The Republic of India as a participant of the said conference initiated the process of implementing reforms in health & family welfare sector in 1996-97. Following the comprehensive resolution emanating out of ICPD, Cairo, 1994, the Department of Family Welfare, MOHFW, GoI in close collaboration with the European Commission, embarked upon the H&FW Sector investment programme in some selected districts of India to start with in 1997. Situation analysis in the H&FW sector with a view to formulate the appropriate district action plans was given prime importance. As the operations progressed it was found out that as far as the Government sector was concerned, operationally, the Chief Medical Officers at district level enjoyed the nodal status in respect of health care delivery services supported by Deputy CMOs and respective Programme Officers. Within a few years after induction into service, the prospective incumbents usually get promotion to higher berths, but more often than not find themselves amidst administrative indecision, because of considerable lack of proficiency, related to management aspects of health care services like General Management, Human Resource Management, Financial Management, Materials Management, Disciplinary/Vigilance matters and more importantly the management of ongoing projects related to health and communication which are not taught in the medical colleges. Besides skills like objective measurements of unmet needs in the communities through techniques like PLA, FGD and computer-aided solutions for problems were also needed, so that the overall return on investment in health sector was commensurate with inputs. These shortcomings were also pointed out in the National Health Policy 2002.

Thus, the Government of India in consultation with the respective State Governments started implementing the reform process within the country in a phased manner and capacity building of district level officers was a part of it. This was reinforced in a landmark national resolve, at the Eighth Conference of Central Council of Health & Family Welfare held in New Delhi (28th-29th August 2003), where it was unanimously resolved that "the professional training of Medical Officers in 12-16 years service bracket in Public Health, Management and Health Sector Reforms, should be made a pre-requisite for promotion to CMOs/Civil Surgeons/Hospital Superintendents to equip them to handle their responsibilities better".

NIHFW was identified as the institute to conduct the course and the first was held in 2001. During the pilot stages, the European Commission Technical Assistance (ECTA) office engaged experts from Tata Institute of Social Sciences, Mumbai to evaluate the outcome of first 3 pilot courses conducted at NIHFW. The observations of the experts who conducted the evaluation, submitted to the Department of Family Welfare, Government of India vindicated the usefulness of the course.

Since training so many DMOs is a mammoth task, the training has been rolled out and is being conducted by other institutes (given below) of the country since 2005. In the coming years senior district level medical officers are expected to be trained after a service period of between 12-16 years, for higher-level administrative posts. This course, in time, is envisaged as a regular refresher training course for middle level medical officers with 12-16 years of experience in the state government services for each state.

The NRHM components in respect of the goals are, decentralisation & devolution, performance linked funding, sustainability of infrastructure/work force, community participation, user-friendly care and public - private partnership. To fulfill these, health care personnel therefore have to now act as "Agents of Change" to ensure availability/accessibility/affordability of products & services, offered as an integral part of the ongoing Health & Family Welfare reform programmes under NRHM in the country.

To achieve this capacity building of the Medical Officers, so that a critical mass of trained personnel are available in the districts, more institutes in the states are in the process of being identified to make this professional development course a comprehensive capacity building exercise. Gradually as NRHM is being implemented with the block as the node for all activities, block level medical officers will be given this training to effectively implement NRHM.

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TNA Formats for Doctors who participated in PDC

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