit (perinatal, maternal and general)

      • OP & IP charts review

      • Referrals review

      • Caesarean sections review

    • Major project: research

    • Ethics in health care through Case Discussion (with involvement of other departments)

    Each Phase ends with assigned 10-12 households to study

    • Student assessment of the programme

    • Evaluation of students’ changes in attitude towards medical care in the community

    • Evaluation of knowledge acquired

    Training of allied heath personnel
    Training of Allied Heath Personnel assigned 10-12 households to study

    • PG Diploma in Health Management – 1 year course

    • BSc in Medical Sociology affiliated to TN Dr M.G.R Medical University

    • 1-12 weeks workshops/courses on “Integrated Health and Development Rural Health Care Programme” for graduate and masters degree students in nursing, social work, Sociology and Health Management courses

    • MPH

    • PhD in Social Science under Tiruvalluvar University

    • PG Diploma in Health Administration affiliated to TISS for health managers in private and public sector organisations [to start this year]

    Family medicine training low cost effective care unit
    Family Medicine Training assigned 10-12 households to studyLow cost effective care unit

    Objectives assigned 10-12 households to study

    • To orient the students to the principles and practice of Family Medicine

      • Management of common illnesses

      • Emphasize on Patient centeredness

      • Socioeconomic impact of illness

      • Sensitised to the Cost of treatment and affordability

    Family medicine training
    Family Medicine training assigned 10-12 households to study


    3 days

    FM posting

    2 weeks

    FM elective

    3 weeks

    Internship training Community health

    2 months


    Secondary hospital programme

    Secondary Hospital Programme assigned 10-12 households to study

    Network of secondary hospitals
    Network of Secondary Hospitals assigned 10-12 households to study

    200 secondary hospitals

    20-200 bed hospitals

    Rural and semi-urban areas of India

    Broad based Services

    2 years ofservice obligation after graduation




    Secondary hospital program
    Secondary Hospital Program assigned 10-12 households to study

    SHP I

    1 week

    SHP II

    2 weeks


    2 weeks

    To orient the students to the practice of medicine in rural Secondary Level Care Hospitals


    assigned 10-12 households to studyAssam itself was a memory to savor, the ubiquitous bamboo, the all-to-real possibility of being shot despite having a military escort, travelling on top a vehicle rather than inside one, bathing in open air, forgetting the intrusions of cell phones and the internet, and the gracious hospitality of villagers who opened their home to us strangers..”

    Student Quote


    Diversity of cases
    Diversity of cases assigned 10-12 households to study

    Bear Mauling

    Huge Ovarian Cyst

    “Everyday we are faced with a host of new experiences we had never dealt with and will unlikely see again..”


    ROLE MODEL TEACHERS assigned 10-12 households to study

    “What shocked me was the hard work, perseverance and commitment of the people who work hand-in-hand as one team. I realized that the life and work in rural areas with the less privileged and no great facilities is ‘no less’ to the work done in a tertiary hospital”

    Student Quote


    Revolutionize health care in india

    Revolutionize Health Care in India assigned 10-12 households to study

    Thank You for your patient attention