NATIONAL INITIATIVE FOR

ALLIED HEALTH SCIENCES

NATIONAL INITIATIVE FOR

ALLIED HEALTH SCIENCES
The Government of India, through the Ministry of Health and Family Welfare,
appointed the Public Health Foundation of India (PHFI) as a technical partner to
develop a strategic framework for building capacity for allied health.
The National Initiative for Allied Health Sciences (NIAHS) is a product of the concerted
efforts of several stakeholders. The report recommends a paradigm shift in approach to
health human resource management, in keeping with the national priority of providing
affordable and accessible healthcare for all.

FROM PARAMEDICS TO ALLIED

HEALTH PROESSIONALS

The fundamental aim of this project has been to equip policy-makers with tools to set
benchmarks in regulation, education and training of allied health professionals, and
bridge the vast demandsupply gap. The Government of India is committed to investing
in national and regional institutes across the country to nurture and retain talent in the
allied health space.
The NIAHS report is the first step towards moving from a doctor-centred health system
to a team-based approach involving allied health professionals a move that has
globally demonstrated improved outcomes in healthcare delivery.

NATIONAL INITIATIVE FOR

ALLIED HEALTH SCIENCES

A STUDY TO AUGMENT THE

CAPACITY AND QUALITY
OF ALLIED HEALTH
PROFESSIONALS IN INDIA

Paramedics
to Allied Health
Professionals:

From

Landscaping the Journey and Way Forward

Public Health Foundation of India

PHD House, Second Floor,
4/2, Sirifort
Institutional
Area, August Kranti Marg
New Delhi 110016, India
www.phfi.org

ISBN 978-81-926145-3-3

A report commissioned by the

9 788192 614533

MINISTRY OF HEALTH AND FAMILY WELFARE

Government of India

From Paramedics to Allied Health Professionals: Landscaping the journey and way forward

From Paramedics to Allied Health Professionals: Landscaping the journey and way forward

Terms of Reference (ToRs)

i. Desk review of the paramedical training landscape, including

situational analysis, methodology of teaching, inputs and regulatory

framework for the paramedical disciplines;

ii. Content development, including training of trainer (ToT) protocols,

facilitation guides for faculty, and resource references and instructional
kits for the NIAHS;

iii. Overall recommendations, including a framework to augment the

availability of paramedical personnel, methodology of teaching,
inputs, protocols for certification, regulatory framework and national
standards, as well as benchmarking for accreditation;
iv. Recommendations for the National Institute of Paramedical Sciences
(NIPS) and the Regional Institute of Paramedical Sciences (RIPS),
including vision and mission statements, model for operations,
implementation plan, relationship matrix outlining the roles of
stakeholders, HR positioning, management arrangements, financial
protocols and budget, protocols for a pedagogical renewal process,
scope of alternate models of learning, framework for long-term
sustainability, creation and updating of training content and modules,
conducting regular in-service training and training on cutting-edge
technologies.

Table of Contents
Page Nos.

Introduction

1-2

Executive Summary

Chapter 1: The Allied Health Ecosystem

Chapter 2: Regulating the Allied Health Profession

Chapter 3: Estimating Imbalances in the Allied Health Workforce

Chapter 4: Standardising the Allied Health Education
Process of Consultations
List of Experts
Abbreviations
Bibliography

3-10

11-44
45-68

69-132

133-172
173-204

From Paramedics to Allied Health Professionals: Landscaping the journey and way forward

INTRODUCTION
In March 2011, the Ministry of Health and Family Welfare nominated the Public Health Foundation

of India (PHFI) as its technical partner and constituted the National Initiative for Allied Health

Sciences (NIAHS) secretariat with a mandate to develop a framework to improve allied health
training, education and regulation in the country.

Fundamental to the national initiative- undertaken by the health ministry- is the vision to bring

uniformity to teaching methodology, clarify protocols of certification and set national standards
for regulation of allied health sciences and professionals. The initiative comes at a time when the
Government of India- under the 12th five year plan- has set itself the target of providing affordable

and accessible healthcare to all citizens. Indias mandate for universal health coverage, to a great

extent, depends on the availability of qualified and adequate allied health professionals at primary,

secondary and tertiary levels in both private and public sector. Addressing shortages in human
resources is the first step towards expanding the reach of health services in underserved areas.

The terms of reference set by the health ministry directed the NIAHS secretariat to map the

allied health training landscape and the current regulatory framework for various allied health

disciplines. Over a period of 10 months the NIAHS secretariat conducted extensive desk review,
primary and secondary research to compile a detailed situational analysis of the existing allied
health space in India.

Central to the recommendations developed for reconfiguring and restructuring the allied

health space, is setting up of dedicated national and regional institutes with the objective of

nurturing talent, retaining allied health professionals and strengthening the health systems to

align it with the overarching goal of providing universal health coverage to Indians. Research by

the NIAHS secretariat has indicated vast inter and intra state differences with public and private
facilities struggling to cope with increasing human resources costs, shortages, uneven distribution
and skill-mix imbalances.

India has traditionally leaned towards a doctor-centered healthcare delivery, with little

attention paid to specialization in allied health sciences. Investing in allied health professionals

has, at no point in history, been so crucial to reforms in public health sector. Corrections to bridge
demand and supply gaps ensuring sustained availability of allied health professionals for future
generations remains a cornerstone in Indias plans for healthcare reforms.

Population based human resource norms, for Indias health services, set as early as 1946

by the Bhore Committee, are yet to be achieved. The Bhore Committee had recommended one
1

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

nurse per 500 persons; one pharmacist per 2000 persons, one laboratory technicians per 30,000
persons; one health inspector per 20,000 persons (Chaddha committee); one male and female
health worker for 3000-3500 persons at primary level of care.

As India struggles with heavy disease burdens, with the emerging challenge of non-

communicable diseases superimposed on the urgency of achieving millennium development goals,

deficiencies in human resources- in terms of both skills and numbers- will be formidable barriers
to Indias health care sector reforms. It is of pivotal importance that these are overcome through
initiatives that address both the scale and quality of our health workforce.

The NIAHS secretariat has studied global best practices, especially models followed by other

low and middle income countries, while developing strategies relevant to the Indian context. To put

together this report, a dedicated project secretariat was established at the Health Systems Support

Unit of PHFI, which consulted over 300 experts while the project was in progress. The NIAHS
secretariat also gained immensely from their consultations with experts in the health ministry.

This report is a pioneering initiative by the health ministry which aims to address the challenges

faced by allied health professionals, for the first time, as a national priority. We hope this report will

encourage public discourse and propel academicians, civil society and policy makers to collaborate
in designing and implementing targeted interventions for the much required corrections in all
aspects of the allied health professional space.

The NIAHS report provides an overarching framework to realign Indias human resources in

accordance with the growing demands of the health sector. This report is only the first step in a

journey that will require concerted efforts from all stake holders to turn the aspirational goal of
universal health coverage into a reality for India.

Prof. K Srinath Reddy

President, Public Health Foundation of India

Executive Summary

Redefining Indias health service delivery

paradigm: from Paramedics to Allied
Health Professionals
the heavy disease burden and the lack of access to
healthcare will see the public health system face an
NCD epidemic in the coming years. Public health
facilities in India are unprepared as there are not
enough specialists clinicians and non-clinicians to
serve the entire country. The government is planning
huge allocations for NCDs and for upgrading primary
health centres with a focus on training personnel at
this level to deal with future epidemics such as NCDs.
Technicians, technologists and therapists will thus be
required in huge numbers in the coming years.

In the past decade, a fundamental shift has occurred in

healthcare delivery, largely due to advances in science
and technology. There is now more recognition, than
at any time in the past, that health service delivery is
no longer just a prerogative of physicians and nurses.
It is now a team effort, drawing upon the expertise of
both clinicians and non-clinicians. These professionals
or health-service providers have been historically
identified as paramedical staff or paraprofessionals
or health technicians.

Better appreciation and utilization of the whole

range of skills possessed by these paraprofessionalscollectively termed as Allied Health Professionals
(AHPs)is the key to health-sector reforms in India,
especially given the shortage of doctors and nurses in
semi-urban and rural areas of the country.

A major problem is an overall human resource

shortage, which leaves gaps within the existing
infrastructure and services, both within and outside
the public sector. The types of human resource crunch
faced across the country vary due to factors like acute
shortages, imbalances arising out of geographical
distribution and low productivity amongst hired staff.
Acute shortage is commonly aggravated by a skewed
distribution within the country and movement of
health workers from rural to urban areas, from
public to private (for-profit and not-for-profit),
or to jobs outside the health sector. Contributing
factors include insufficient investment in pre-service
training, migration, work overload, inadequate
growth opportunities and work environment issues
(infrastructure, technical and safety, amongst others).

As the Indian government sets about reforming

the public health sector and making universal
health coverage a reality in India, the availability of
qualified human resources for health has emerged as
a significant challenge facing the healthcare delivery
mechanism. There is an urgent need for the Indian
government to plug policy gaps and ensure generation
of adequate and effective human resources for health
to provide quality care at primary, secondary and
tertiary levels of health delivery in the country. There
is a huge dearth of trained technologists/technicians
in the system; advancement in technology in recent
times demands trained individuals who can provide
reliable results in conjunction with patient safety.

India, currently, has the worlds greatest burden

of maternal, newborn and child deaths. In 2008 alone,
India lost 68,000 mothers and 1.8 million children
under the age of five to maternal and child morbidity(3)
Thus, in addition to the tribal population, mothers,
infants and children constitute the majority of the

Globally, the incidence of non-communicable

diseases (NCD) is steadily increasing and in India,

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

underserved. There are other vulnerable populations

in India as well, such as the elderly and the disabled
who do not have ready access to healthcare services.

delivery in the past, including the National Knowledge

Commission, which placed more importance in
producing more AHPs over doctors, despite the
acknowledged scarcity of the latter:

According to the most recent figures reported in

the World Health Statistics 2011, the density of doctors
in India is 6 for a population of 10,000, while that of
nurses and midwives is 13 per 10,000 population.
India has a doctor to population ratio of 0.5:1000 in
comparison to 0.3 in Thailand, 0.4 in Sri Lanka, 1.6
in China, 5.4 in the UK, and 5.5 in the United States
of America. A recent study undertaken by the Public
Health Foundation of India (PHFI) for the Ministry of
Health and Family Welfare (MoHFW) has indicated
a supply-demand gap of about 65 lakh allied health
professionals, when demand was calculated using
basic international norms.

the opinion of 72 experts in the country over

40 years there is no need to increase the number of
doctors but instead improve the quality and orientation
of service provision towards better meeting the health
needs of the people and that, there is a dire need to
focus on increasing the quantum and quality of human
resources for nursing and paramedical/allied health
services.

Globally, there is mounting evidence that

healthcare as a composite whole can only be improved
if human resources for nursing and allied health
services are developed, nurtured and enhanced in
a systematic and planned manner. In India, there is
a significant lack of standardization across medical
education in general and in teaching advances in skills
and technologies that emerged in the past decade, in
particular.

These Human Resources for Health (HRH)

shortfalls have resulted in the uneven distribution
of all cadres of health workers, medical and nursing
colleges, nursing and ANM (Auxiliary Nurse and
Midwife) schools, and allied health institutions
across the states with wide disparity in the quality
of education. The uneven distribution of professional
colleges and schools has led to a severe health system
imbalance across the states, both in the production
capacity and in the quality of education and training,
leading to poor health outcomes.

In the case of AHPs, since the nomenclature for

different categories of health professionals varies
in different countries, there is a considerable lack
of clarity as to what constitutes a paramedical,
paraprofessional or allied health service. For example,
the term used for a person engaged in diagnosis and
consultation regarding management and intervention
of speech disorders differs in different countries.
Australia uses the term speech pathologist whereas
the United States calls him or her a speech language
pathologist and in the United Kingdom, he or she is
known simply as a speech and language therapist.

The public health system in India suffers from

weak stewardship and oversight, HR shortages, weak
HR management and ineffective service delivery.
Doctors, nurses and allied health providers are in
short supply for the populations they serve. The ratio
is often skewed, resulting in fewer health providers
in rural areas (especially in primary health centre
settings), inefficient secondary services in smaller
towns and a high concentration of tertiary health care
services in urban cities. The skill mix, autonomy and
funding of the medical bureaucracy at the district
level need to be augmented, and initiatives for health
need to be coordinated with efforts to address social
determinants of health.

AHPs are woven into the fabric of public health in

India. They are in the vanguard of creating a service
based on people being healthy rather than a service
based on fixing ill-health. There is ample international
evidence suggesting that empowered AHPs can be the
leaders of change, playing critical role in improving the
reach of health services in underserved areas.

With a vast variety of allied health professions

already present and with newer categories coming on
board each day, India too, faces a similar challenge as

Many committees and experts have highlighted the

importance of paramedics (allied health) in healthcare
4

Executive Summary

medical functions.

different states have been using different definitions to

describe this ever-growing field.

As American physician and educator, Leon Kass,

points out, all kinds of problems now roll to the
doctors door, from sagging anatomies to suicides,
from unwanted childlessness to unwanted pregnancy,
from marital difficulties to learning difficulties, from
genetic counselling to drug addiction, from laziness to
crime....

The breadth and scope of the allied health practice

encompasses the following:

The age span of human development from neonate

to old age;

Working with individuals with complex and

challenging problems resulting from multi-system
illnesses;

Several factors have contributed to the uneven

power balance between doctors and AHPs. Medical
dominance coupled with what is called Medicalisation
is considered to be a major reason.

Working towards health promotion and injury

prevention, and the assessment, management and
evaluation of interventions;

Medicalisation, has not only broadened the scope

of medicine but also raised its status. It reinforces the
image of medical practitioners as being omniscient
and omnipotent and impels societies to allocate
continually growing proportions of gross domestic
product to their preferred healthcare services.

Working in a broad range of settings from a

patients home to acute, primary and critical care
settings; and

Having an understanding of the healthcare issues

associated with diverse cultures within society.

The importance of these professionals has been

explained with an example by K.S. Reddy, Dean of
the Jawaharlal Institute of Post-Graduate Medical
Education and Research (JIPMER), Puducherry. He
noted that, during the process of cardiac surgery, the
functions of the heart are taken over by a machine. The
person who handles this machine literally holds the
life of the person. Any mistake can be life-threatening.
This is why we now insist on trained staff to handle
such machines.

Closely linked with medicalisation is medical

dominance; they reinforce each other. According to
American academician and sociologist, Professor
Eliot Freidson, medical dominance has at least three
components:

Trust, faith and confidence by the public in the

medical profession;

With advancements in technology over the past few

decades, the quality of medical care has vastly improved
across the world. This has thrown up fresh challenges
for the medical field. Today, there is an urgent need for
competent people who can handle highly sophisticated
medical machinery with competence. In fact, diagnosis
has become so dependent on technology that the role
of allied health staff has become vital in delivering
successful treatment.

A position of authority based on exclusive

command over a body of specialised knowledge;
and
Dominance in the division of labour, that is, control
over other health professions.

To these may be added the privilege of selfregulation, whereby the profession regulates the
behaviour of its members and monopolises decisionmaking and the use of resources.
Medical dominance of healthcare has traditionally
been the organising principle in the healthcare delivery
system. Medical power is manifested through the
professional autonomy of doctors, their pivotal role in
the economics of the health services, their dominance
over allied health occupational groups, administrative
influence and the collective influence of medical
associations. The clear hierarchy of occupations

There appears to be an increasing healthillness

medicine complex in the society wherein people seek
medical solutions to various problems which are not
medical in nature and consider them as illnesses.
Functions that were once the domain of parents, clergy,
teachers, judges and social workers are now seen as
5

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

established through the growth of hospital medicine is

attributed as a major contributor to the dominance of
medicine in the division of labour.

Thus, high medical domination has been

instrumental in lowering the status of AHPs in the
eyes of people and is one of the reasons for the low
morale and self-esteem among AHPs which needs to
be addressed immediately if they were to contribute
meaningfully to the well-being of people.

Are physicians, too, allied health professionals?:

Of course. Why would you even bother to ask? We
are all on the same team.

Effective delivery of healthcare services depends

largely on the nature of education, training and
appropriate orientation towards community health
of all categories of medical and health personnel,
and their capacity to function as an integrated team.
For instance in the UK, more than 84,000 AHPs, with
a range of skills and expertise, play key roles within
the National Health Service, working autonomously, in
multi-professional teams in various settings. Though
some of them may have a PhD and use the title Dr
(for example, psychologists), they are not medically
qualified. All of them are first-contact practitioners
and work across a wide range of locations and sectors
within acute, primary and community care. Australias
health system is managed not just by their doctors
and nurses, but also by the 90,000 university-trained,
autonomous AHPs vital to the system.

In many countries, notably the United States,

the United Kingdom, Canada and Australia, policy
rationalisations by their governments have facilitated
the release of AHPs from medical dominance. The Pew
Health Professions Commission report (1995), titled
Critical Challenges: Revitalizing the Health Professions
for the Twenty-first Century observed: the needs of
the integrated systems will not be met simply by hiring
[new] public health professionals [but by] substantial
and ongoing retraining of nurses, physicians, allied
health personnel, and managers . . . [who are] required
to apply the skills in new contexts. The report calls for
creative and risk-accepting leadership in providing
training and education, a renaissance in educating
public health professionals. Training and retraining for
public health should be based on competencies, that is,
the focus should be on what people should be able to
do, rather than what they should know.

The recent modernisation of healthcare has

initiated a team-based healthcare delivery model
(Baker, et. al., 2006; Wagner, 2004). Medical teams
are usually action teams due to their dynamic work
conditions, wherein teamwork and collaboration are
the pre-requisites for optimum results. The process
of teamwork is inherently interdisciplinary, requiring
a division of labour among the medical, nursing and
allied health fraternity. Poor teamwork skills have been
found to contribute to negative patient-care incidents.

Professor Donald M. Berwick, President and

Chief Executive Officer, Institute for Health Care
Improvement, and Clinical Professor of Paediatrics
and Health Care Policy, Harvard Medical School in the
Foreword of the book Managing and Leading in the
Allied Health Professions, makes a strong case for demedicalisation and eliminating medical dominance
when he raises and answers several pertinent
questions as follows.

Allied to what?: ...the continual pursuit to relieve

suffering for those we serve.

Why health and not healthcare?: To broaden

the base of our capacity to serve.

Not only is this team approach important for

safe patient outcomes, it is also critical for efficient,
cost-effective operations. Lets take a case in point
at the William Harvey Hospital, East Kent Hospitals
of the NHS Trust, where an accident and emergency
assessment team is made up of an occupational
therapist, a physiotherapist and a care manager.
The team provides a full functional and social care
assessment for frail elderly patients who arrive at the
Accident and Emergency department in Ashford. The
teams immediate care package often allows patients

In what way professional?: In the willingness

to subordinate self-interest and prior assumptions
to the pursuit of continual improvement in
our effectiveness as a team, and to redraw the
boundaries in the status quo.

Executive Summary

to return home immediately to more appropriate care,

with the support of an occupational therapist. The
impact of the teams work has been to free up 12 extra
acute beds the equivalent of 4,500 acute bed-days
per year. The service is also far quicker; the team can
often see patients within two hours, whereas earlier it
often took more than two days.

A representative of the MoHFW apprised the

Parliamentary Standing Committee on Health
and Family Welfare about the circumstances that
necessitated the firming up of a Bill to set up the new
council. He pointed out the following problem areas,
which require regulation at the earliest:

Para-medical professions are not regulated;

The team believes that patients have benefited

because the decision-making is better and faster. We
can now see the whole picture; our care is much more
holistic. As a team we have the most appropriate skills
to make the best decisions on whether a patient can go
home safely or should be admitted to hospital.

Currently, due to the absence of a central

regulatory authority for allied health professionals
and courses in India, they are divided into smaller
groups, appearing to be regulated by independent
professional bodies at national and state levels. For
instance, the rules or norms of professional practice
vary from extremely professional and well-organised
groups such as physiotherapists, optometrists and
speech and audiology professionals to diffused groups
such as operating room technicians and radiation
therapists.

Entry-level qualifications are different at different

levels;

Level of knowledge and skills is not uniform, since

the period of training differs from place to place
and has no uniformity;
Course curricula are not uniform;

Fee structure and facilities in these institutions

are not regulated; and
Ethical standards are not uniform and are not
being enforced.

The lack of planned courses and institutions, nonuniform nomenclature for the existing courses, diverse
standards of practice and lack of qualified faculty
pose a threat to the quality of education and skills
of the AHP in India. Although there are professional
associations for certain AHPs, for example, the Indian
Optometric Association and the Indian Occupational
Therapy Association, the fruitful engagement of these
associations remains to be explored. Lack of definitive
and uniform criteria for faculty regarding essential
qualifications for their classification, nomenclature,
entry (direct versus lateral) and the absence of faculty
development programmes perpetuate the challenges
pertaining to the quantity and quality of AHPs.

For the allied health cadre to grow in the

healthcare system, these professional associations
need to be bound by a common authority that will help
the AHPs to flourish as a family rather than different
classes within the community of the healthcare
system. The role of regulating both the profession and
professionals cannot be an optional path but rather a
condition for participation in the profession.

The availability of educational resources such as

libraries, simulation centres and modern information
technology tools at various centres is also variable.
While established centres managed by large medical
institutions offer a reasonable level of facilities, the
educational resources are abysmal in stand-alone
centres or smaller set-ups.

It is therefore necessary to regulate these

professions by setting up councils on the lines of the
councils for pharmacy, nursing and other professions.
In 2007, the government of India proposed setting
up separate councils for medical laboratory technicians,
radiology
technicians,
and
physiotherapists/
occupational therapists. These councils would be
responsible, inter alia, for the maintenance of uniform
standards of education in the respective disciplines
and the registration of qualified personnel to practice
the profession.

The Confederation of Indian Industry (CII) believes

that private partners can play a key role in capacity
building and training through PPP modes to better
utilise the infrastructure of government hospitals.
7

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

The government can encourage private sector interest

through initiatives such as provision of tax incentives,
and permits to corporates to undertake healthcare for
optimised use of resources. For example, a medical
college with a 500-bed capacity could produce 150
students annually, instead of the 100 as per the current
MCI norms. A CII policy paper points out that capacity
building and training initiatives by the government
need sharpened focus not only for a quantitative
increase in trained manpower but also for improving
the effectiveness of existing methods in training.

on educational levels and specialty qualifications to

match international nomenclature and highlight their
importance as vital team players in the healthcare
delivery system. Standardised nomenclature is
also recommended for AHPs as part of their career
progression, so that promotional levels and associated
pay grades may be normalised accordingly.
Courses should follow international standards so
that they are widely accepted and receive worldwide
recognition. Students passing out from colleges should
be in great demand and get good jobs. The educational
methods should lead to a product that is worthy of
recruitment; therefore, it is very important to keep
abreast of knowledge and maintain good liaison with
the industry. Course delivery, practical training and
assessments should be standardised. Committees
should be formed to look into all aspects and
standardisation. Standardisation should incorporate
the demonstration of learning as well.

Extensive research by the PHFI team during

the course of 12 months indicates the need for an
overarching regulatory body for AHPs, excluding
doctors, nurses, dentists and pharmacists. The PHFI
team has recommended the establishment of national
and regional institutes for allied health sciences,
dedicated to nurturing and retaining talent in the
allied health space. In the absence of a Council, this
could be an interim multi-stakeholder body comprised
of experts from different allied health professions,
administrative leadership and even patients. This body
would be responsible for ensuring standardisation
of education and putting in place quality control
mechanisms for educational institutions, teaching
methods, clinical protocols, workforce management
and any other related issues.

Each institution conducting courses on allied

health should analyse and keep a record of the
student base. This should consist of key statistics and
qualitative information such as demographics and
the type of applicants for each course, the number
that are selected, enrolled and those that ultimately
graduate, and the number of drop-outs each year by
specialty. This will help generate a better picture of the
supply demand issues for the future. Strategies should
be developed to create flexibility in course delivery
through alternative delivery modes, multiple locations
and timings. There is also a need to look at options for
fast education especially for persons with experience
but without adequate qualifications. Additionally,
short term educational programmes need to be put in
place for those who have a basic education such as a
B.Sc. degree in any science subject and want to pursue
a career in allied health sciences.

Standards and acceptable terminologies for the

various professionals encompassing allied health
starting must be established; with the group being
referred to as Allied Health Professionals or AHPs
in lieu of paramedics. A definition put forth by the
PHFI team is thus: Allied health professionals include
individuals involved with the delivery of health
or related services, with expertise in therapeutic,
diagnostic, curative, preventive and rehabilitative
interventions. They work in interdisciplinary health
teams including physicians, nurses and public health
officials to promote, protect, treat and/or manage
a persons physical, mental, social, emotional and
environmental health and holistic well-being

For each course, centres of excellence and globally

recognised institutions should be identified along
with hospitals with known good practices, which may
become possible training sites. Those institutions
willing to conduct courses or to become training
sites should be incentivised by the government. It is

In addition, it is critical to undertake a complete

reorganisation of the various categories of AHPs based

Executive Summary

important to motivate both government and private

institutions to conduct courses at various levels
(diploma to post-graduate and doctoral) depending on
their capacities, thus increasing the number of courses
in various streams and the students for each course.
However, if this is not possible, then they should be
motivated to at least become clinical training sites
rendering quality education to students.

and ensuring that the required numbers of students

graduate each year. Some incentive or financial
support should be provided to start these courses.
Strengthening community colleges in terms of proper
committees and faculty, and following standards is
essential. It is also necessary that recognition by the
Union Ministry of Human Resources Development and
the Directorate of Employment as well as training by
the respective State governments be carried out so
that the students from these colleges get national and
regional acceptance.

All bottlenecks that may be related to regulatory or

financial issues that prevent institutions and hospitals
from serving as clinical sites for training should be
identified and efforts should be made to minimise
them. Solutions should be found for interactions
between educationists and potential employers to
assess the availability of clinical sites.

The Path Forward

The national initiative for allied health sciences aims

to go beyond prescribing basic project development
and management norms. It hopes to convert academic
arguments for strengthening allied health sciences
into politically articulate policies that help in capacity
building and value realization of allied health
professionals in the healthcare delivery system.

Quality improvement can be implemented

by establishing partnerships with international
institutions of excellence and PPPs to bring out the
best in the profession. The standards developed at the
centre and state levels should be in complete harmony
with each other. Emphasis on research activities
needs to be enhanced and the funding provided at
regular intervals either by the centre, state or foreign
direct investment, etc., which can be used for the
development of the research centres.

Nine premier institutions (eight RIAHS and

one NIAHS) will be the lead technical resources for
education and training of students. Moreover, to
provide education on such a scale assumed extensive
collaboration between various stakeholders at the
Centre, state and intra-state levels. The initiative may
be introduced in a phased manner. Activities will
include setting up National and Regional Institutes
of Allied Health Sciences (NIAHS and RIAHS),
establishing interim regulatory mechanisms in order
to standardize curricula, training programmes and
develop faculty across India in the allied health
streams, while engaging a network of institutions,
as indicated in Chapter 3. Thus, the implementation
arrangements would also require the establishment
of management structures at the national, state and
institutional levels.

Along with the applicability of the desired means to

augment capacity, it is also essential to focus on quality
education. The Government will need to develop a
number of options to encourage flexibility in the allied
health sciences education without compromising
on its quality. Improvement in infrastructure and
availability of faculty is a challenge that needs to
be addressed, and the Government should provide
relevant support.
There is a need to define a pathway of an upgraded
lateral entry within the allied health educational
universe, such as for a diploma holder to enter a degree
programme. All avenues for each level of transition
should be defined. With respect to public awareness,
candidates should be well-versed with the difference
in opting for any degree or diploma programme.

There is also a need to form a task force for

curriculum development cells in existing universities,
which will be affiliated with project institutions and
spread best practices to non-project institutions. There
is a need to establish industryinstitute partnership
promotion cells, along with sharing of best academic,

Robust Public Private Partnership (PPP) models

need to be established for the training of faculty

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

administrative and governance practices through

workshops and specific groups.

to not utilise the capacities of this resource at a time

when the government is bringing in critical reforms in
public health and aiming to improve access to health
by focussing on preventive, promotive, curative and
rehabilitative needs of the population.

The NBAHS will be responsible for overall

monitoring of allied health education and practice in
the country, and its coordination with other Ministries/
Departments and the All India Council for Technical
Education (AICTE). The Board will be supported
by two committees under it; the National Allied
Health Education Committee (NAHEC) and National
Allied Health Evaluation and Assessment Committee
(NAHEAC) to ensure that standard and acceptable
terminologies are used for the various professionals in
allied health.

While the government is considering strategies

to best utilize AHPs, the private sector has realised
their potential and established several institutions
and mechanisms to integrate these professions and
professionals into the organised healthcare sector.
However, the growing demand has resulted in the
mushrooming of big and small institutions claiming to
provide allied health education.

To conclude, Allied Health Professionals (AHPs)

constitute a vital part of the health system delivery,
both nationally and internationally. In the Indian
context, however, their significance and role has been
marginalised due to the prevalent culture of medical
dominance and the lack of a statutory body to give
prominence to their contributions and concerns.

As the Ministry of Health and Family Welfare in

India gets ready to undertake a facelift for the entire
allied health workforce by establishing national and
regional institutes of excellence, the time is opportune
for the government to study this provider group in
detail; review existing inputs, processes and outputs;
standardise institutions, educational tools and
methods; revisit career paths and progression; and reintroduce these professionals into the public system to
reap much-awaited rewards in the form of improved
health outcomes for the population.

Allied health workers are an untapped treasure,

critical to fixing the gaping holes in Indias health
workforce, particularly the severe shortage of
physicians and specialists. It would be a grave mistake

10

Chapter 1

The Allied Health Ecosystem

1. Introduction
Health is defined by the World Health Organization
(WHO) as a state of complete well-being, i.e. physical,
mental and social well-being, and not merely the
absence of disease. By that definition, all people
engaged in the promotion, protection or improvement
of the health of the population are health workers(1)

At present, the shortage of quality human

resources is one of the major challenges faced by the
public health domain in India. To redress the imbalance
in human resources, the Working Group on Medical
Education Training and Manpower Training of the
Planning Commission (1984) prioritised training of
paraprofessional and auxiliary personnel as follows:(3)

In the past decade, a fundamental shift has

occurred in healthcare delivery, largely due to advances
in science and technology. There is more recognition
than at any time in the past that health service delivery
is no longer just a prerogative of physicians and nurses.
It is now a team effort, drawing upon the expertise of
both clinicians and non-clinicians. These professionals
or health-service providers have been historically
identified as paramedical staff or paraprofessionals or
health technicians.

Many committees and experts have highlighted the

importance of paramedics in healthcare delivery in the
past, including the National Knowledge Commission,
which placed more importance on producing more
paramedical professionals than doctors, despite the
acknowledged scarcity of the latter. Based on the
opinion of 72 experts in the country over the last 40
years, the paper on production and utilization of health
manpower towards improvement of health services in
India states that
there is no need to increase the number of
doctors but instead improve the quality and
orientation of service provision towards better
meeting the health needs of the people and
that, there is a dire need to focus on increasing
the quantum and quality of human resources
for nursing and paramedical/allied health
services.(2)

Training and development of auxiliary personnel

Training and development of paraprofessional

personnel
Basic and pre-service/induction training in public
health and health management;

Continuing education in health management and

public health
Undergraduate medical education; and
Postgraduate medical education

Acknowledging the shortage of clinicians, the

Mudaliar Committee,(4) in 1962, underscored the need
for redesigning health service delivery with better
roles for auxiliary and paramedical personnel, leading
to better utilization of doctors and nurses. Fifty years
later, the recommendation still remains pertinent
to reforms in the Indian public health sector as
paramedics can reduce costs and augment the quality
of care. Better appreciation and utilization of the whole
range of skills possessed by these paraprofessionals
collectively termed allied health professionals
(AHP)is the key to healthsector reforms in India,
especially given the shortage of doctors and nurses in
the country.
Many new health occupations (physicians
assistants, nurse practitioners, certified nurses) have
11

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

emerged over the past several decades to assume

some of the work that doctors used to perform. Not
only is the work deskilled, but it is also increasingly
conducted without the doctor/physicians control
and supervision as other professional workers seek
their own identity and autonomy. These processes
have received support from administrators who are
constantly searching for cheaper labour, apart from
the controlled trials revealing that AHPs can, in many
circumstances, do the same work just as effectively
and efficiently for those patients who must use them.
Preference for the term allied health professional
rather than physician extender or physician assistant
reflects the promotion of this occupational division of
labour.

patient needs in therapeutic fields where getting the

services of a general physician (GP) or consultant
invariably takes longer.

AHP-led services significantly reduce the cost

of similar services structured around a consultant
physician model.(5) They play a supportive role in
providing personalised care in dealing with children
with communication difficulties, young offenders,
the elderly, cancer patients and those with longterm conditions such as diabetes. AHPs also have
an important role to play in the treatment of those
with disability, such as those with vision problems,
amputees and others.

For some patients, such as stroke survivors, it

is the support of AHPs that greatly enhances their
rehabilitation and return to normal life in the longterm;
AHPs also play a significant part in the care and return
to well-being of patients who struggle with mental and
emotional challenges.

Service users are becoming more empowered

through the consumerism of health, which has resulted
in better access to information and user-consultation
in service development and delivery. Each of these
factors has the potential to inuence the roles of
existing professional groups and presents a challenge
to workforce planners.

The above description of AHP functions is an

incomplete listing of the many categories of patients
and potential beneficiaries who are helped by the
personalised attention given by AHPs. The role of the
AHP has grown in knowledge and competence with
the evolution and specialisation of medical care.

In India, students are not aware of all the allied

health courses available in the medical education
system. Their career choices are generally influenced
by their parents and peer groups, who themselves are
unaware of the prospects in this area. By understanding
that an entry-level position is just a first step, youth
can realistically plan for their future and have a
better understanding of what is needed for long-term
success. This approach also benefits employers who
need a steady inflow of workers at all levels of their
organisation.

3. Classification of AHPs

AHPs are typically divided into two categories:

technicians (assistants) and therapists/technologists.

Technicians are trained to perform procedures

and their education lasts for less than two years.
They work under the supervision of technologists or
therapists and include physical therapy assistants,
medical
laboratory
technicians,
radiological
technicians,
occupational
therapy
assistants,
recreation therapy assistants and respiratory therapy
technicians.

2. Who is an allied health

professional?

AHPs work in all areas of public health and social care.

They often provide the cross-boundary integration
needed to deliver seamless services to patients and
their caregivers, thus creating a model of social
solidarity. In some areas, AHPs offer open access
to their services, thus providing rapid responses to

Therapists or technologists, on the other hand,

acquire procedural skills and learn to evaluate patients,
diagnose conditions, develop appropriate treatment
plans by judging potential side-effects, ascertain
12

The Allied Health Ecosystem

The Pennsylvania Workforce Investment Board

summarises the main roles performed by AHPs under
the headings shown in table below:

therapy responses, and make appropriate decisions

about treatment continuation/modification.(6)
Diagnostic
Medical services
Non-direct care
Rehabilitative

Cardiovascular technologists
Medical and clinical laboratory technicians
Radiological technologists and technicians

Dental assistants
Emergency medical technicians and paramedics
Medical assistants
Dental laboratory technicians
Medical appliance technicians
Pharmacy technicians
Occupational therapists
Speechlanguage therapists
Respiratory therapists

addition, there are multipurpose workers, both male

and female, and auxiliary nurse midwives (ANMs).

Dr. Gauripada Dutta, senior member of State

Planning Board, Government of West Bengal has
offered an alternative classification of AHPs, as given
below:

Peri-medical

They are general duty assistants, sweepers and

group C workers (clerks, accountants, storekeepers,
ward-masters) and non-medical technical hands. They
could play an important role in both preventive and
curative services.

Paraprofessional

These are voluntary workers from the community

who are not part of a structural organisation. These
voluntary activists receive training and some form of
recognition from the community and the local selfgovernment. Community health volunteers/guides
and traditional birth attendants were recruited with
this idea. Many state governments, for example,
Madhya Pradesh and Chhattisgarh, are initiating such
schemes in various towns. There is a need for a system
to objectively review their efficacy and sustainability
while retaining control of the community over them.

4. Role of allied health

professionals

Allied health professionals play a range of roles from

health promotion, health improvement and early
intervention to the support of those with long-term
conditions, disability and those on palliative care.(7)
Mid-level practitioners (MLPs) have rendered care to
indigenous populations since colonial times. At present,
they assist professionals or render care independently,
especially in areas with a scarcity or absence of
professionals such as therapists, doctors, dentists,
pharmacists and nurses. AHPs provide services both
in urban and rural areas, in primary-, secondary- and
tertiary-care institutions and in health centres.

Paramedical

They are associated with preventive, promotive

and curative health procedures. They include nurses of
different categories, social welfare/extension officers,
pharmacists, computer workers, and technicians of
different categories (e.g. laboratory X-ray technicians,
ophthalmic assistants and physiotherapists). In
13

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Figure 1: Areas of function of allied health professionals

An AHP needs to be skilled in various fields to

provide a particular expertise for patient care. With
the rise in various non-communicable diseases such as
heart disease, stroke, cerebral palsy and developmental
disorders, there is a need for specialised care provided
by various members of the allied health team such as
physiotherapists, occupational therapists, speech
language pathologists, podiatrists, psychologists and
dieticians, to name a few. Therefore, the role of an AHP
as a part of the multidisciplinary team is open-ended
and is projected to increase in the coming years.

machine. The person who handles this machine

literally holds the life of the person. Any mistake
can be life-threatening. This is why we now
insist on trained staff to handle such machines.
(8)

With advancements in technology over the past

few decades, the quality of medical care has vastly
improved across the world. This has thrown up fresh
challenges for the medical field. Today, there is an
urgent need for competent people who can handle
highly sophisticated medical machinery. In fact,
diagnosis has become so dependent on technology
that the role of allied health staff has become vital in
delivering successful treatment.

The breadth and scope of allied health practice

encompasses the following:

The age span of human development from neonate

to old age;

Training of AHPs is an important issue. However,

the Indian healthcare education system has centred on
medical, nursing and a few allied programmes. There
are hardly any institutes and systems to train other
cadres, except those offered through the executing
departments or their associated agencies.

Working with individuals with complex and

challenging problems resulting from multi-system
illnesses;
Working towards health promotion and injury
prevention, and the assessment, management and
evaluation of interventions;

Though structured training for AHPs is important,

no conscious efforts have been made for positioning
and mentoring of AHPs in India and, worse, they are
not directly part of the health directorate domain and
often do not come under the health system.

Working in a broad range of settings from the

patients home to acute, primary and critical care
settings; and

Having an understanding of the healthcare issues

associated with diverse cultures within society.

5. Placing AHPs in a global context

The importance of these professionals has been

explained with an example by Dr K.S. Reddy, Dean
of the Jawaharlal Institute of Post-Graduate Medical
Education and Research (JIPMER), Puducherry:
During the process of cardiac surgery, the
functions of the heart are taken over by a

14

Internationally, there is mounting evidence that

healthcare as a composite whole can only be improved
if human resources for nursing and allied health
services are developed, nurtured and enhanced in a
systematic and planned manner. There is a significant

The Allied Health Ecosystem

lack of standardization of the newer skills that emerged

in the past decade, as technology advanced.

and practical medical services is a pre-requisite for

occupations in this category.

New technologies and subsequent emergence

of newer disciplines in health service delivery have
made the categorisation of services provided by
AHPs difficult. The absence of a universally accepted
definition for paramedic means that it may have been
used broadly and mostly synonymously with the term
allied health professional (AHP).

To sum up, the term paramedical encompasses

a variety of functions with differing requirements for
qualifications, skills and providing support services
in fields such as dentistry, pharmacy, physiotherapy,
ophthalmology and others.

This, however, does not include persons dealing

with emergency treatment and ambulance practice
among paramedics and rather classifies them as
ambulance workers. Emergency medical technicians
(EMT) who respond to medical emergencies in the field
are usually termed paramedics. In the United States,
they are classified according to their level of training.
However, in France, a central control function SAMU
(Service dAideMdicaleUrgente, meaning urgent
medical aid service), supported by the fire services
first-response vehicles and the SMURs (Service Mobile
d Urgence et Reanimation, meaning mobile emergency
and resuscitation service) Mobile Intensive Care Units
(MICU) provide emergency medical services.(10)

In the case of AHPs, since nomenclature for

different categories of health professionals varies
in different countries, there is a considerable lack
of clarity as to what constitutes a paramedical,
paraprofessional or allied health service provider.
For example, the term used for a person engaged
in diagnosis and consultation for management and
intervention of speech disorders differs in different
countries. Australia uses the term speech pathologist
whereas the United States calls such a person a speech
language pathologist and in the United Kingdom, the
term used is simply speech and language therapist.

In March 2000, WHO defined AHPs as participants

who have specific connections with the art and science
of healthcare and are recognized as members of
the health team in the national health system. They
are educated at professional levels in a recognized,
accredited health or health-related academic
institute.(11)

Paramedical professionals are defined and

interpreted differently within and among countries.
According to the International Standard Classification
of Occupations (ISCO), paramedical practitioners
work autonomously or with limited supervision to
provide medical services with a more limited scope
and complexity than those provided by doctors.(9)
Completion of tertiary-level training in theoretical

BOX 1: Illustrative definitions for allied health professionals

The US Department of Labor Agency for Employment and Training Administration defines AHPs as people
who are involved with the delivery of health or related services pertaining to the identification, evaluation,
and prevention of diseases and disorders; dietary and nutrition services; rehabilitation and health systems
management, among others. According to this definition, AHPs would include dental hygienists, diagnostic
medical sonographers, dieticians, medical technologists, occupational therapists, physical therapists,
radiographers, respiratory therapists, and speech language pathologists.(12)
The US Department of Health and Human Services defines AHPs as experts in a multitude of therapeutic,
diagnostic and preventive intervention. These professionals are leaders in the degree and blend of clinical
and technical expertise they bring to their specialty areas and represent approximately 5060 per cent of the
healthcare workforce.(13)
15

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

BOX 1: Illustrative definitions for allied health professionals

Though there is no agreement on the composition of allied health services in Australia, the Health Professions
Council of Australia (HPCA), in 2002, provided the following definition: Allied health professionals are tertiary
qualified providers of mainstream healthcare and members of the following professions: audiology, dietetics,
occupational therapy, optometry, orthoptics, orthotics and prosthetics, pharmacy, physiotherapy, podiatry,
psychology, radiography, social work and speech pathology. Allied health professionals are not medical doctors
or nurses. The professions of chiropractory and optometry seem to fit most definitions of allied health and yet
are not usually included in this list.(14)

According to Fitzgerald and Hudson, Allied health professionals are tertiary-trained health practitioners (who
are not doctors or nurses) from one of several individual professionals who have, for the purpose of presenting
a collaborative position, come together to work towards a common goal. Professions represented in any allied
health practitioner group vary depending on the goal of their collaborative effort. Professions may include, but
are not limited to, Audiology; Nutrition and Dietetics; Occupational therapy; Orthoptics; Orthotics; Pharmacy;
Physiotherapy; Podiatry; Psychology; Radiography; Social Work; Speech Pathology. Hence, a clear definition is
still needed.(15)
have, over the years, developed local MLP categories,
from birth attendants to health assistants, which are
not modelled on traditional health professions, but
respond to specific needs.

Since Canada and South Africa do not have legal

restrictions on the use of paramedic as a job title,
it is legitimately used to refer to all ambulance crew
members. They further identify their grades and
nomenclature based on the paramedics training, such
as primary, intermediate or advanced.(16)

From the above examples of varying descriptions, it

is clear that an AHP is someone who is well qualified to
provide care to a patient as part of a multi-disciplinary
team. Given the various aspects of patient care which
are affected and enhanced by the intervention of an
AHP, it is clear that an AHP is an important part of the
multidisciplinary team. Additional definitions of an
AHP are delineated in Annexure-1.

Many countries provide healthcare through cadres

that, though not trained as physicians, perform many
diagnostic and clinical functions. These are variously
referred to as substitute health workers, auxiliaries,
non-physician clinicians, or mid-level health
providers. There is no official definition of mid-level
providers (MLP) that represents a direct match with
any of the professional categories, such as paramedical
practitioners, recognised in ISCO. The use of these
terms is fairly broad, ranging from internationally
recognised groups, including nurses and midwives to
whom specific diagnostic and clinical skills have been
delegated (nurse practitioners), to cadres developed
to meet a specific need in a country for example,
surgical technicians in Mozambique, clinical officers in
East African countries. In many African countries, most
MLPs have been modelled on professional cadres, such
as medical doctors, pharmacists, registered nurses
and environmental health officers. Asian countries

In Australia, allied health is a broad term used

to group diverse health professions with different
educational standards, registration requirements,
legislative controls and variable practices, leading to
an identity crisis for the group as a whole.(17)Australias
health system is managed not just by their doctors
and nurses, but also by the 90,000 university-trained,
autonomous AHPs vital to the system.
The Canadian government has recognized the
valuable contributions of this skilled and highly
educated group of health professionals. The Canadian
healthcare system is ensuring that the need for an
appropriate mix and number is met over the long term.
16

The Allied Health Ecosystem

In England, more than 84,000 AHPs, with a range of

skills and expertise, play key roles within the National
Health Service (NHS), working autonomously, in multiprofessional teams in various settings. Though some of
them may have a PhD and use the title Dr (for example,
psychologists), they are not medically qualified. All of
them are first-contact practitioners, and work across
a wide range of locations and sectors within acute,
primary and community care. They perform essential
diagnostic and therapeutic roles, with functions
ranging from primary prevention to specialist disease
management and rehabilitation throughout the care
pathway.(18, 19)

promoters and technologists. The other half is full of

the richness of Indias traditional healing system.
The Ministry of Health and Family Welfare
(MoHFW) has made a separate department for the
traditional systems of medicine called Indian Systems
of Medicine and Homoeopathy (ISM&H) in 1995, and
renamed itin 2003 as the Department of Ayurveda, Yoga
and Naturopathy, Unani, Siddha and Homoeopathy,
better known by its acronym AYUSH.
In India, the modern system of medicine, which has
evolved from the countrys colonial past, dominates
the provision of health services, both in the public and
private sectors, despite the governments support and
attention to Ayurveda, Yoga and Naturopathy, Unani,
Siddha and Homeopathy.

In the South-East Asia region, AHPs provide an

array of services in both urban and rural settings at
various levels of care. Largely, non-physicians and nonnurses are described as paramedical health personnel
instead of allied health personnel or auxiliary health
personnel, terms which are commonly used in the
Western world. Education and formal training of
AHPs remains a neglected field in most South-East
Asian countries, in spite of their growing importance
in the delivery of healthcare services. In the absence
of clearly laid-out training programmes, AHPs receive
training in the public and private sectors, on the basis
of widely varying curricula.(11)

Keeping in mind these realities and to keep

pace with the advancement of medical science and
development of new diagnostic and therapeutic
techniques, there has been a quantum jump in
the demand for AHPs. This has resulted in the
establishment of a large number of institutions and
centres for training these professionals, many of which
are run without any supervision and control over the
quality and standard of education. Given the crucial
role that AHPs play in healthcare delivery, maintenance
of proper standards in their training and education is
essential.

The roles and job descriptions of AHPs are not

clearly defined in many countries, leading to an
inappropriate skills mix in times of changing healthcare
needs. It is also seen that these professionals have a
limited role in decision-making processes related to
their work.

On the other hand, the private health sector

has grown exponentially in the country since 1949
currently accounting for 93 percent of hospitals and 85
percent of doctors in India.(20) It is therefore necessary
to regulate these professions by setting up councils
on the lines of the councils for pharmacy, nursing and
other professions. In 2007, the Government of India
proposed setting up separate councils for medical
laboratory technicians, radiology technicians and
physiotherapists/occupational therapists. These
councils would be responsible, inter alia, for the
maintenance of uniform standards of education in
the respective disciplines and registration of qualified
personnel to practise the profession.(21)

6. The situation in India

Indias human resources for health are diverse and

multi-faceted. They range from rigorously trained
biomedical specialists and super-specialists to an
assortment of community- and household-based
healers. Half of this workforce is constituted by
qualified doctors of allopathic or modern biomedicine,
a range of paramedical professionals, policy-makers,
social workers, researchers, health educators,
17

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

7. Challenges with the present

allied health education system

The MoHFW apprised the Parliamentary Standing

Committee on Health and Family Welfare about the
circumstances that necessitated the firming up of a Bill
to set up the new council. The following problem areas
that require regulation at the earliest were pointed
out:

Paramedical professions are not regulated

a) Training systems and institutions

Training for allied health services in India is conducted
by institutions ranging from government-affiliated
universities,
distance-learning
universities
to
public and corporate hospitals, medical equipment
manufacturing firms and even pharmaceutical
companies.

Entry-level qualifications are different at different

levels

The level of knowledge and skills is not uniform,

since the period of training differs from place to
place and has no uniformity

The lack of planned courses and institutions, nonuniform nomenclature for the existing courses, diverse
standards of practice and lack of qualified faculty pose
a threat to the quality of education and skills of the
AHP.

Course curricula are not uniform

Fee structure and facilities in these institutions

are not regulated
Ethical standards are not uniform and are not
being enforced

Although there are professional associations for

certain AHPs, for example, the Indian Optometric
Association and the All India Occupational Therapists
Association, the fruitful engagement of these
associations remains to be explored. Lack of definitive
and uniform criteria regarding essential qualifications
for the classification of faculty, nomenclature for
faculty, entry of faculty (direct versus lateral entry)
and absence of faculty development programmes
perpetuate the challenges pertaining to the quantity
and quality of AHPs.

The governments various policy documents

on AHPs club alternative health services (systems
of medicine), ambulance services and allied health
services under a single group. Although the Indian
Public Health Standards (IPHS) has not distinctly
defined a paramedic, the contents indicate inclusion
of two kinds of functionaries those who directly
contribute to patients healthcare delivery and those
who maintain the health facilities.

The availability of educational resources such as

libraries, simulation centres and modern information
technology tools at various centres is also variable.
While established centres managed by large medical
institutions offer a reasonable level of facilities, the
educational resources are abysmally poor in standalone centres or smaller set-ups.

The Madhya Pradesh Paramedical Council Act(22)

and the Himachal Pradesh Paramedical Council Act(23)
(both passed in 2003) cover professionals practising
traditional systems of medicine (Ayurveda, Unani or
Homeopathy) who are regulated by their own separate
councils at the central level. Since the central and state
laws are applicable to these professions, practitioners
in these states have to register themselves with both the
councils. The Kerala Paramedical Council Bill describes
a paramedical technician as an ECG technician, EEC
technician, EMG technician, X-ray technician, medical
laboratory technician or ophthalmic assistant, and
includes such other technicians as may be specified
and notified by the government as paramedical
technicians from time to time.(24)

b) Infrastructure
A literature review and field visits indicate that most
institutions lack separate infrastructure and dedicated
teaching/learning aids for allied health services. Some
allied health schools have instituted modern methods.
For example, Manipal University has a common
simulation laboratory and library for all the students
pursuing healthcare sciences, the Johnson and Johnson
Ethicon Institute of Surgical Education has animated
18

The Allied Health Ecosystem

laboratories across India for imparting hands-on

training to medical and allied health professionals.
The Post Graduate Institute of Medical Education and
Research (PGIMER), Chandigarh and Guru Gobind
Singh Medical College, Faridkot have learning resource
centres.

specifically onprofessional skills development for

teaching among the faculty. Most institutions do not
have an orientation programme or training-of-trainer
protocol.
d) Curricula
Central institutes such as the All India Institute
of Medical Sciences (AIIMS), New Delhi; PGIMER,
Chandigarh; and Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Puducherry, and autonomous institutes such as the
Manipal College of Allied Health Sciences (MCOAHS),
Karnataka and Christian Medical College (CMC),
Vellore run a variety of allied health programmes with
a structured curriculum. However, there is a lack of
uniformity in the existing curricula and standards of
training between these institutions.

c) Training programmes and methods

The education and training courses for AHPs in India
range from short-term (up to three months) certificate
and diploma courses to graduate level, postgraduate
and even doctorate programmes.(11) However, there
are discrepancies in the structure and content of
the same courses in different areas across India.
Some courses are well organised and are certified by
proper universities or associations but most are not
under the ambit of any university and have evolved
as demand for services grew. Therefore, there is a
need for standardisation of the course curricula and
regulations.

For the same skills set, for example, medical

laboratory technology (MLT); a range of courses
exist at various institutionsa one-year course, a
certificate, a two-year diploma, and a three-year
degree programme.

Availability of competent faculty is the key to

quality education. Most institutions in India do not
have a separate wing of teachers dedicated to allied
health sciences. The result is that the existing graduate
and postgraduate students do not get the right
training that would enable them to take up teaching
positions. There is an acute shortage of dedicated
faculty. Teaching in allied health is predominantly
done by medical specialists. No attention is paid to
faculty development to ensure uniformity in teaching
methods. Incentives that could motivate AHPs to take
up teaching jobs are inadequate. On top of that, the
best students are absorbed by the market with better
salary offers. Hence, there is a need to attract good
students in universities and institutions to take up
teaching as a career. There are no simple and quickfix solutions, as it takes several years of hard training
to groom a competent teacher in any branch of higher
learning.

There is wide variation within these courses with

regard to the content of the curriculum and type of
training. For example, for the BSc MLT programme
at the Armed Forces Medical College, Pune; 60 hours
of general management is included in the course
curriculum. However, this is excluded in most of the
other institutions running the degree programme.
The curricula of these courses vary even within
institutes affiliated to the same council. For example,
in Optometry, CMC Vellore has incorporated dissection
of the eyeball, which is not included in other similarly
affiliated institutions.
e) Fee structure
Given the wide diversity of institutional ownership, it
is not surprising that there is a lack of standardisation
in the fee structure of these courses. While structured
courses in government-run or reputed autonomous
institutions such as AIIMS, PGIMER and CMC have a
well-defined fee schedule with a nominal entry fee,
the fees payable at private institutes and smaller setups are much higher as the fee schedule is designed

The faculty development programmes or other

efforts to develop teaching capacity in medical
education need to look beyond clinical competence
and scientific research skills. They have to focus

19

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

to generate profits for the institute. Ill-informed

candidates often get cheated by fly-by-night operators
marketing education for AHPs.

While some of the courses offer a token stipend to

the candidates in lieu of their supportive services in
running laboratories or departments, the remaining
courses have no such provision.(25)

BOX 2: Role of the private sector in shaping allied health services

The private sector has played a significant role in strengthening paramedical/allied health education in both
developed and developing countries.

According to the WHO, Several countries have private human resources for health (HRH) pre-service training
schools and governments facilitate or stimulate investment by private sector pre-service training capacity to
alleviate public sector capacity limitations that otherwise constrain HRH scale-up. WHO advises governments to
streamline approvals and accreditation processes, offer tax breaks, or provide scholarship support for student
tuition payments and also seek partnerships with the private sector to encourage contributions to investments
in public institutions.(26)

In USA, for example, the California Hospital Association recommends creating an allied health initiative to
incentivize public private partnerships (PPPs) for allied health workforce education and training. This initiative
is to be modelled after the successful Nursing Education Initiative, which created a multi-agency task force to
address Californias critical shortage of registered nurses, wherein PPPs have proven very effective in addressing
the need to expand programs, increase faculty supply, and provide additional clinical training sites.(27)
In India, realising the challenges of producing an adequate number of AHPs with appropriate competencies,
several private sector players have set up training institutions. In addition, the opening of super-specialty
hospitals has led to the incorporation of the latest technology and techniques in healthcare. This has encouraged
the private sector to get involved in pre-service education. Several groups in the private sector have introduced
simulation laboratoriesa tool for accelerating skill-building of the allied health workforce by decreasing the
demand on clinical sites.

The Confederation of Indian Industry (CII) believes that private partners can play a key role in capacity building
and training through PPP modes to better utilise the infrastructure of government hospitals. The government
can encourage private sector interest through initiatives such as provision of tax incentives, and permits
corporates to undertake healthcare for optimised use of resources. For example, a medical college with a 500bed capacity could produce 150 students annually, instead of the 100 as per the current MCI norms. A CII policy
paper points out that capacity building and training initiatives by the government need sharpened focus not
only for a quantitative increase in trained manpower but also for improving the effectiveness of existing methods
in training.(28)

8. Medical dominance and

medicalization: their effect on and
perception of AHPs

Focus group discussions with AHPs have revealed

that most of them work under the shadow of doctors
and they hardly get any recognition in society. People
go for these careers only when they have no other
options in the health sector. The profession of a
paramedic/AHP is not a coveted career choice for the
student pool in the country. Usually, only students
from the poor strata of the society join the allied health
professions. The middle and upper classes prefer to
join medical/engineering/management streams.(29)

In India, there is a conspicuous lack of recognition in

the form of accreditation, quality control, career plan
and respectable pay scales for AHPs. That there is little
involvement of AHPs in policy development related
to their work highlights the doctor-centred nature of
medical services.
20

The Allied Health Ecosystem

Physicians generally view AHPs as non-medical

staff. As a result, they seem unwilling to permit AHPs to
undertake tasks that they consider medical in nature.
Several factors have contributed to the uneven power
balance between doctors and AHPs. As American
physician and educator, Leon Kass, points out,
all kinds of problems now roll to the doctors
door, from sagging anatomies to suicides,
from unwanted childlessness to unwanted
pregnancy, from marital difficulties to learning
difficulties, from genetic counselling to drug
addiction, from laziness to crime....(30)

autonomy of doctors, their pivotal role in the economics

of the health services, their dominance over allied
health occupational groups, administrative influence
and the collective influence of medical associations.
The clear hierarchy of occupations established
through the growth of hospital medicine is attributed
to be a major contributor to the dominance of medicine
in the division of labour.
Thus, high medical domination has been
instrumental in lowering the status of AHPs in the
eyes of people and is the one of the reasons for the
low morale and self-esteem among AHPs. This needs
to be addressed immediately if they are to contribute
meaningfully to the well-being of the people.

According to American academician and

sociologist, Professor Eliot Freidson, medical
dominance has at least three components:(31)

Trust, faith and confidence by the public in the

medical profession;

Addressing medical dominance: viewpoints

In many countries, notably the United States, the

United Kingdom, Canada and Australia, policy
rationalisation by their governments have facilitated
the release of AHPs from medical dominance. The Pew
Health Professions Commission report (1995), titled
Critical challenges: revitalizing the health professions
for the twenty-first century, observed: The needs of
the integrated systems will not be met simply by hiring
[new] public health professionals [but by] substantial
and ongoing retraining of nurses, physicians, allied
health personnel, and managers . . . [who are] required
to apply the skills in new contexts.(33) The report calls
for creative and risk-accepting leadership in providing
training and education, a renaissance in educating
public health professionals. Training and re-training
for public health should be based on competencies,
that is, the focus should be on what people should be
able to do, rather than what they should know.(34)

A position of authority based on exclusive

command over a body of specialised knowledge;
and
Dominance in the division of labour, that is, control
over other health professions.

There appears to be an increasing healthillness

medicine complex in society, wherein people seek
medical solutions to various problems that are not
medical in nature and consider them as illnesses.
Medical dominance coupled with what is called
medicalisation is considered to be a major reason.
Medicalisation, therefore, has not only broadened the
scope of medicine but also raised its status. It reinforces
the image of medical practitioners as being omniscient
and omnipotent, and compels societies to allocate
continually growing proportions of gross domestic
product to their preferred healthcare services.(32)

Professor Donald M. Berwick, President and

Chief Executive Officer, Institute for Health Care
Improvement, and Clinical Professor of Pediatrics
and Health Care Policy, Harvard Medical School in the
Foreword of the book Managing and leading in the
allied health professions, makes a strong case for demedicalisation and eliminating medical dominance
when he raises and answers several pertinent
questions as follows:

To these may be added the privilege of selfregulation, where by the profession regulates the
behaviour of its members and monopolises decisionmaking and the use of resources. Medical dominance
of healthcare has traditionally been the organising
principle in the healthcare delivery system. Medical
power is manifested through the professional
21

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Allied to what?: ...the continual pursuit to relieve

suffering for those we serve.

isolated and non-rational manner; and there

has been far less concern, almost amounting to
negligence, for the planning and production of
allied health professionals as compared to that
for medical manpower. Indeed, the primary
reason for this is the medical bias in the entire
process of health system planning and health
manpower development.(35)

In what way professional?: In the willingness

to subordinate self-interest and prior assumptions
to the pursuit of continual improvement in
our effectiveness as a team, and to redraw the
boundaries in the status quo.
Why health and not healthcare?: To broaden
the base of our capacity to serve.

9. Relevance of defining allied

health professionals now: political
and social environment

Are physicians, too, allied health professionals?:

Of course. Why would you even bother to ask? We
are all on the same team.

In India, too, the need and approach to address the

issue of medical dominance is well articulated in the
report of the Mudaliar Committee (1962), which made
some important recommendations regarding the
scope of utilisation of AHPs.(35)

AHPs are woven into the fabric of public health in

India. They are in the vanguard of creating a service
based on people being healthy rather than a service
based on fixing ill-health. Empowered AHPs can be
the leaders of change.

The institution of a Master of Science degree, which

will be available for graduates in science who
have taken up mathematics, physics, chemistry,
botany or zoology, is rewarded. There is a wide
field for useful employment of such graduates and
postgraduates for medical relief both in the public
health department and in many institutions; and

With a vast variety of allied health professions

present today and with newer categories coming on
board each day, India too, faces a challengeas different
states have been using different definitions to describe
this ever-growing field.
There is a wide variation in the understanding of
the concept of paramedic in India. The nomenclature
and functions vary widely. No concerted initiative has
been taken to understand the roles and responsibilities
of AHPs, the governance and regulation issues of
the sector, and deployment strategies in the Indian
context. The roles and responsibilities conferred on
a paramedic are largely decided by the programme
under which she or he is employed.

It is essential that a large number of technicians

be trained for multipurpose duties in the field of
medicine. It is felt that all district headquarterlevel hospitals and large hospitals with a bedstrength of 200 can train these technicians. The
period of training may vary from one year to two
years, and persons to be taken on for training must
be those who have completed their school final or
equivalent course.

There is a strong case to, therefore, standardise

a comprehensive definition of AHP for the overall
regulation, deployment and development of this
growing cadre (Figure 2).

Presently, besides medical and nursing personnel,

medical auxiliaries are crucial for assisting doctors
and public health workers.

Acknowledging the medical bias, the Mudaliar report

notes that:
The growth and development of health
services and manpower over the Five-Year
Plan period reveals that health services and
health manpower have been developing in an

22

The Allied Health Ecosystem

Figure 2: Need to define allied health professions

BOX 3: Experiments and experiences in career planning

Results of a study by Thomson and others (1991) in Houston showed that only 8 per cent of respondents
expressed an interest in allied health as a career choice. Many were even unaware of what an AHP is. The results
of this study were consistent with other reports suggesting that new strategies must be employed to promote
greater participation in allied health, especially where there is under representation in these professions.
In 1996, the Association of American Medical Colleges launched the Health Professions Partnership Initiative
(HPPI) to increase the representation of minority communities in the health services. Under the HPPI, health
profession schools were to link with neighbouring colleges and schools to improve curricula in ways that would
attract students to health careers.

Among the many medical colleges to implement the HPPI was the Creighton School of Medicine. The overall
goal of the Creighton Collaborative Health Professions Partnership was to implement programmes in partner
institutions, which would increase the academic achievements and health career preparation of students
from the minority communities and ultimately translate into enrolment in the colleges health professionals
programme.

Feedback surveys after the programme revealed changed perceptions. Students who earlier only identified
doctor and nurse as medical professionals, now named more specialised choices, including many in the realm
of allied health after presentations from various AHPs.(36)
However, in India, career counselling generally does not include these options for students, nor are these courses
advertised in schools.

In the United States, programs guiding youth through a pathway to employment in allied health occupations
take many forms. Such programs can focus on in-school youth as early as middle school to point students in
the direction of allied health opportunities. In contrast, programs can be directed to older out-of-school youth
who require specific assistance to transition them through education and training and on to employment in an
allied health occupation or one leading to allied health. Job shadowing is an approach being used by the Lehigh
Valley, Pennsylvania Workforce Investment Board program and the ECHO program in Lafayette, Louisiana.(10)

23

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

BOX 3: Experiments and experiences in career planning

According to the study titled Allied health access: how to develop programs for youth in allied health careers
published by the U.S. Department of Labor Employment and Training Administration, developing an allied
health programme for youth requires the inclusion of three principal partners:(10)

The agencies responsible for recruiting, enrolling and supporting the youth on their career pathway;

The institution responsible for training and/or educating the youth; and

Health industry employers.

It further says, In most situations, recruiting and enrolling the youth will be the responsibility of communitybased organisations. Training and education for allied health occupations is often provided by community
colleges but this can vary, based on the specific occupation. Employers are most often hospitals and other major
healthcare providers. Other partners can be included, such as agencies providing supportive services.

10. Key issues and policy

considerations for augmenting
allied health capacity

be made to understand the relationship between

allied and other health professionals to overcome any
resistance and bias from the medical profession.

The cost of training and skills development

methods required to train professionals is on the
rise as is the cost of inputs such as physical facilities,
teaching and learning resources. This puts additional
pressure on attempts to upgrade the education, retraining and other forms of continuing education
of trainers and trainees. Training has become more
commercialised and competitive with the increase in
recognition of institutes in the country and abroad,
and with local institutes being compared with their
foreign counterparts.

The continuously changing health needs and service

requirements influence the allied health ecosystem
in terms of both service provision and education. In
todays scenario, it is imperative to keep the right
balance between curative, preventive, promotive and
rehabilitative healthcare. AHPs play an important role
in providing all these levels of care and hence must
get their due recognition and status in the healthcare
sector.

In this era of globalisation, it is also essential to

prevent the brain drain of AHPs, besides ensuring
optimum utilisation of skilled human resources to
meet the service requirements of the healthcare
delivery system. Due to the intricate nature of the subspecialties and undefined work profiles within the
allied health professions, there is intense overlapping
of roles and responsibilities, leading to an unnecessary
work overload.

There is a pressing need for licensing/accreditation

of training institutes. It is also important to reorient
the education at these institutes with new approaches,
introduce new methods for training and more selfdirected learning that emphasises learning processes
rather than content. This realisation has led to a
more vigorous training curriculum, with an increase
in the duration of training, improvements in entry
requirements and selection criteria, collaboration and
sharing of resources between the allied health services
and the education sectors.

In order to have a defined career pathway for

AHPs, there should be an emphasis on developing
their managerial skills. Concerted efforts should also

24

The Allied Health Ecosystem

11. Recommendations

of the various categories of AHPs based on

educational levels and specialty qualifications to
match international nomenclature and highlight their
importance as vital team players in the healthcare
delivery system. There is a need to bring clarity into the
way these health professionals will fit into the system
with other professions such as medical, nursing, etc.
Thus, we may define AHPs as follows:

The wide variation in the understanding of the

concept of allied health professional, better known as
paramedic, the nomenclature, and functions has led to
the poor image of allied health sciences. Despite a huge
demand for services from this sector, the allied health
sciences domain is highly fragmented. The government
currently has limited options for employment,
numbers for which need to be re-examined. It is hence
essential to address the issue of perception urgently.

Allied health professionals include individuals

involved in the delivery of health or related
services, with expertise in therapeutic,
diagnostic,
curative,
preventive
and
rehabilitative interventions. They work in
interdisciplinary health teams including
physicians, nurses and public health officials
to promote, protect, treat and/or manage a
persons physical, mental, social, emotional and
environmental health, and holistic well-being.

The use of the word paramedic itself limits the

activities of AHPs in the system. Hence, it is imperative
to adequately compensate these professionals based
on their qualifications and specialities. There should
also be a defined career pathway, salary structure and
cadre formation to ensure their growth prospects.

Standardised nomenclature may improve the

overall perception and image of the allied health
sciences, as well as streamline career progression, so
that promotional levels and associated pay grades may
be standardised accordingly.

Recommendation 1
Establish standards and acceptable terminologies
for the various professionals who form a part ofthe
allied health services, starting with the group being
referred to as allied health professionals (AHPs) in
lieu of paramedics.

In view of the varied and inappropriate

terminologies used currently, a set of uniformly
accepted terminologies is hence recommended based
on the qualification of the personnel working in the
allied health cadre, as it has a bearing on the training
courses and on the jobs for AHPs.

a) Recommended change in terminology from

paramedics to allied health professionals
It is critical to undertake a complete reorganisation

Table 2: Recommended terminology

Qualification of the allied health personnel

Recommended terminologies

Degree holders

Allied health professionals

Diploma holders

Allied health providers

Certificate holders

Allied health workers

25

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

by choice. Each level of education in the field should

comply with University Grants Commission (UGC)
norms. This is essential to promote a uniform level of
education imparted across all institutes throughout
the country. Therefore, it is recommended that a
standard duration for each level of education in the
field be followed to promote uniformity.

The Government of India should include more

occupations in their list, as allied health is a vast
field and encompasses every specialty in health- and
hospital-based services, including the community.
Hence, the courses should range from certificates to
diplomas, graduation, post-graduation and doctorate.
This would increase the scope of the work and
ultimately attract many more prospective students

Table 3: Levels of courses recommended for allied health personnel and their duration
Type of course

Duration

Internship

Certificate courses

1 year

3 months

PG Diploma

1 year

6 months

Diploma courses

Graduate courses
MSc courses

2 years

6 months

3 years

1 year

2 years

6 months (teaching/research)

A list has been compiled of 139 courses that fall

within the purview of existing, emerging and essential
cadres in the Indian healthcare system. This may
be revised as more professions emerge in the near
future spanning diagnostic, curative, non-direct,
rehabilitative and community-based care. (Refer to
Annexure-2 for the Recommended list of professions).

Considering the vast arena of these terminologies,

it is also very important to draw a definite line of
boundaries to define the task distribution for each,
along with other issues of task shifting or the pattern
of task sharing, etc. National and international
evidence suggests that doctors are overburdened due
to which the shift in healthcare is now increasingly
based on a team approach, with shifting tasks and care
by protocols, resulting in many tasks being delegated
to other levels. It is thus imperative to structure a
taskforce which would play an important role in
generating awareness and thereby improving the
perception and image of allied health sciences.

Currently, due to the absence of a central

regulatory authority for AHPs and courses, they are
divided into smaller groups, appearing to be regulated
by independent professional bodies at the national
and state levels. For instance, the rules or norms of
professional practice vary from extremely professional
and well-organised groups such as physiotherapists,
optometrists and speech and audiology professionals
to diffuse groups such as operating room technicians
and radiation therapists.
For the allied health cadre to grow in the healthcare
system, these professional associations need to be
bound by a common authority that will help AHPs to
flourish as a family rather than different classes within
the community of the healthcare system. The role
of regulating both the profession and professionals
cannot be an optional path but rather a condition for
participation in the profession.

b) Formation of a specific multi-stakeholder

taskforce
A specific multi-stakeholder taskforce needs to be
formed comprising personnel from the Medical
Council of India (MCI), Allied Health Sciences (AHS),
Indian Nursing Council (INC), and the industry.
i.

26

This taskforce should advocate for the important

role played by AHPs and also highlight the
advantages of all non-invasive and preparatory
work done by them. Clear roles and scope of

The Allied Health Ecosystem

AHPs should be chalked out so that their role

as important team members is well known. An
awareness campaign should be launched for AHS
based on the target audiencehigher secondary
students, college students, parents and various
health councils.

Recommendation 2

ii. Career counselling should be promoted at the

school level to create awareness among candidates
on the options available in the allied healthcare
field, and they should choose their option rather
than face limited options elsewhere.

Establish an overarching regulatory body for allied

health professionals (excluding doctors, nurses,
dentists and pharmacists).

iii. The following activities can be undertaken to

increase awareness of the allied health sciences
among the general public so that more and more
persons want to join the profession:

Involve all science schools, colleges, vocational

training institutes, community colleges
(especially those related to the Indira Gandhi
National Open University [IGNOU]) for wide
publicity.

We propose that a National Board for Allied Health

Sciences be set up as an interim measure to undertake
the work of capacity augmentation and reorganisation
for this group of the healthcare workforce. The proposed
regulatory structure would be responsible for ensuring
standardisation and putting in place quality control
mechanisms for educational institutions, teaching
methods, clinical protocols, workforce management
and any other related issues. (The NBAHS framework
has been modelled on the lines of the Bill NCHRH that
was recently presented in parliament.)

Develop comprehensive information material

including details of the profession, institutions
conducting courses, career options at various
levels and lateral entry options, for use in
campaigns and awareness building.

Develop a film on the important roles of the

different allied health streams at various
levels.

Develop an awareness campaign for AHS

based on the target audience. For higher
secondary students, college students and
the general public, use various media and
forums that are popular among the youth
such as Facebook, blogs, videos on YouTube,
electronic and interactive media. For parents
and teachers, presentations during parent
teacher meetings and the use of electronic
and print media can be productive. In all
institutions, workshops, seminars and events
should be carried out. Career counselling in
schools and colleges and career fairs should
include the various courses ion allied health
sciences.

a) Development of standards
Courses should follow international standards so
that they are widely accepted and receive worldwide
recognition. Students passing out from the colleges
should be in great demand and get good jobs. The
pedagogy should hence lead to a recruitable product;
therefore, it is very important to keep abreast of
current knowledge and maintain good liaison with
the industry. Course delivery, practical training and
assessments should be standardised. Committees
should be formed to look into all aspects and
standardisation. Standardisation should incorporate
demonstration of learning as well.

Promote career exposure activities such

as volunteering, internships, summer
programmes and observation sessions in
various allied health occupations in clinical
settings, and opportunities for these should
be made available so that students get a good
exposure to the career before joining.

27

b) Certification of courses
Degrees and certification should follow university
norms or technical education certification, as would be
mutually decided by the National Board of Education
(NBE), state governments and universities. This
is imperative to bring uniformity into educational
standards and a relatively standardized career

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

degree courses in nursing and every district hospital

should have a nursing school for certificate and
diploma courses in nursing.

pathway for the AHPs (Annexure- 3).

Recommendation 3

i) Planning of allied health education should address

the careful projection of the needavailability gap
in the education/training capacity in the country
for various specialties. The expansion of training/
education capacity should be linked to career
planning, with the development of a live register
of AHPs, which should include disaggregated
data relating to the various specialties, level of
qualifications, availability of faculty, etc.

Undertake reforms to address and correct the

varied supplydemand gaps in the allied health
workforce in both the public and private sectors,
with special consideration for geographical and
epidemiological needs.
Increasing the capacity of the public sector would
involve the creation of new AHP courses adaptable to a
modern health system in order to ensure task shifting
and resource maximisation of the otherwise short
supply of doctors and nurses. Ensuring standardised
accredited course curricula that are skills- and
competency-based, and engaging actively with the
private sector in a PPP model will greatly improve
employment opportunities and thus reduce the human
resource gap.

ii) Protocols should be developed for undertaking

education in new, cutting-edge courses and
disciplines for which the demand may be limited.
It is very important to ensure that there is no glut
in the number of AHPs available and that they are
gainfully employed in the country.

iii) The cost of education should be reduced or

students supported through the provision of lowinterest student loans, scholarships and bonds or
moratorium.

The allied health sciences education capacity in

the country requires overall expansion. Education
methods and techniques, over the years, have
undergone a sea change and these need to be
incorporated, including adult learning techniques.
The curricula need to incorporate several soft skills
and information technology (IT), besides introducing
a large number of courses relevant to the needs of
today. The availability of skilled AHP can be increased
through:

Increasing the intake capacity in various allied

health courses

Introducing new allied health courses

phlebotomy)

iv) Basic allied health education should be included

as a part of public health.

v) Basic allied health education should be provided

at the district level by setting up of allied health
sciences schools, which should be attached to the
district hospitals. A dedicated faculty similar to
those at ANM training centres should be in place.
vi) The faculty will have to be developed for the
district allied health institutes by imparting skills
for teaching to the district hospital personnel.
Incentives should be given to such persons to
motivate them to teach.

(e.g.

Encouraging lateral entry in various allied health

courses

vii) National and regional institutions of excellence

should be set up for allied health sciences
education.
The Government of India has approved the setting up
of national and regional institutions of excellence for
allied health sciences education. The National Institute

Encouraging institutions to institute degree-level

courses
Facilitating existing institutions to include allied
health sciences.

The 11th Five-Year Plan recommends that every

medical college should have a nursing college for

28

The Allied Health Ecosystem

of Allied Health Sciences, which is being established at

Najafgarh in New Delhi, is mandated to be the prime
institution of excellence for allied health sciences
education. It is expected to discharge multiple roles
in the arena of building the allied health sciences pool
in the country. In order to create capacity for training
and opportunities for practical experience, the NIAHS
is mandated to develop affiliations with institutions
located at Delhi and other states. These affiliations may
develop in the form of off-campus sites, and affiliate
and satellite centres.

charged.
iv. Additional payments should also be considered
for the faculty working in institutions set up in
difficult areas.
v. The scope for part-time work should be considered
with the possibility of hiring people on an hourly
basis, as the willingness to work full time may vary.
This will be useful in supplementing the funds
available with students for completion of their
studies. Hence, avenues for ad-hoc arrangements
should be instituted.

Maintaining the quality of institutions inspite

of competition and increasing commercialisation is
a great challenge. Due to commercialisation of the
education system, the cost of education has risen
considerably in the recent past, which has limited the
capacity of the population to access quality education
pertaining to the allied health sciences. The demand
for specialised services is also increasing and needs
to be kept in mind while addressing the shortage of
personnel.

b) Increasing allied health occupations in

government institutions
It is well known that government institutions,
especially tertiary hospitals, district hospitals, subdistrict hospitals and a large number of community
health centres (CHCs), are overloaded with patients.
There is a dearth of specialists and doctors are unable
to cope. It is also seen that there is an acute deficit
of allied health staff in the basic scope of services.
With the strengthening of district hospitals and
advancement of technology in areas such as echo
machines, pulmonary function tests laboratories, CT
scans, MRI and oncology services, the need for support
staff is large and people with appropriate skills have to
be available to facilitate services. Thus, it is essential to
undertake the following measures:

In the context of the issues mentioned above,

there is a dire need to reduce the cost of education
and support students who project a willingness to
pursue these sciences. Our experts have suggested the
following measures to augment capacity.

a) Reducing the cost of education or supporting

students of allied health sciences
The shortage of personnel can be addressed by
encouraging students to enrol in allied health science
courses. Hence:

i.

i.

Provisions should be made for low-interest

student loans through negotiations with banks.
ii. Scholarships should be given to meritorious
students.
iii. Bonds or moratoriums should be instituted by the
government for students to work in specified hardto-reach areas, and for those students for whom
the government pays fees. For those persons
who default on their agreements, high penalties
commensurate to the fees sponsored should be

This problem can easily be addressed through

the recruitment of AHPs who can take care of the
primary needs and screening in every specialty of
healthcare, starting with the care of emergency
patients in the ambulance to writing down case
histories, taking the blood pressure, preparing
patients, doing the initial ophthalmic examination
including visual acuity, preparing equipment, etc.

ii. Hence, more AHPs need to be inducted in PHC up

to the tertiary-care levels.
iii. A detailed assessment of the scope of the AHP
needs to be carried out in each area.

iv. There is a need to induct a wider range of allied

29

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

i.

health specialists than just medical laboratory

technicians,
physiotherapists,
ophthalmic
assistants, X-ray technicians, dental technicians,
etc. into the government healthcare system.

ii. Professional development strategies need to be in

place along with a clear career path. Continuing
education and options for higher education are
important mechanisms for retention.

c) Recruitment of AHP
The first stage in engaging more AHPs is recruitment:
i.

iii. A good salary is very important for retaining

people. Other issues are related to security,
including social security, facilities for childcare,
etc.

The recruitment process should be flexible, easy

and fast. The entire process, from advertisement to
selection, should not take long. Walk-in interviews
may be conducted to ease the process such as

iv. Incentives for preference in postgraduate

education, such as for doctors, are also attractive

those undertaken by the Haryana Government

to fill vacant Medical Officers posts in various
facilities. Advertisements for government jobs
should be attractive and various electronic media
should be used.

options.

v. Personnel working in difficult areas should be

given the choice of their preferred place of posting
after five years of rural service.

ii. The job description and remuneration should be

clearly spelt out. The pay scales should be the
same for the same qualifications. Those persons
willing to work in hard-to-reach or deprived areas
should be given additional allowances.

e) Strengthening and expanding the capacity of

existing institutions of allied health sciences
education
The government has already operationalised a large
scheme for strengthening the existing allied health
sciences education capacity in the country through
a one-timegrant-in-aid to state medical colleges for
expanding education capacity. This grant may be used
for improving the infrastructure at the institutions
or adding faculty, teaching aids, etc. The government
may continue its efforts in this regard and also identify
institutions of excellence in the non-government
sector, which are engaged in allied health sciences
education and strengthen them as well.

iii. Recruitment should begin at the time when

students are enrolled. Campus placements should
be instituted as is done at all premier institutions
in engineering and management. The government,
hospitals, research laboratories and the industry
should be encouraged to participate in campus
placements. This will encourage more students to
join the allied health sciences.
iv. Recruitment for future faculty programmes should
also be encouraged to develop an academic cadre.

v. District cadres should be created so that persons

are specifically employed in those areas and
cannot be posted elsewhere.
d) Retention
Retention of AHPs needs to be seriously addressed. It
is well documented that a large number of personnel
leave the profession or migrate abroad or specialize
in other streams where there are better opportunities
and respect. Thus:

Retention strategies should be developed for

various levels in the careers of the personnel.

30

f) Establishing new institutions for allied health

sciences training
This would remain the mainstay of the initiatives
of the government for the next few years. New
institutions for allied health sciences education and
training would need to be set up in all states. As far
as possible, all medical colleges must strive to set up
a parallel allied health sciences training institution.
The district hospitals in the country have become the
hubs for training nurses and ANMs, and are also being

The Allied Health Ecosystem

considered for three-year training of rural doctors. The

large district hospitals may be identified as institutions
for allied health sciences education also. The patient
load at these facilities provides valuable training
opportunities, and undertaking standardised courses
in these institutions would expand the available allied
health sciences pool in the country while making
captive technical human resources available to the
hospitals after the first year of education in most
courses.

the autonomy to regulate with the government.

Appropriate incentives/funding should be provided by
the government for institutions to take up the training.

g) Instituting basic allied health education as a

part of public health
Basic allied health education should be provided at
the district level by setting up institutes attached to
district hospitals and with a dedicated faculty, similar
to that available at ANM training centres. The faculty
will have to be developed for the district allied health
institutes by imparting skills for teaching to the district
hospital personnel. Incentives should be provided to
such persons to motivate them to teach.

A mapping exercise of the geographical areas for

the presence of AHS should be undertaken for each
state. Institutions should be setup in difficult areas
and those regions where there is limited presence
or absence of educational institutions proving allied
health education.

h)
Strengthening community colleges for
conducting allied health education
The community college is an alternative system of
education, which is aimed at empowerment of the
disadvantaged and underprivileged (urban poor, rural
poor, tribal poor and women) through appropriate
skills development leading to gainful employment.
These colleges work in collaboration with the
local industry and community to achieve skills for
employment and self-employability of these sections
of the society. The community college system has
the advantages of easy access, flexibility in teaching
methodology, cost effectiveness and equal opportunity.

In the initial phases, training will be taken up by

medical colleges, district general hospitals, and large
private hospitals through physicians, nursing, and
doctors in the preclinical and paraclinical fields. CII
is planning to develop a curriculum that will contain
standard instructions for the entire year, after which
the candidate will get a certificate on completion of
credit hours.
Multinational companies can take up training
skills required for certain disciplines through a
PPP model using the government curriculum with
BOX 4: Community Colleges

IGNOU has 128 affiliated community colleges at present, for which IGNOU has developed guidelines. IGNOU also
plans to set up 500 such community colleges, and ultimately in every panchayat. The community colleges are
regulated by IGNOU through committees, each of which has a representative from IGNOU.
A study should be conducted to assess issues that can lead to the strengthening of community colleges as
community colleges generally have a two-year curriculum that either leads to an associate degree for transfer
to an undergraduate college or to the students direct entry into any occupation or trade. NIAHS can work with
IGNOU in strengthening these colleges.
Strengthening community colleges in terms of having
proper committees, faculty and standards is essential,
as this may address the gap in the rural healthcare
delivery system. It is also necessary that they gain
recognition by the Ministry of Human Resource
Development and the Directorate of Employment, and

that training be carried out by the respective state

governments so that students are encouraged to get
an education at these colleges, which has national and
regional acceptance. It will also ensure the horizontal
mobility of students in terms of getting employment
all over the country.
31

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

on simulation tools from the first year itself.

Simulation tools are a cheap, effective method of
building/evaluating the skills of students without
exposing patients to unethical risks.

i) Augmenting the capacity of existing institutions

and medical colleges in all states for quality
allied health sciences education
There are over 350 medical colleges and approximately
940 stand-alone institutions based on desk review
research (listed in Appendix-1) in the country, of which
at least half can adopt a standard allied health sciences
education regimen with standardised curricula,
and entrance and exit examinations. The following
activities will need to be conducted for strengthening
these institutions:
i.

j) Provision of support to stand-alone institutions

to make them financially sustainable
Institutions that do not have an attached hospital
or medical college (stand-alone institutions) find it
very difficult to be financially viable as they cannot
charge high fees from the students. A study should be
conducted to see how stand-alone institutions sustain
themselves. The government should provide special
grants and incentives to stand-alone institutions only
if they provide quality education.

Each state should map out all its allied health

sciences training institutions, including their

infrastructure, fee structure, courses conducted,
faculty, students, equipment, teaching/ learning
aids and other facilities. Based on this, efforts
should be made to develop their capacities and
move towards the standards set by the regulatory
body.

As seen during our research on the institutes

in India, the path for a professional to move up the
career ladder is blurred. This situation is prevalent
in all specialties of the field. This long-ignored need
to standardise the cadre structure and growth ladder
has caused a great sense of dissatisfaction among
professionals. A defined career pathway will not only
help AHPs to excel in their respective fields but also
encourage lifelong learning and professionalism.

ii. Institutions should be supported in developing

their faculty and strategies formulated to
overcome the shortage of faculty.

iii. These may be knitted together with the Regional

Institutes of Allied Health Sciences (RIAHS) chain
into a large, multi centre group of institutions for
allied health sciences education. They may receive
a centralised mandate for certification under the
umbrella of the NIAHS. Medical college hospitals
associating with such institutions stand to gain
from the first year onwards as the students become
available to work in the hospital laboratories.

Recommendation 4
Establish a clearly defined cadre structure for
AHPs based on a combination of educational
qualifications and years of work experience with
a distinct career pathway for three tracks: clinical
practice, academic faculty and management.

iv. The medical faculty at the hospital may serve as the

trigger faculty until sufficient students graduate
to feed the faculty cadres. Within the hospital,
the allied health sciences education institutions
should not create large space requirements, as the
facilities can be shared across various courses and
subjects.

a) Cadre reforms
There is an immediate need for cadre reforms for
AHPs. This will result in motivation of personnel and
also encourage large numbers to join the profession.
Cadres need to be created along the lines of the nursing
profession:
i.

v. There should be flexibility within the hospital to

adapt to the requirement of various courses. The
technical skills of the students should be honed

Qualifications should be specified for every level.

ii. No new unqualified people should be allowed to

enter technical work in the future. Existing people
32

The Allied Health Ecosystem

should be certified through tests and assessments

to come at par. The time limit should be five years
for all persons to clear the exams. Bridge courses
should be organised to support such persons.

in the US or UK model should be developed for all

allied health courses. This way, a student gathers
coursework credits that he/she can use to move
up the ladder in terms of promotion opportunities
or to get higher qualification.

iii. Service and teaching cadres should be developed.

b) Defined career path

A career path is an essential element in maintaining
the motivation levels of all personnel. Career paths for
every specialty in the allied health sciences should be
chalked out. There is a need to study each specialty and
address this issue. Diploma holders can do graduation,
then post-graduation and eventually a doctorate.
Personnel can remain in the clinical field or become
faculty or do both. They can enter research or become
hospital administrators or even enter the civil services.

iv. Grades and staff levels need to be clearly spelt out

in terms of experience and qualifications in the
service cadre.
v. In the teaching cadre, the levels can be instructor,
lecturer, assistant professor, associate professor,
professor and head of department.

vi. Health provider teams at all levels from the

subcentre, primary health centre (PHC), CHC,
district hospital to medical colleges should be
defined. Peculiar inter-cadre relationships in India
may prevent the senior cadre from mentoring
even a closely related junior.

A clear path for lateral movement, change in

specialty or multi-specialisation should also be
addressed with shorter bridge course options for those
professionals who may lack a higher-level qualification
but make up for it with extensive work experience.

vii. A credit-based system similar to that in operation

Figure 3: Recommended career pathways

c) Employment options
Huge opportunities exist for employment of AHPs both
in the government and private sector. The following

employment options are suggested by our expert

group:
33

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

i.

Medical colleges, allied health colleges, hospitals,

nursing homes, clinics, diagnostic and research
laboratories, wellness centres, spas, rehabilitation
centres, and the equipment industry all need AHPs
and their demand is increasing.

where there are better opportunities. Thus, retention

strategies should include professional development,
continuing education and options for higher
education, a good salary, social security, incentives for
postgraduate education, etc.

ii. It is necessary to define the qualifications of

personnel required for each level of health facility.
MSc degree holders should only be posted in
medical colleges, academic institutions, district
hospitals or research laboratories. At PHCs and
CHCs, graduates and diploma holders can be
posted.

Recommendation 5

Build an allied health science knowledge

community through the creation of systems /
mechanisms for networking, information sharing,
real-time data capture and innovative research
which will be responsible for all knowledge
activities in allied health.

iii. Part-time employment should be allowed

depending on the workload, and in the case of
women who have to look after their children.

a) Establishment of an AHS information and

resource cell
An allied health sciences information and resource cell
should be established. This cell should be responsible
for collecting and filtering all the information for the
government, students, AHPs, the industry, etc. This
information should be hosted on a dynamic website
containing all allied health occupations, including
details of courses and training institutions, career
scope and options, job opportunities, research papers
and articles, resource material and information on
workshops or seminars or conferences. Discussion
forums through blogs and solution exchange should
be part of the website, besides providing counselling
online and motivating unemployed youth to join the
allied health sciences.

iv. A national floor salary for each level and each

cadre should be designed.

v. No contract employment should be adopted by the

authorities and institutions, especially hospitals
and facilities, which are primarily a source of
employment for professionals.
d) Work norms and standards
The issue of work norms needs to be systematically
resolved. Some professionals, such as radiologists,
have clearly stated the number of clients they can
attend to. The other specialties too should examine the
number of clients / tests a professional can attend/
do in one hour and one day while maintaining quality.
Too many patients per day or too many tests per day
will definitely affect the quality of work. Calculations
relating to the ratio of tasks to staffstrength need a
separate consultation and comprehensive inputs from
cadre experts. This will also help in calculating staff
requirement. This exercise may be undertaken at a
later time.

b) Developing a dynamic online database for each

AHP
An online database shall be maintained on each AHP.
Each person, on completing the course, should fill in
an online registration form. Once the form is filled, it
will generate a unique ID, a password and a printable
document. A system of updating the database can be
established by every individual using the unique ID
and password. Each training institute will also enter
all the details of individuals passing out on software
developed by the National Board of Allied Health
Sciences.

e) Human resource (HR) policies

HR policies need to be streamlined for AHPs. Efforts
should be made to retain AHPs to prevent a large
number of personnel from leaving the profession
or migrating abroad or specialising in other streams
34

The Allied Health Ecosystem

The online registration of individuals can be

correlated with the training institutions database
through online software developed by the National
Board or Council. The document should include all
the details related to the special competencies of
the individual, career history, training undertaken,
education and qualifications of the AHP. When an AHP
applies for a job, his/her history can be easily verified
as all records are online and computerised. The details
of each individual can be printed out if required. The
advantage of this document is that all records of AHPs
are available at one place, which will reduce time in
cross-checking records.

prominence to their contributions and concerns.

Allied health workers are an untapped treasure,

and are critical to fixing the gaping holes in Indias
health workforce, particularly the severe shortage of
physicians and specialists.

It would be a grave mistake to not utilise the

capacities of this resource at a time when the
government is bringing in critical reforms in public
health and aiming to improve access to health by
focusing on the preventive, promotive, curative and
rehabilitative needs of the population.

While the government is considering strategies

to best utilize AHPs, the private sector has realised
their potential, and established several institutions
and mechanisms to integrate these professions and
professionals into the organised healthcare sector.
However, the growing demand has resulted in the
mushrooming of big and small institutions claiming to
provide allied health education.

c) Earmark research funds for improving quality

standards for AHPs
Quality improvement can be implemented by
establishing
partnerships
with
international
institutions of excellence and PPPs to bring out the
best in the profession. The standards developed at
the central and state levels should be in complete
harmony with each other. More emphasis should be
placed on research activities and funding provided at
regular intervals either by the Centre, state, or foreign
direct investment, etc., which can be used for the
development of the research centres.

The needavailability gap is large but not

insurmountable. A careful plan to expand the training
capacity has to be drafted, which is discussed later in
this report. While designing education in the allied
health sciences in India, the changing demographical
patterns and epidemiological transitions need to be
kept in mind, besides globalisation, technological
developments and information technology.
Planning for allied health education should address
the following:

Along with augmenting capacity, it is also essential

to focus on quality education. The government will
need to develop a number of options for encouraging
flexibility in allied health sciences education
without compromising on the quality of education.
Improvement in infrastructure and availability of
faculty is a challenge that needs to be addressed, and
the government should provide the required support.

i.

Carefully project the needavailability gap in the

education/training capacity in the country for
various specialties.

ii. Connect the expansion of training/education

capacity to career planning in the public system.
This would,inter alia, address issues of recruitment
rules,
cadre
structures,
remunerations,
promotions, continuous education, etc.

12. Conclusion
Allied health workers constitute a vital part of the
health system, both nationally and internationally. In
the Indian context, however, their significance and role
has been marginalised due to the prevalent culture of
medical dominance and lack of a statutory body to give

iii. Develop a live register of AHPs with disaggregated

data on the various specialties, level of
qualifications, availability of faculty, etc.
35

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

iv. Develop protocols for undertaking education in

new, cutting-edge courses and disciplines for
which demand may be limited.

national and regional institutes of excellence, the time

is opportune for the government to study this provider
group in detail; review existing inputs, processes and
outputs; standardise institutions, educational tools
and methods; revisit career paths and progression;
and re-introduce these professionals into the public
system to reap much-awaited rewards in the form of
improved health outcomes for the population.

v. Ensure that there is no glut in the number of AHPs

available and that they are gainfully employed in
the country.

As the MoHFW gets ready to undertake a facelift for

the entire allied health workforce by establishing

36

The Allied Health Ecosystem

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38

The Allied Health Ecosystem

Annexure 1
Additional definitions of AHP
The American Medical Association in 1965 defined AHPs as A large cluster of health-related personnel who fulfill
necessary roles in the healthcare system, including assisting, facilitating, and complementing the work of physicians
and other healthcare specialists. 1

U.S. Division of Allied Health Manpower, in 1969 defined AHPs as All those professional, technical, and
supportive workers in the field of patient care, community health, public health, environmental health and related
research who engage in activities that support, complement, or supplement the professional of administrators and
practitioners.11

The Pew Advisory Panel for Allied Health in 1992 defined allied health as including all health-related
disciplines except nursing, medicine, osteopathy, dentistry, veterinary medicine, optometry, pharmacy and podiatry.1

An AHP, as defined in section 799B(5) of the Public Health Service Act (USA) (42 U.S.C. 295p (5)) is anyone
who: (A) has graduated and received an allied health professions degree or certificate from an institution of higher
education; and (B) is employed with a Federal, State, local or tribal public health agency, or in a setting where patients
might require healthcare services, including acute care facilities, ambulatory care facilities, personal residences, and
other settings located in health professional shortage areas, medically underserved areas, or medically underserved
populations, as recognized by the Secretary of Health and Human Services.

The Association of Schools of Allied Health Professionals defines AHPs as being involved with the delivery
of health or related services pertaining to the identification, evaluation and prevention of diseases and disorders
dietary and nutrition services rehabilitation and health systems management, among others.

In 2006, Services for Australian Rural and Remote Allied Health (SARRAH) members held a workshop to
define allied health to guide strategic action for the organization. This definition is contained within the SARRAH
Constitution: SARRAH recognises that allied health professionals are tertiary qualified health professionals who
apply their skills to restore optimal physical, sensory, psychological, cognitive and social function. They are aligned
to each other and their clientsAHPs mean individuals other than medical staff members who are authorized by law
and by the hospital to provide patient care services within the hospital.

Douglas HE III, Drew CR. Allied health professions. 2004. Available at: http://www.bahaistudies.net/asma/alliedhealthprofessions.pdf
http://democrats.senate.gov/pdfs/reform/patient-protection-affordable-care-act-as-passed.pdf Washington, January 2010
3
Medical staff bylaws, policies, and rules and regulations of Piedmont Newnan Hospital.Policy on allied health professionals. 2008. Available at: http://
www.piedmont.org/doc/Page.asp?PageID=DOC000755
1
2

39

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Annexure 2
List of allied health professions
Diagnostic

Cardiovascular technologist

Haematotechnologist

Curative services

Medical and clinical laboratory technician

Cytotechnologist
Histopathologist
Phlebotomist

Molecular technologist

Cytogenetic technologist

Dermatology/STD/leprosy laboratory technician

Radiological/imaging technician
Diagnostic medical sonographer
Blood bank technician

Neuro-diagnostic laboratory technologist

Sleep laboratory technician
Radiotherapist

Nuclear medicine therapist

Anaesthesia technician
Anaesthesia assistant
Perfusion technician

Neurophysiologist/END technologist
Optometrist

Ophthalmic assistant

Emergency medical technician and paramedic

Critical care technician

Critically ill children technician

Respiratory therapist
Medical assistant
OT technician

ICU technician

Dialysis technician
Nursing assistant
Dental assistant

Dental hygienist
ECG technician

40

The Allied Health Ecosystem

EEG technician

Ultrasound technologist

Non-direct care

Rehabilitative

EMG technician

Perfusion technician
Medical dosimetrist

Endoscopy technician
Urological technician
Palliative nurse

Mental health counsellor

Medical physicist

Dental laboratory technician

Dieticians and nutritionist

Medical appliance technician

Central Sterile Supply Department (CSSD) technician

Dark room assistant

Biomedical technician
Pharmacy technician

Medical transcriptionist

Medical recordstechnician

Health information technician

Physician assistant
Medical secretary

Medical and health service manager

Health and hospital administrator
Medical social worker

Hospital hospitality worker

Epidemiologist
Biostatistician

Health sanitary inspector

Nursing aide, orderly and attendant

Mortuary technician

Forensic technologist
Physiotherapist

Occupational therapist

Speechlanguage therapist
Audiometry technician

Prosthetic and orthotic technician

Hearing aid and ear mould technician

41

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Community related

Community-based rehabilitation therapist

Manager of community-based health programme

Multipurpose rehabilitation worker

Home-based care worker/home aide

42

The Allied Health Ecosystem

Annexure 3
Protocols for certification of courses and quality control
(evaluation) of desirable skill sets
Admission, award of Degree/Diploma and Certification by NIAHS
NIAHS at its inception will not be a university to award degrees. It is proposed that as a stop-gap arrangement, the
National Board of Examinations will be the body for conducting entrance examinations, term-end examinations and
awarding degrees.
Entrance examination

To effect this, the prerequisites are as follows:

i. Notification to the NBE for starting an Allied Health Sciences wing for the purpose. This would be necessary to
protect any devaluation of their post-doctoral and PG programmes in medical education.

ii. The NBE will enter into an agreement or memorandum of understanding (MOU) with the NIAHS for conducting
examinations and will be paid for the assignment according to the agreed terms and conditions.

iii. The NBE will conduct entrance examinations for admission into the NIAHS and RIAHS centrally using an
electronic medium. The use of electronic media will facilitate deeper penetration into rural areas. The language
of the test can be optional.
iv. Such arrangements can be made on the lines of the Central Admission Test (CAT), BITS Pilani, etc.

v. The selection list will be posted on internet and published in the regional vernacular newspapers. The
reservation for entitled categories will be made as per Central Government rules on the subject.
vi. Choice of institution and stream will be done on merit cum availability.

Term End examination

i. The theory examination will be conducted by the NBE. The question bank will be provided by the NIAHS
and each institution will use different sets. Question papers will be printed and dispatched by the NBE to the
controller of examinations at the RIAHS and NIAHS.

ii. The concerned institutions will nominate external and internal examiners in advance from a pool already
created by them. Each set of examiners can continue for two years as per university rules.
External examiners will evaluate the answer sheets and conduct practical examinations, etc. The answer sheets
with evaluation rolls will be submitted to the NBE who will declare the results and subsequently award degrees
after satisfying itself that the candidate has fulfilled all other criteria for such an award as per the curriculum.

43

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

44

Chapter 2

Regulating the Allied Health Profession

1. Introduction
Allied health professionals (AHPs) have long been
neglected in terms of education and career growth due
to several factors ranging from medical dominance
and policy gaps to lack of infrastructural support. This
has led to growing dissatisfaction among the huge
cadre of health professionals whose career prospects
remain uncertain despite an abundance of talent and
willingness to contribute.

a) Definition of regulation
The prime objective of professional regulation in
the field of healthcare is to safeguard the health and
well-being of persons using or needing the services
of registrants.(1)The key purposes of regulation are
to improve performance and quality; to provide
assurance that minimally acceptable standards are
achieved; and to provide accountability both for levels
of performance and value for money.(2)

The National Initiative on Allied Health Services

(NIAHS) Secretariat was instituted by the health
ministry to map gaps that require attention in
the regulatory system as a part of health reforms
undertaken during the Twelfth Five-Year Plan period. A
considerable regulatory gap in the allied health space
is attributed to the lack of a comprehensive regulatory
framework and absence of centres for excellence or
apex bodies for professional development and training
of AHPs. The objective of this endeavour is to ensure
the availability of quality human resources across the
country to fill the demand in the public and private
sector and reorient the medical conglomerate so that
they recognise AHPs as an integral part of the service
delivery mechanism.

The term regulation can be defined in many ways.

According to Philip Selznick regulation is: sustained
and focused control exercised by a public agency, on
the basis of a legislative mandate, over activities that
are valued by the society, and more specifically in a
healthcare context as any set of influences or rules
exterior to the practice or administration of medical
care that imposes rules of behaviour.(3)
The Organisation for Economic Co-operation and
Development (OECD) has defined the term regulation
to include: the full range of legal instruments by which
governing institutions, at all levels of government,
impose obligations or constraints on private sector
behaviour. Constitutions, parliamentary laws,
subordinate legislation, decrees, orders, norms,
licences, plans, codes and even some forms of
administrative guidance can all be considered as
regulation.(5)

45

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Figure 1: Various aspects of regulation

profession, manifested in various mechanisms of selfregulation.

The intent of regulation is:

To establish, monitor and enforce essential

standards, improve and sustain education,
training and practice; and provide a framework
for allied health practice relevant to meeting the
health needs of the population and protecting the
public;

With increasing entitlement literacy among

patients, increasing complexity in medicine and
frequent reports of poor performance, the ability and
willingness of healthcare professionals to regulate
them is no longer taken at face value. Increasingly,
stakeholders outside the professions are seeking
more detailed reassurance and explanation about the
delivery of healthcare services. In many countries,
there is a movement towards more rigorous and
transparent regulation, effectively reducing reliance
on the professions to monitor their own quality of care
and remediate cases of poor performance.

To provide public authority, credibility, protection

and support to permit AHPs to perform to the
maximum extent of their capabilities;

To promote regulation by AHPs themselves to

ensure appropriate standards of education and
practice;
To permit and encourage AHPs to participate in
and influence public debate on health policy; and

A range of mechanisms have been used to regulate

the healthcare professions, including the following:

Licensure: The granting of legal permits to practice

to individuals who demonstrate appropriate levels
of knowledge, skill and competence. Mandatory
licensure assures minimum acceptable levels of
competence.

To ensure that each of its practitioners is

accountable to the public for their professional
practice.(6)

b) History of regulation

Historically, medical professionals have enjoyed

significant autonomy and freedom from external
control. As a result, professional regulation has
primarily been the preserve of an elite subset of the

46

Registration: The compilation of a list of

individuals who have satisfied an authority that
they are qualified to practice. In most countries a

Regulating the Allied Health Profession

medical register is maintained, either by state or

government departments.

the challenges of standardisation of care provided,

rational use of drugs, free structures, etc.

Certification: An acknowledgement of a predetermined level of achievement or performance,

generally recognising achievements exceeding
those set as minimum acceptable standards (such
as those set for licensing purposes).

Healthcare markets generally require regulatory

interventions for the following reasons:

Revalidation and recertification: Processes

that require individual practitioners to maintain/
collect appropriate evidence to attest to the
standards of their practice and to demonstrate
their continuing competence. The use of these
interventions is increasing as it is acknowledged
that the validity of certificates and qualifications
erodes over time and that skills, knowledge and
competence require periodic reaffirmation.

Credentialing: The systematic collection, review

and verification of a practitioners professional
qualifications. This often includes using patient
data to attest to the clinical competence of an
individual in a particular activity (e.g. specific
surgical procedures).

Privileging: The granting of permission to

perform specific professional activities under
the jurisdiction of an organisations (usually a
hospitals) authority.(7)

c) Regulation and the market

Managing competition: Regulators act to ensure

a level playing field and allow market forces to
deliver efficiency by limiting concentration of
power in monopolies.

Patient protection: Regulators protect the

patient or the consumer by assessing the quality
of services. They ensure that robust grievance
and appeal procedures are in place to protect
confidential patient data.

Public accountability: Regulators ensure that

consumers are able to choose from among
the healthcare options available as per their
expectations of cost, outcomes and needs in
quality. To be able to make such choices, consumers
require accurate information about healthcare
services. Providers must also be held accountable
for the services they deliver to the masses.
Supply management: Through its expansion
around the entire healthcare sector, regulation
ensures that optimal conditions of participation
and availability of care are maintained throughout.
It also addresses the issues of over- and undersupply of services and other necessities.

Regulatory interventions need to be introduced at

the institutional and professional levels along with
creating a level playing field for public facilities by
reining in the largely unregulated private market. The
following approach can be used for the purpose as
indicated in the figure 2.

While India has an extensive legal and regulatory

framework for public health delivery, there is a lack of
a nuanced policy that nurtures human resources for
health. There is also a disconnect between bureaucratic
approaches to regulation and the realities of a health
sector dominated by private players. There is an urgent
need to introduce a regulatory framework to address

47

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Figure 2: Types of regulatory interventions

During the desk review phase of the NIAHS project the

following key issues and concerns were identified:

Lack of understanding of the Acts and their

implications

Confusion regarding the definition of allied health

and who belongs to the profession

Uncertainty regarding the role and benefits of a

single Allied Health Council

Varied expectations of what the composition of

the Allied Health Council should be
Uncertainty

regarding

the

implications

of

registration and whether individuals would be

able to register

Defining a time frame of practice for staff returning

to the workforce after an absence
Need for a transitional period to enable staff
without minimum qualifications to gain
competencies that would enable full registration
Identifying a source for competency examinations
for those staff with extensive on-the-job training
but no formal qualification.

BOX 1 CASE IN POINT

Central institutions such as the(SGPGI, AIIMS, and JIPMER) follow their own criteria and procedures for
accreditation. The standards of professional practice are not available, and there is no central registry to enrol and
track the AHPs in the country. In the absence of a central database, the information on the available and required
number of AHPs is based on crude estimates, rather than the exact status and distribution. The comparatively
larger cadres such as Physiotherapy, Optometry, Radiology and Medical Laboratory Technology, among others,
who have stronger national associations, have been trying to push the agenda for formation of their professional
councils through the government machinery. It is to be noted that formation of separate councils for each and
every cadre will lead to confusion and conflict of powers, and encourage competition between the cadres, which
may not develop in a healthy way to promote the allied health profession.
48

Regulating the Allied Health Profession

2. Situation in India

This Bill aimed to set up three councils to regulate

physiotherapists and occupational therapists, medical
laboratory technicians and radiology technicians, with
minimum educational and professional standards
for each. It mandated that every practising AHP be
registered with the council. It was also proposed that
all clinical establishments can only appoint those AHPs
who are registered with their respective councils.
Unfortunately, the Bill was pending and eventually
lapsed, leading to a void across the allied health cadres.

a) Indias policy pipeline

A number of councils such as the Medical Council of India
(MCI), Dental Council of India (DCI), Pharmacy Council
of India (PCI) and the Indian Nursing Council(INC)
have already been established by Government of
India for regulating the standards of education and
training, as well as the registration of practitioners
in these fields. The aim is to prevent unqualified
people from practising and also for maintaining the
standards of these professions. However, there is no
central regulatory mechanism for AHPs. Till date, only
the states of Madhya Pradesh, Himachal Pradesh and
Kerala have a statute governing the state paramedical
council which regulates education, recognises courses
and maintains registers. For education and training
of AHPs, there are a number of courses ranging from
short-term (up to 3 months), certificate, diploma and
graduation.

Professions with large cadres such as those for

physiotherapy, optometry, radiology and medical
laboratory technicians, which have stronger national
associations have, therefore, been trying to push the
agenda for the formation of their professional councils
through the government machinery. It is to be noted
that the formation of separate councils for each and
every cadre will lead to confusion and conflict of
powers, and encourage competition between them,
which may not develop in a healthy way to promote
the allied health profession.

Attempts are being made to create a regulatory

framework on similar lines as the MCI and DCI. No
consensus has been reached at the highest level.

Due to this absence of a standard-setting body in

the field, the following problems arise:

Lack of standardised entry-level qualifications

and examination procedures

b) Regulation of AHPs at national level

The absence of any statutory provision implies that the
regulatory function is not appropriate. Rapid strides in
medical technology have led to an increase in demand
of support staff with various skills, and large cohorts
of such on-the-job trained personnel have entered
the field. There is no set process for recognising
the new centres that offer training in various allied
health programmes except for programmes under the
Rehabilitation Council of India (RCI), MCI, INC and DCI.
Though the RCI lacks statutory support, it regulates
training programmes and training institutes in the
rehabilitation and disability sector.

Lack of national standards and benchmarks for

accreditation and regulation of paramedical
institutions
No certifying authority for paramedical courses

No grievance mechanism at the central level to

address issues
Lack of uniformity and enforcement of ethical
standards

Lack of a regulatory mechanism for skills

assessment in cases of upgradation of personnel.

c) Regulation of AHPs at state levels

At present, the RCI regulates training programmes and
training institutes in the rehabilitation and disability
sector. The Paramedical Council and Specialty Council
under state governments exist in certain states such
as Maharashtra, Madhya Pradesh, New Delhi, Kerala,

In view of the desperate need for a comprehensive

regulatory framework to ensure uniform training,
employment and standardisation for allied health
services staff, the Paramedical Council Bill, 2007 was
drafted and subsequently proposed in the Parliament.

49

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Karnataka, Himachal Pradesh and Andhra Pradesh.

Currently, registration is almost guaranteed if the
education (certificate/diploma/degree) undergone

is recognised by a university recognised by the

University Grants Commission (UGC) or any other
similar regulatory body.

Figure 3: Chronology of events for the proposed Paramedical Bill

BOX 2 The Proposed Paramedical and Physiotherapy Central Councils Bill, 2007
This Bill has not been approved yet. The highlights of the Bill are as follows:

The Paramedical and Physiotherapy Central Councils Bill, 2007 seeks to set up three councils to regulate
physiotherapists and occupational therapists, medical laboratory technicians and radiology technicians.

Each central council shall set minimum educational standards for the profession it regulates and maintain
a register of qualified practitioners. It can specify standards of professional conduct for each profession and
take disciplinary action, including the removal of a persons name from the register, against any practitioner
found to be guilty of violating such standards.
Every university or institution offering educational courses in the relevant subjects has to seek the prior
approval of the Central Government.
Every person practicing under the Act has to be registered with the respective council.

Clinical establishments can appoint only those physiotherapists, occupational therapists or paramedics
who are registered with the respective council.

Any person whose name has not been entered or whose name is not deemed to have been entered in the
register of the Central Council under this Act and is practising as a paramedic or physiotherapist, as the case
may be, shall be punishable with imprisonment for a term which may extend up to six months, or with fine
which may extend to twenty thousand rupees, or with both.
50

Regulating the Allied Health Profession

BOX 2 The Proposed Paramedical and Physiotherapy Central Councils Bill, 2007
The Bill further states:

Paramedic means a person whose name has been entered in the registers of the Paramedical (Medical
Laboratory Technology) Central Council and Paramedical (Radiology Technology) Central Council.

Paramedical means the medical laboratory technology and the radiology technology.

The Bill defines occupational therapy and physiotherapy as medically directed therapies, which implies
that patients may not be able to approach professionals in either of these fields without a reference from a
doctor.

Commonalities within the state councils

In the Indian context, few states have framed legislation

to govern the paramedical profession.

These provisions primarily intend to regulate

education and prescribe standards thereof. There
are no licensing exams or skills upgradation/
renewal system.

It is seen that all the state councils are supported

by acts passed by the state legislative assembly
with partially autonomous authority.

The final authority remains vested with the

respective state governments. The tenure of
authority is 5 years in the states of Madhya
Pradesh and Maharashtra while it is 3 years in the
states of Himachal Pradesh and Kerala.

There is also the provision for university affiliation

with the council on fulfilling certain set criteria.
The education and training of trainees falls under
the control of the state council.

However there is no provision of regular audits

conducted in the institutes affiliated. Instead the
audits conducted are done by the designated
Charted Accountant (CA) as and when required.
All the councils have similar punitive powers with
the appellative authority vested with the state
government.

The present councils in India were analysed using a

comparative tool on the following ten parameters:i.

Legislative backup supporting the council

ii. The controlling authority

None of the state councils have any political

standing.

iii. Tenure of the authority

All the present paramedical acts have a similar

structure with provision of registration and
licensing along with renewal of the same. The
provisions to deal with malpractices along with
other punishment provisions are similar. Only
the state of Kerala has the exclusive provision of
mandatory employment of licensed paramedics
in healthcare institutions. The Act in Kerala
mandates healthcare facilities to employ trained
professionals.

iv. Any political affiliation

v. Key provisions in the document

vi. Training and curriculum
vii. Restrictive provisions
viii. Promotive provision

ix. Disciplinary provision

x. Appellative provision

The standards mentioned with regard to training

and curriculums are general in all the states with
provisions of UG, certificate, diploma and PG
courses available.

51

The findings of the comparative analysis elucidate

differences in regulatory bodies across states as
depicted in the table below: The details of few of
the State Paramedical Acts are enumerated in
appendix-3.

Tenure Of
authority

52

Key provisions

Details

Provision for registration and licensing (Y/N)

Mandatory employment of licensed

paramedic in Health Care facility

Other punishment provisions present

Provisions to deal with malpractice

If yes, what trades?

Provision of independent practice(Y/N)

If yes, what is the renewal procedure?

Statute

Madhya
Pradesh

5 years or more

4 years

3 years

2 years

Fully controlled by Government

Government control+ people partnership

Partially autonomous

Fully autonomous

Add on to existing Act/Bill or Ordinance

Pending Bill

Ordinance

Statute/ Act

Inclusion of any
Y/N
political member

Controlling
authority

Backbone

Parameters

S. No.

Statute

Himachal
Pradesh

Table 1: Comparative analysis of regulatory framework for states

Statute

Kerala

Act

Andhra
Pradesh

Maharashtra

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

53

Appellative role

10

Disciplinary role

Promotive

Restrictive
provision

Parameters

Training and
curriculum

S. No.

Are matters for appeal clearly defined?

Is appeal procedure clearly defined?

Is there an authority defined?

Is process clearly defined?

Does it have punitive powers?

Does the authority have only watch dog role?

Provision for research

Provision of inclusion of new disciplines

Maximum students v/s infrastructure

restrictions

Age-specific restriction

Any gender-specific restrictions

Restriction for disabled, etc.

If yes, is it regular/ periodic or need based/

for start-ups only?

If yes, inspection and audit mechanism

defined or not?

State govt.

State govt.

State govt.

As
required

General

Kerala

N
N

Regular

General

Himachal
Pradesh

Are these provisions for regular audit?

Exclusion list of courses provided(Y/N)

Provision for university affiliation

Madhya
Pradesh

Provision for certificate/ diploma/ degree/ PG

Quality Reasoning (QR) for faculty prescribed

Is there a standard studenttrainer ratio

prescribed?

Is there an infrastructure prescribed?

Are standards, subject-specific or general

Details

Periodic

Andhra
Pradesh

Periodic

General

Maharashtra

Regulating the Allied Health Profession

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

3. Global context of regulation

Training parameters for every allied health

profession are prescribed but training institutions for
these are governed by the education department of
the country. This system clearly demarcates the areas
of jurisdiction and hence helps in avoiding a clash of
authorities by providing clear roles and responsibilities
to the various stakeholders. This drastically reduces
overburdening of the regulatory bodies, which already
have the onerous task of standardisation, compliance
monitoring, etc.

A close scrutiny of regulatory frameworks applied

internationally
indicates
consistent
patterns
emerging from developed and developing countries
to regulate AHPs. The regulatory process evolves
from standardising training and skills development
to controlling individual practice. Globally, there are
successful models with and without overarching
regulators in the healthcare arena. This section aims to
review international regulatory best practises, which
range from over-regulation in the United Kingdom to
self-regulation as seen in Australia.

The literature review

summarised in table 2.

Courses are usually recognised by a university,

government department, technical council or an AHP
council with legislative backing, while education
institutions are regulated by a different body. It is
seen that in developing countries, the emphasis is on
regulating the standards of training and education.

countries

is

4. Governance and regulation in

allied health system
A literature review of regulatory practices in developing
countries has indicated an emphasis on regulating
the standards of training and education. Mostly,
registration is guaranteed if a degree/certificate is
obtained from recognised institution. The authorities
have the power to de-register the institutions and/or
the professional in case of malpractice. There is not
much emphasis on skills mapping, skills upgradation
and registration renewal systems. The legislation and
subsequent regulation meet the purpose of dissuading
untrained people and quacks to some extent.

In developed nations, there is more emphasis

on monitoring the possession of appropriate skills
required for professions; the focus is on regulating
the profession by continuous monitoring of skills and
performance through a license renewal mechanism.
This, basically, includes principles of on-going
competence and separation of the registration process
from the disciplinary process. It is seen that having one
legislative framework allows consistent procedures
and terminologies across the professions.

Regulation of the allied health profession in the

United States is mainly consumer driven and its main
concern is ensuring consumer safety. It is based on
a stringent licensing system and individuals have to
pass tests and obtain scores to satisfy the standards.
The boards also specify training standards, prelicensing training and skill needs. Hence, training
is indirectly regulated. The focus is on monitoring
the quality of education with a view to ensure that
professionals, after undergoing the curriculum, would
be in possession of the necessary skills and attitude
to render services to the community with a minimum
risk of harm. In this system, the aspects of continuous
upgradation and aspiration are neglected.

across

In developed countries, there is an over arching

super regulator over different councils which are
separately responsible for their specific allied health
professions.
Training parameters for every allied health
profession is prescribed but training institutions
for these are governed by the education department
of the country. This system clearly demarcates the
areas of jurisdiction from each other and hence
helps in avoiding a clash of the authorities and
defines clear roles and responsibilities of the various
stakeholders. This drastically reduces overburdening
of the regulatory bodies, which already have the
tasks of standardisation, compliance monitoring,
54

Regulating the Allied Health Profession

etc. Possession of a degree/certificate may be a prerequisite but it does not guarantee licensing. Skill and
competence levels are mapped on a regular basis.
The conduct and behaviour of the professional is
taken seriously and attracts penalty. The cost element
involved in the licensing system needs to be weighed
in perspective with the merits of imposing restrictions
for entering a profession and the urgent need to make
human resources with minimum skills available at
minimal cost.

a) Regulating the profession

In developed countries the focus is more on
regulating the profession by continuous monitoring
of skills and performance through a license renewal
mechanism. In addition, conduct and ethical issues are
addressed through disciplinary institutions integrated
into the system.

Regulation of professions comprises two parts

Accrediting the institutions (measuring them

against benchmarks)

55

Accrediting the programmes

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

monitor performance.

While the former is to guide students in selecting

a legitimate institution (which complies with the
accepted standards of inputs and resources), the latter
seeks to identify courses within the institution which
are measured against benchmarks. The third part of
regulation is certifying/licensing the practitioners of
the occupation. The final part of regulation addresses
the needs for practice of a vocation.

However, in developing countries, the focus is more

on monitoring the quality of education, with a view
to ensuring that professionals, after undergoing
curriculum training and successfully passing the exams
towards award of a certificate/diploma/degree, would
be in possession of the necessary skills and attitudes to
render services to the community with minimum risk
of harm. In this system, the elements of continuous up
gradation and aspiration get neglected. However, there
is a cost element involved in the licensing system. In
a developing economy, one has to weigh the merits of
over-restriction in the profession with that of making
available an abundant supply of professionals with the
minimum required skills at the least cost. Regulation
of professionals by peer-review mechanisms is also
common in the West.

Universities are governed under the UGC Act, 1956

for post school-level education.
Universities give credence to qualifications from
the graduate level onwards.

The
All
India
Council
for
Technical
Education(AICTE) has approved a number of
courses in the allied health professions.
There is no central council for recognising allied
health courses under the Ministry of Health.

ii. Stakeholders

State-run institutions

Private institutions

National Open School

Indira Gandhi National Open University (IGNOU)

Private medical colleges running selective courses

Private/corporate hospital

Military and paramilitary forces that have their

own institutions.

c) Governance of universities
Irrespective of the establishment of the university
under any legislation, central or state, each university
is intended to function as an autonomous institution,
with the freedom to organise and administer itself as
a corporate body in accordance with the law by which
it is established. The Act under which it is established
determines the nature and extent of its autonomy.

b) Regulating education
Although education represents a fundamental element
for building workforce capacity, due to regulatory
(e.g. accreditation) and logistical (e.g. faculty
shortages) issues, academic healthcentres and other
institutions struggle to produce sufficient graduates
to meet the nations rising demand or need for health
professionals, especially for allied health. In exploring
the complexities of the regulatory, educational and
practice environments, the need for a structural
framework and an initiative at the national level
cannot be overstated. Much needs to be done at the
national and sub-national levels.

There are two major components in the management

of universities:
i.

Functions and processes associated with

administration of the institution, such as personnel
management, finance and infrastructure

ii. Academic
management:
teachinglearning
functions and their processes, such as curriculum
design, instructional system, teaching and student
assessment.

i. Indian context
The National Health Policy (NHP) 2002 recognises the
need for the establishment of statutory professional
councils for paramedical disciplines to register
practitioners, maintain standards of training and

These two functions determine the governance of the

universities. Every university has two decision-making
bodies. The Executive Council (Board of Management
56

Regulating the Allied Health Profession

situated, from among the reputed industrialists or

technologists within the system

or Syndicate) deals with the first component mentioned

above, and the Academic Council (Senate) takes all
decisions pertaining to the academic management of
the system. Both the councils are expected to work
with mutual respect and in coordination for better
administration and management.

iii. Four persons having special knowledge or

practical experience in engineering or science
education to be nominated by the Council
iv. Two professors of the institute, to be nominated
by the Senate.

The important functions of the Executive Council are

as follows:
i.

Unlike universities, the Board does not have any

representation from political parties and bureaucrats.
Many innovative approaches have been taken in
institutes such as the IITs. These include creation of
posts of functional deans, such as for academic affairs,
research and development, student affairs, among
others. These have enabled these institutes to manage
the disciplines more effectively and comprehensively.

Making statutes and ordinances that govern the

system

ii. Controlling finances and properties

iii. Managing personnel

iv. Supervising the management of institutions

affiliated to the university
v. Grievance redressal

The Academic Council undertakes the functions of:

i.

5. Policy issues for consideration

Laying down the academic policies of the

university

i.

ii. Supervising the academic policies and providing

direction on the method of instruction, evaluation
of research and improvement in academic
standards
iii. Interfaculty coordination for joint programmes
and projects
iv. Recommending statutes and ordinances
matters pertaining to academics.

ii. Minimum standards should be adapted for

affiliation, institutional requirements, application
formats, evaluation procedures, and appellate and
adjudication procedures.

in

iii. Practice acts should be based on demonstrated

initial and continuing competence. This process
must allow and expect different professions to
share overlapping scopes of practice. Pathways
should be explored to allow all professionals to
provide services to the full extent of their current
knowledge, training, experience and skills.

d) Other models of governance

It was also seen that there are professional universities
of national importance which have a different pattern
of governance within the system, such as the Indian
Institutes of Technology(IITs). The Board of Governors
is responsible for the general superintendence,
direction and control of the affairs of each of the IITs. It
is constituted by the following members:
i.

Entry-to-practice requirements should be

standardised and limited to competence
assessments for health professions to facilitate the
physical and professional mobility of the health
professions.

iv. Health
professional
boards
should
be
redesigned and their functions should reflect
the interdisciplinary and public accountability
demands of the changing healthcare delivery
system.

The Chairman Director Ex-officio

ii. One person representing each of the states

comprising the zone in which the institute is
57

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

v. A framework should be created for quality

assurance and continuous improvement.

vi. Boards should educate consumers to assist them

in obtaining the information necessary to make
decisions about practitioners and to improve the
boards public accountability.

vii. Boards should cooperate with other public

and private organisations in collecting data on
regulated health professions to support effective
workforce planning.

viii. Standardised and understandable language

should be used for regulation of health professions
and their functions. These should be clearly
described for consumers, provider organisations,
businesses, and the professions.

58

Regulating the Allied Health Profession

6. Recommendations

quality which does not match the required industry

standards. A drastic regulation imposed suddenly may
be counterproductive, raise resistance and cause legal
complications. Hence, there is a need to start with a
graded approach.

Currently, due to the absence of a central regulatory

authority for AHPs and courses, smaller voluntary
associations have been created at the state and
national levels to fill the void of a regulatory body. For
instance, the rules or norms of professional practice
vary from extremely professional and well-organised
groups such as physiotherapists, optometrists, speech
and audiology professionals to diffuse groups such as
operating room technicians and radiation therapists.

Recommendation 1

Setting up a National Board for Allied Health

Sciences (NBAHS) - An interim arrangement for
the setting up of a National Board for Allied Health
Sciences is recommended, which can eventually
merge into an overarching council.

For the allied health cadre to grow in the healthcare

system, these professional associations need to be
bound by a common authority that will help AHPs to
flourish as a family rather than different classes within
the community of the healthcare system. The role of
regulating both the profession and the professionals
cannot be an optional path but rather a condition for
participation in the profession.

It is recommended that the umbrella model may

be adopted for regulation of allied health sciences.
Although the National Commission for Human
Resources for Health Bill, 2011(7) has been currently
withdrawn from parliament, the bill provides a
good starting point from which an allied health
council framework may be derived. Realising that a
parliamentary approval to moving this critical agenda
may be rather a long drawn process with uncertain
outcomes we have recommended an interim board
structure that may be put into effect through an
executive order, if deemed appropriate and therefore
fast track the progress.

Presently, AHP education is fragmented, with

small institutions at one end and a systematic
education system in large medical institutions at the
other. In the absence of regulatory mechanisms to
control these categories, the mushrooming of these
training institutes has continued unabated and has
the potential to cause more damage to the clientele
of the medical profession. Lack of standards for
courses and institutions has led to an erosion of

This system will function as the umbrella structure

59

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Figure 4: Proposed allied health regulatory structure

where every aspiring cadre will be represented

through its professional committee along with the
existing allied health professions councils under the
allied health umbrella.
Some key issues for consideration for the
establishment of the NBAHS

The NBAHS may be setup as a corporate body.

Education (NBHE) and National Evaluation

and Assessment Committee (NEAC), as per the
National Commission for Human Resources for
Health Bill with respect to allied health sciences
only.
The board can function from institutional
premises immediately with minimum staff.

The functioning of the board is independent of the

establishment of the NIAHS.

It should be formed as per the functions

envisioned for the National Board for Health

60

Regulating the Allied Health Profession

Figure 5: Functions of national board for allied health sciences (NBAHS)

human resources in discipline of health education and

training.

Key functions of the NBAHS

Professional conduct

The Board will specify and enforce the standards of

professional conduct and etiquette to be observed
by professionals for each cadre and take disciplinary
action, including the removal of a persons name from
the register, against any practitioner found to be guilty
of violating such standards. It will also communicate
the expected professional standards to professionals.

The Board will advise government bodies or the

appropriate statutory regulatory authority on any
policy matter concerning evaluation and assessment.
The Board will be responsible for the formulation of
the financial plan required for the creation of human
resources and subsequently make recommendations
on the measures to strengthen healthcare delivery,
operational efficiency and healthcare infrastructure.

Creation and maintenance of live registers

A significant function of the board will be to maintain

and publish registers of health professionals across
the various cadres of allied health who meet the
standards set by the Board. The Board will enrol
persons with recognised qualifications on payment
of a prescribed fee and fulfilment of other criteria or
conditions as may be specified by the National Council,
for a specified period. Only after enrolment will the
person be considered fit to practise in the respective
discipline of allied health.

Advising the government

Ethics and compliance manager

The Board will house the ethical function overseeing

research applications related to human subjects
and the compliance thereof. It will lay down and
communicate the code of conduct to be observed by
the personnel in each cadre. The Board will have the
responsibility to set up inquiries into such matters
related to ethical compliance.

Standards-setting

Dispute resolution

The Board will function as an interim authority

to handle all kinds of disputes between nationalregional-level institutes.

The Board will take measures to determine, maintain

and coordinate the minimum standards of and promote
61

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

ii. The member secretary would be ex-officio director

of the NBAHS.

Growth and development of cadres

The Board will also facilitate coordination among

bodies or national councils constituted under this
Act, conduct social audit and obtain public feedback
on their performance and achievements. It will grant
permission for the establishment of health educational
institutes, and ensure compliance of its terms and
conditions or withdraw such permission. It will
carry out studies and collect data required to assess
the needs and requirements of human resources
for health of training facilities in different states and
Union territories (including the number, type and
geographical location), and formulate the action plan
for development of human resources, through the
institutions/committees/bodies under its jurisdiction.
It will promote and regulate inter-professional
cooperation among health professions. It will
coordinate the existing healthcare infrastructure in
Central and State Governments for effective utilisation
thereof.

iii. Other members:

Ex officio: Secretary Ministry of Human Resource

Development or nominee, Joint Secretary in
charge, MoHFW, Financial Advisor, MoHFW,
Director General, Armed Forces Medical Services
(DGAFMS), Advisor, Planning Commission

Composition of the governing board

i.

The chairperson of the governing board (NBAHS)

will be appointed by the Central Government and
should be a person of eminence, integrity and
outstanding calibre with a postgraduate degree
in the discipline of health, health policy, public
health, management, technology, law or finance
from a recognised university or institution, with
at least 20 years of experience in the respective
field. The chairpersons position should not be an
ex-officio position.

Ex officio: Directors of NIAHS and RIAHS; Directors,

All India Institute of Medical Sciences (AIIMS),
New Delhi and Post Graduate Institute of Medical
Education and Research (PGIMER); President,
NBE; Director, Indian Council for Medical Research
(ICMR);Director, Institute of Applied Management
and Research (IAMR).
Representatives from UGC, AICTE, IGNOU

Members from professional associations and

councils and state paramedical councils
Nominated members:

Persons of eminence representing the

industry, namely, health service providers
ororiginal equipment manufacturers (OEM)

Persons of eminence with experience in

the field of health administration, modern
medicine or public health.

Recommendation 2

The National Board for Allied Health Sciences will

consist of the National Allied Health Education
Committee (NAHEC) and National Allied Health
Evaluation and Assessment Committee (NAHEAC).

62

Regulating the Allied Health Profession

Figure 6: Illustrative structure of the National Board for Allied Health Sciences (NBAHS)

Figure 7: Functions of the committees under the board

National Allied Health Education Committee (NAHEC)

Academic functions

Coordinating role

Affiliation related

Advisory role to the National Commission for Human Resources for Health
Publish journals, memoirs, transactions and other publications

National Allied Health Evaluation and Assessment Committee (NAHEAC)

Standard setting for evaluation and assessment

Quality assurance

Certification of courses

Accreditation and certifying institutions

Other functions

Composition of the NBAHS

The functions of each component, namely, NAHEC and
NAHEAC, have been drawn on the lines of the NCHRH
Bill.

Functions of the NAHEC(8)

Academic functions Develop coordinate and

maintain standards for health education and
research.
63

Develop minimum standards of infrastructure,

faculty, training requirement and workload norms
for individuals, and clinical workload for the
establishment of institutions in the discipline of
health.

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

i.

Design and approve new courses of study as

recommended by institutes, hospitals, colleges or
universities for imparting allied health training
and conducting courses for these.

ii. Advisory role to the National Commission for

Human Resources for Health

Advice the Allied Health Sciences Central Cell in

the Ministry.

Lead the curriculum development for various

courses.

Organise seminars, trainings or conferences for

continuous medical education and such other
courses, workshops or programmes as may be
specified by regulations made by the Commission.

Advise the Commission on establishment of

laboratories, institutes and training centres for
continuous medical education in the allied health
sciences.

iii. Coordinating role

Coordinate with institutes, universities and

bodies at the international level for discharge of
its functions.

Undertake standards for faculty development

programmes.

Specify schedules of admissions to various courses

of study.

Specify calendars of examinations and scheme of

examinations.

Establish and implement the examination/

assessment process for entry to any undergraduate,
postgraduate, doctoral, post-doctoral, superspecialty or diploma courses, fellowship
examination and screening test (protocols
for certification mentioned in appendix-3 of
chapter-1.

Coordinate between allied health scientific

academies,
societies,
professional
associations,various allied health councils,
institutions and government departments and
services.
Promote and maintain a liaison between MCI, INC,
DCI and PCI.

iv. Publish journals, memoirs, transactions and

other publications

Take such steps as may be desirable to improve the

standards of training and development of quality
health professionals.

Functions of the NAHEAC

Foster research in various aspects of allied health

sciences.

i.

Specify parameters for equivalence between

academic qualifications granted by different
health institutions in the discipline of allied health
sciences, whether in India or abroad.

Affiliation related
Provide a framework for affiliation: minimum
standards for affiliation, institutional requirements,
application formats, evaluation procedures,
appellate and adjudication procedures.

Provide affiliation (recognition) to various allied

health science courses.

64

Standard-setting
for
evaluation
and
assessment
Specify standards, norms and processes for
registration of evaluation and assessment
agencies.
Undertake audit for adherence to the code of
ethics, including policies on obviating conflicts
of interest, disclosure of information, evolving
transparency in processes and procedures of
evaluation and assessment.
Develop methodologies of evaluation and
assessment in collaboration with other agencies
such as the NBE.
Promote research and innovation in evaluation
and assessment.

Regulating the Allied Health Profession

Scrutinise the report of the evaluation and

assessment agency on the applications for
consideration of grant of permission for
establishing of a college, institute or university
and make its recommendations to the Commission

v. Perform such other functions as may be

assigned to it by the Commission.

ii. Quality assurance

Create a framework for quality assurance and

continuous improvement.

Recommendation 3
Certification of allied health courses maybe
performed by the National Board of Examinations,
until a similar structure is established under the
NAHEC and accreditation of institutes conducting
such courses may be ordained to be performed
by the National Accreditation Bureau of Technical
Education (NABET) under the Quality Council of
India (QCI).

Recognise and encourage merit in all branches of

allied health sciences and technology.
Recommend improvement in academic quality.

Lay down policies for providing information to

the public with regard to all aspects of quality
and performance of institutions providing health
education and programmes conducted by them.

Quality should be in built right from the beginning. It

should be incorporated into all the aspects starting
with the infrastructure, teaching, course curriculum,
methodology, course delivery, training institutions,
faculty, assessments, examinations, internships,
mentoring and all other aspects, including governance.

Specify and monitor standards for the selection

and training of experts for the purposes of
evaluation and assessment.

iii. Certification of courses

Conduct skills certification through NBE-like

protocols.

Regular student performance, and teacher-student

feedback are very good ways of quality improvement
and should be instituted in all institutions. A number
of partnerships will need to be established to achieve
quality across all programmes and institutions.
International partnerships will also need to be
established. A robust publicprivate partnership (PPP)
model will go a long way in ensuring quality. Research
is a very important aspect for establishing quality in
allied health sciences. Funding for research will have
to be earmarked.

iv. Accreditation and certifying institutions

Lead a consortium of accrediting /regulatory

agencies which would certify skills while the
formal council is under development.

Approve and notify norms and standards of

maintenance of academic quality for accreditation
and benchmarking of education in recognised
health educational institutions imparting
approved courses in the discipline of health
throughout the period of accreditation.
Develop guidelines for
accrediting institutions.

accreditation

Collect, compile and disseminate information

regarding accreditation of health institutions and
programmes conducted by them to the public.

Institutions can be accredited by the National

Accreditation Board for Education and Training
(NABET) in line with international standards and
guidelines. It functions under the Quality Council of
India (QCI) and has developed guidelines. Some of
the quality interventions include auditing of academic
training evaluation records at regular intervals by
internal and external auditors through the scrutiny of
attendance registers, teaching hours, unit planning,

and

Monitor adherence to such norms, guidelines and

standards of academic quality, as may be specified
under any law for the time being in force by the
appropriate statutory regulatory authority, in
health educational institutions.

65

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

evaluation of internal assessments carried out, and

equipment maintenance.

Issues to be considered while designing the

regulatory framework:
i.

NABET will be responsible for performing the

following functions:
i.

Define criteria for accreditation of institutions for

training in terms of the human resources, patient
load (inpatient beds, outpatient department,
surgical and clinical procedures, investigations,
etc.), infrastructure and facilities, library, teaching
facilities, hostel facilities, etc.

Standardised and understandable language

should be used for regulation of health professions
and their functions to clearly describe them to
consumers, provider organisations, businesses,
and the professions.

ii. Entry-to-practice requirements should be

standardised and limited to competence
assessments of health professionals to facilitate
the physical and professional mobility of health
professionals.

ii. Specify the application format and guidelines for

institutions desirous of running courses, including
accreditation fees, etc.

iii. Practice acts should be based on demonstrated

initial and continuing competence. This process
must allow and expect different professions to
share overlapping scopes of practice. Pathways
should be explored to allow all professionals to
provide services to the full extent of their current
knowledge, training, experience and skills.

iii. Specify criteria for identification of inspectors and

inspection format for inspectors.

iv. Set guidelines for the accreditation process

such as criteria for selection of members of the
accreditation committee, functional aspects,
notification, etc.

iv. Health

v. Establish mechanisms for periodic inspection to

professional

boards

should

be

redesigned and their functions must reflect

the interdisciplinary and public accountability
demands of the changing healthcare delivery
system.

ensure standards of training.

NBE, under the Board, can continue to conduct all

the courses in addition to new courses. It will be
responsible for conducting postgraduate examinations
for every allied health cadre. It will oversee the manner
of conducting examinations for entry to graduate,
postgraduate, doctoral, post-doctoral, super-specialty
or diploma courses and fellowship examinations by
the Board. It will provide common standards and
mechanisms of evaluation for the minimum level
of education required in the various allied health
educational streams and overall profession. Moreover,
intra-country and international comparison is
facilitated with the availability of a commonly accepted
evaluation mechanism.

v. Boards should educate consumers to assist them

in obtaining the information necessary to make
decisions about practitioners and to improve the
boards public accountability.
vi. Boards should cooperate with other public
and private organisations in collecting data on
regulated health professionals to support effective
workforce planning.

66

Regulating the Allied Health Profession

7. Conclusion
The primary role of a government should be to
protect patients welfare by instituting regulations
and rigorously monitoring their enforcement.
However, drawing up laws in a sector such as health
can be complex. The objective of regulations must
therefore be to increase awareness and create a sense
of accountability among providers regarding the
quality of patient care, and not a routine application
of a standard or a rule. Thus, supervision needs to
be supportive, and not prescriptive or fault-finding,
as the objective must not be to drive away providers
but to persuade them, through the judicious use of
carrots and sticks, of the need to adhere to quality and
ensure patient safety. Since health is a State subject
with the Centre having concurrent jurisdiction in only
a few areas, states have the liberty to legislate their
own laws. Given the wide variation across states, it is
necessary to undertake a comprehensive assessment
of the adequacy or otherwise of the existing laws,
identify gaps and come up with a package of public
health laws.

Regulation is limited in what it can accomplish and

is not a solution to the various problems. And when
regulations remain unenforced, they count for little. It
is therefore equally important to develop the capacity
and social consent to enforce them. Enforcement
is expensive, requiring extensive data collection,
collation, analytical research and computerisation,
and trained persons to inspect, verify, correct and
monitor implementation of the contractual obligations.
Likewise, micro-planning, restructuring of health
provider markets, price-setting, etc. require patience,
negotiating skills and dialogue with various provider
associations. Thus, financial resources and making laws
is only one part of the solution; having the required
human skills and technical capacity to enforce them
is another issue altogether that needs to be built up
immediately. Without this capacity, institutionalising
PPP is difficult to sustain.

The standards by which these programmes are

measured have generally been developed by the
professionals involved in each discipline and are
intended to reflect what a person needs to know
and be able to do to function successfully within
that profession. Accreditation in the health-related
disciplines also serves a very important public interest.
Along with certification and licensure, accreditation
is a tool intended to help assure a well-prepared and
qualified workforce for providing healthcare services.

Regulations will need to effectively address

market failures that give rise to malpractices such
as fee-splitting, overmedication and poor adherence
to quality standards. They also need to ensure
ethical practices, transparency and dissemination
of information on prices and quality to consumers,
impose requirements for licensing and accreditation
of hospitals, protocols and prices.

67

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

References
1.
2.
3.
4.
5.
6.
7.
8.
9.

The Health Professional Order 2001: healthcare and

associated Profession, (2001).
Kim Sutherl and K, Leatherman, S. Regulation and
quality improvement. A review of the evidence. 2006.
Richard B. Saltman RBaEM. Regulating entrepreneurial
behaviour in European health care systems 2002.
Development of EC-oa. Recommendation of the Council
of the OECD on Improving the Quality of Government
Regulation. 1995.
Salvage J., Heijnen S. Nursing in Europe: A Resource
for Better Health. 1997. WHO regional publications.
European series, 0378-2255; no. 74.
Sutherl and K., Leatherman S. Regulation and quality
improvement: A review of the evidence. October 2006.
The Health Foundation, London.
National Council for Human Resource for Health Bill
2011, (2011).
Report of the Working Group on Medical Education.
New Delhi: National Knowledge Commission, 2005.
Sundstrom E, De Meuse K, Futrell D. Work teams:
applications
and
effectiveness.
Am
Psychol.
1990;45;120-33.

*Please refer to Bibliography for additional references (attached at the end of the document).

68

Chapter 3

Estimating Imbalances in the Allied Health

Workforce
1. Introduction
The task of addressing the shortage of human
resources starts with identifying the current
availability and quality of allied health personnel, and
then maximizing training efforts to fill the gap. Allied
health professionals (AHPs) are intrinsic to effective
healthcare delivery, especially in developing countries
which have a heavy disease burden and traditionally
widespread shortage of human resources in the
healthcare system.

interventions to address the demandsupply

mismatch that plagues the allied health system in the
country. This chapter attempts to grasp the challenges
in training and retention of AHPs while creating a
conducive environment for encouraging more students
to consider allied health as a career option.
A look at the official estimates of the numbers
of the allied health workforce in India indicates the
extent of the problem. The table below indicates the
existing number and density (per 10,000 population)
of the allied health workforce in the system as per
the National Sample Survey Organisation (NSSO) and
Census of India estimates.

As Indias health sector undergoes major policy

reforms during the 12th Five Year Plan (2012
2017), this time is ideal for comprehensive, targeted

Table 1: Number and density (per 10,000 population) of allied health professionals (AHPs)
Estimate
Category

NSSO
NCO
Classification

Dietician &
nutritionist

Dietician &
nutritionist

Medical assistant

Optician &
optometrist

& technician

Dental assistant
Physiotherapist

Other hospital staff

All

Census

Number
(per 10000
population)

Density

260

0.002

Medical assistant

168159

1.51

Total

168159

Optician &
optometrist

& technician

Dental assistant
Physiotherapist
Total

Other hospital staff

All health workers

3539

10002

165753

515872

0.03

1.51
0.09

1.49
5

NCO Classification
Dietician & nutritionist

0.03

16240

0.15

13678

Medical assistant

99010

Medical equipment
operator
Total

Dental assistant
Physiotherapist
Modern health
associate
Total

Other hospital staff

All health workers

Density

3587

Optometrist

Sources: National Sample Survey Organisation 200405; Census of India 2001

69

Number
(per 10000
population)

115250
2658
7265

15396
22662
NA

295746

0.12

0.89
1.03
0.02
0.07
0.14
0.20
NA
3

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

The national estimates mentioned above do not cover

all allied health cadres as listed in Annexure 2 of
Chapter 1. The present system lacks any live register/
record that covers the various AHPs. Hence, it was felt
necessary to conduct a needs assessment of human
resources based on the national requirement of the
population rather than on the positions available.

vii. Medical technology

viii. Dental assistance technology

ix. Surgery and anaesthesia
x. Miscellaneous

Strategy

A multi-pronged strategy was used to quantify the

national demandsupply gap. This consisted of the
following:

The Public Health Foundation of India (PHFI),

in partnership with General Electric (GE)s Healthy
Imagination group, aimed to assess the present
situation of the allied health workforce along with the
current gaps in the system. A detailed study addressing
all the existing and emerging allied health cadres was
therefore undertaken.

a) Data collection from over 350 educational

institutes in the country (using a questionnaire)

to obtain details on parameters under the ambit

of allied health such as the annual intake, course
duration, ratio of theory and practical components
and frequency of examinations, to name a few.
(The questionnaire is given at Appendix 5 and the
list of institutes is given at Appendix1). Figure 1
reflects a zone-wise distribution of institutions
sampled for the study.

Objectives

The study had the following objectives:

a) To review the structure and functions of

educational institutions in the country offering
allied health courses

b) Field visits for a first-hand view of infrastructure

and related aspects to the following twelve centres
of excellence which generate all levels of the allied
health workforce, and are benchmarked against
international standards:

b) To evaluate allied health courses in terms of the

number of professionals they produce per year
c) To calculate the number of degree, diploma and
certificate holders graduating each year
d) To assess allied health courses in terms of
educational methods and content

i.

e) To compute the number of professionals needed

at every level of the healthcare delivery system

ii. Amrita Institute of Medical Sciences (AIMS), Kochi

iii. Ali Yavar Jung National Institute for the Hearing
Handicapped (AYJNIHH), Mumbai

f) To calculate imbalances in the number of AHPs

and identify gaps/shortfalls among the following
ten major categories at the national and state
level:
i.

All India Institute of Physical Medicine and

Rehabilitation (AIIPMR), Mumbai

iv. Christian Medical College (CMC), Vellore

v. Institute of Public Health and Hygiene (IPHH),

New Delhi

Ophthalmology

vi. Jamshedjee Jeejeebhoy (JJ) Hospital, Mumbai

ii. Rehabilitation

vii. Ethicon Institute of Surgical Education (EISE),

Johnson and Johnson(J&J), Delhi

iii. Surgery and intervention

iv. Medical laboratory technology

viii. King Edward Memorial (KEM) Hospital, Mumbai

v. Radiography and imaging technology

ix. Post Graduate Institute of Medical Education and

Research (PGIMER), Chandigarh

vi. Audiology and speech language pathology

70

Estimating imbalances in the Allied Health Workforce

Figure 1: Spread of sample institutions across India

x. Government Medical College (GMC), Chandigarh

xi. Safdarjung Hospital, New Delhi

xii. Sri Chitra Thirunal Institute of Medical Sciences &

Technology (SCTIMST), Kerala.
c) Focus group discussions to gauge perspectives
on the allied health situation in the country:

Two different groups were taken into consideration

students (currently pursuing the allied health
course) and practicing professionals representing
various allied health cadres.

Questions included their reason for joining the

particular allied health specialty; perception of
the demand of their course both nationally and
globally; satisfaction with course modalities such
as faculty, infrastructure, facilities, equipment and
duration; perception on employment locations
and salaries; and suggestions to improve their
situation, to name a few.

d) Analysis of the shortfall in the number of AHPs

using all the data obtained:

71

To calculate the imbalance, an approach developed

by Zurn et al was used, in which the supply of these
professionals based on the current scenario was
compared to the demand for these professionals
based on targets set as per international health
standards for developing countries.(1)

The analysis was based on data and information

obtained from various published and unpublished
sources. We reviewed the literature in the English
language using PubMed, Google Scholar, Google
Search and institutional and government websites
such as World Health Organization (WHO),
Ministry of Health and Family Welfare (MoHFW)
and the US Department of Labor Bureau of
Labor Statistics. Sources for statistics on AHPs for
calculation of the demandsupply imbalance are
given in Annexure 1.

We focused our search on issues related to human

resources for healthcare including shortage,
imbalance, retention and optimal need for all
specialization categories mentioned above. Grey
literature included Ministry of Health reports,

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Figure 2: Various parameters used for demandsupply analysis

health workforce planning documents

capacity data from training institutions.

and

using transport infrastructure factor. Two parameters

were used to estimate this: (i) road length per 100 sq
km of area, and (ii) road length per 1 lakh of population.
The above data were obtained from a report on basic
road statistics of India.(5) The two numbers were then
multiplied together and the resultant number was
normalised on a scale of 01 (where 0 represents
states having good infrastructure, e.g. Delhi, while
1 represents states having poor infrastructure, e.g.
Jharkhand).

Various parameters used for demandsupply

analysis are given in Figure 2.

Adjustment for efficiency parameter

To account for differences in efficiency of care provided

by qualified professionals, trained unqualified
professionals and unqualified professionals, an
efficiency adjustment factor (0.28) was used to
adjust total numbers of both rural and urban
professionals(2)(3). This number was based on the
findings of a study that concluded that the likelihood of
recovery among patients visiting private doctors was
3.6 times greater than that among patients visiting
other types of doctors.(4)

After obtaining the access and efficiency

parameters, the unadjusted supply numbers were
multiplied using, separately, the efficiency parameter
and the access parameter. Thus, there were totally
three estimates of supply numbers:
(i) Unadjusted estimates;

(ii) Efficiency-adjusted estimates; and

Adjustment for access parameter

(iii) Access-adjusted estimates. For final comparison

with demand numbers the following were
selected:

To account for differences in access, the number of

accessible and total practitioners was calculated using
the following formula(2)

(a) Unadjusted supply numbers

Am = (Tm) (1/G)
where Am and Tm denote the accessible and total
numbers of practitioners, respectively, in an area and
G is the geographical size of the area in square km. The
exponent y captures the effect of geographical size on
the number of accessible practitioners; its magnitude
will be greater the poorer the state is of the transport
facilities.
y

(b) Minimum among efficiency-adjusted and accessadjusted supply numbers.

Projection

Depending on data availability, a range of sources

including Indian or international health standards set
by the WHO or the US Bureau of Labor Statistics were
used in the analysis.

The exponent factor y was modelled in our case

72

Estimating imbalances in the Allied Health Workforce

An optimal demand number was obtained for

each sub-category of the workforce. These demand
numbers were obtained through various sources in the
literature and government reports. In several cases,
numbers were estimated based on the US Bureau of
Labor Statistics numbers.

Shortfall

The final shortfall numbers were calculated based on

two methods:

(a) Unadjusted estimates: In this method, the supply

numbers were directly subtracted from demand
numbers to estimate the shortfall.

(b) Adjusted estimates: In this method, the supply

numbers were adjusted based on efficiency and
difficulty of access parameters. The adjusted
supply number was then subtracted from the
demand number to get the adjusted shortfall.
These methodological steps were used to obtain
shortfall across all states and union territories for all
the specialization categories.

Assumptions and limitations in the study

All the educational institutes contacted as part

of the data collection activity were as per the list
obtained from the website of the Medical Council
of India (MCI). These were assumed to be running
one allied health course or the other. However, it
was found that a sizeable number of institutes did
not conduct any allied health course.

Inconsistent, inadequate, incorrect (due to

misunderstood questions) responses, or absence
of responses to some variables, led to an
inconsistent sample size.
Logistic constraints and unwillingness of some
institutes to share information

Availability of supply and demand data for various

categories of specialization was unavailable by
state, and best available estimates from other
states or countries were used.

The number of workers retiring from the

73

workforce was not included in the analysis.

This analysis estimated a cross-sectional

scenario of the gaps. The longitudinal scenario
incorporating projections of population growth
and mortality are not included in the analysis.

Results for states/union territories with large

urban areas may not reflect the actual distribution
of the allied workforce, as the results depend on the
percentage of community health centres (CHCs)
+ primary health centres (PHCs) + sub-urban
centres present in the state. For example, states
such as Delhi and Chandigarh have fewer numbers
of CHCs and PHCs, so the current analysis shows a
relatively fewer number of health workers present
in large urban areas.
For certain categories of workforce, the supply
numbers were obtained using estimates of the
number of students admitted in the colleges and
the average number of years for which the college
had been in existence. Data obtained as part of the
supply analysis exercise indicated that the average
age of a college offering courses to train the allied
health workforce was 25 years. This number was
then multiplied by the students getting admitted
to the college to obtain the total such workforce
present in India. A correction factor of 0.6 was
applied on the calculated number based on
comparison with actual data for some categories.
To obtain the optimal number of the health
workforce in certain categories, it was assumed
that the ratio of the ideal number of the health
workforce to the Indian population would be
the same as the ratio of health workers to the US
population as presented in the US Bureau of Labor
Statistics.
The current method of estimating the number of
AHPs was based on a framework developed to
measure the shortage of doctors.(2) It was assumed
that the framework developed for physicians
applied equally to AHPs.

The supply numbers for various categories of

the allied health workforce were obtained at the
country level. Not much data was available on the

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Supply Estimates

distribution of this work force at the state level. To

obtain the distribution at state level, one of the key
estimates used was percentage of female health
workers at sub-centres and PHCs across different
states as obtained from the report on rural health
care system in India.(6)

This section identifies the present status of the entire

allied health system in terms of infrastructure, courses
and capacity of the allied health system with respect
to seat capacity, futuristic courses and internship/
field training plans, to name a few. The Organisation
for Health Management Research and Development
(OHMRD) undertook a majority of the field visits and
subsequent data collection on behalf of PHFI. The
parameters taken into consideration for the detailed
analysis are discussed below.

An uneven distribution of the health workforce in

rural and urban areas exists due to factors such as
the distribution of health facility infrastructure,
poor working and living conditions in rural
areas and the concentration of income-earning
opportunities in urban areas. A joint study done by
the PHFI and the World Bank in 2008 indicates that
across most health worker categories, typically
60% are present in urban areas. To account for
this difference, rural and urban numbers were
calculated separately. Demographic parameters
such as total, rural and urban population numbers
and percentage of rural and urban areas were
obtained from the 2011 Census data.(6)

a) Institutions
i.

Six states, namely Karnataka, Maharashtra,

Tamil Nadu, Uttar Pradesh, Andhra Pradesh
and Kerala contribute to more than 50% of
the institutions spread across India.

ii. Of the institutions surveyed, 53% belong to

the public sector, 30% are private and 17%
are owned by charitable organisations.

iii. Although the majority of institutes are either

less than 10 years old or more than 50 years
old (together forming 58%), this is not
an indicator of the duration for which the
institutes have been conducting allied health
courses.

2. Research findings

The data obtained and the subsequent calculations

made indicate a vast shortfall of AHPs. The data were
analysed and the findings are presented in three major
sections supply, perception and demand.

Figure 3: Percentage of institutes affiliated or in proximity to a training facility (hospital)

74

Estimating imbalances in the Allied Health Workforce

iv. An overwhelming majority of institutes are

in close proximity/affiliated to a teaching
hospital (Figure 3).

list, 109 colleges had no allied health course

running under their ambit. The list of
courses pertaining to allied health streams
that are not being conducted in any college
includes Bachelor of Rehabilitation Therapy,
postgraduate Diploma in Haematotechnology
and Diploma in Neuro Electrophysiology , to
name a few.

v. Seventy-one per cent of the institutes do not

have any separate infrastructure for allied
health courses and yet have a large number
of faculty members. The average number
of faculty members per institute without
exclusive infrastructure for allied health
courses is 89 (which includes the medical
faculty), compared to 48 for institutes with
exclusive infrastructure

iii. Of the institutes surveyed, the most common

level of educational qualification offered is a
diploma. Educational qualifications higher
than the postgraduate level such as PhD and
MPhil are offered in courses such as Hearing
and Speech Language Pathology, Optometry
and Refraction Technique and Physiotherapy,
to name a few. The complete list of the levels
of educational qualification offered under
various streams is given in Annexure 2.

b) Allied health courses

i. Of the 134 courses offered by various

institutes across the country, the top 10
most offered allied health courses (Figure 4)
constitute 49% of the total number of students
graduating each year. The other 124 courses
are run by less than 10% of the institutes. The
detailed list of courses being run by particular
institutes is given in Appendix 6.

iv. More than 50% of the allied health workforce

produced annually graduate from only two
courses, namely Diploma in Sanitary/ Health
Inspector 12,134 (39.30%) and Diploma
in Medical Laboratory Technology 3,789
(12.27%).

ii. The majority of sampled colleges were

medical colleges as the list was obtained
from the MCI. A few of the allied health
colleges were also considered in the study
as they were identified through the snowball
technique in various regions. Of the complete

A complete list of all the AHS courses

along with the numbers of the allied health
workforce produced annually is given in
Appendix 7.

Figure 4: Top ten allied health courses offered by 351colleges sampled across India

75

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

BOX 1: High number of Sanitary Inspector graduates

It is pertinent to note that the Diploma in Sanitary Inspector is conducted by only five institutions. One of these
five institutions conducts this course through its 26 branches across India, producing around 12,000 allied
health workers annually. Figure 5 indicates the percentage distribution of workforce produced annually across
all allied health streams.
Figure 5: Percentage distribution of annual intake under various allied health streams

v. Profiling of more than 900 institutions through a

desktop literature review indicates the number
of courses available for major disciplines at each
level. The complete list of institutions is given in
Appendix 2.

as one of the key requirements for 81% of courses.

The details are given in Appendix 8. Field training,
which is another essential component for skill
development of the students, is absent in 62%
of allied health courses. The complete list of
courses with field training component is given in
Appendix 9.

vi. Only two courses, namely Sanitary/Health

Inspector and Medical Laboratory Technology
(MLT) are offered at the apprentice level.

viii. The study indicates that the course fee is usually

calculated on the following parameters:

vii. Overall, the average ratio of theory to practical

component for various allied health courses
is around 59:41, though it differs from course
to course. For example, some courses such as
the Diploma in Optometry devote a balanced
attention to theory and practical education
(45:55), whereas this differs for the Bachelor of
Optometry and Ophthalmic Technique course
(71:29). Students have to submit a project report

76

Cost per course in addition to operating cost

of the institution
Affiliation fees charged by the university for
running courses
Faculty-to-student ratio

Estimating imbalances in the Allied Health Workforce

BOX 2: Trends in teaching pattern

At Ali Yavar Jang National Institute for the Hearing Handicapped (AYJNIHH), Mumbai, the practical sessions
include 45 hours of clinical exposure on a daily basis right from the first year. Supervision by the supervisor
is done through closed circuit television (CCTV) cameras.

At Christian Medical College (CMC), Vellore the training is based on classroom teaching for about 3 hours a
day and clinical training for about 6 hours per day. A weekly workshop list is developed which is knowledgeand skills-based. Regular seminars are organised where students do presentations.

At Jamshetjee Jejeebhoy (JJ) Hospital, Mumbai practical sessions vary from 23 hours to 56 hours in a
week, depending on the load on the laboratory.

ix. The quality of institutes is determined by their

accreditation status, registration with a state
council or professional associations/boards and
status of affiliation. However, in the absence of
a single regulatory authority, the parameters of
quality education differ for all education institutes
offering allied health courses.

Most of the colleges offering allied health

courses are affiliated with somebody or the
other, though these may not be particularly
affiliated for the course itself. Of these,
52% are affiliated to a university, 46% to a
board and 1% to a statutory body. Details of
affiliation are given in Appendix 10. The list
contains the names of councils (as mentioned
by the institutes) which register and recognise
courses at the state/national level. Many of
these are not paramedical (allied health)
councils.

National Assessment and Accreditation

Council (NAAC)
Bharat SevaSamaj, Thiruvananthapuram
Cochin

University

of

Science

Indira Gandhi National Open University

(IGNOU)

International Accreditation Organisation

(IAO)
Maharashtra Medical Council
Dental Council of India (DCI)

National Accreditation Board for Hospitals

and Healthcare Providers (NABH)
HomiBhabha National Institute

Para Medical Board, Hyderabad

Medical Council of India (MCI)

National Board of Examinations (NBE)

Rehabilitation Council of India (RCI).

c) Teaching

National Accreditation Board for Education

and Training (NABET)

Jammu & Kashmir Government

of

In the strict sense of the term, the above-mentioned

institutes are not formal accreditation bodies for allied
health courses. However, the institutions understand
them as such and have responded accordingly.

Only 25% of the institutes surveyed were

accredited. The accreditation bodies varied
widely and included the following:

International
Organisation
for
Standardisation (ISO)

Technology (CUSAT) Department

Medical Education (DME)

and
77

i.

Faculty

Generally, all institutes of excellence share

the faculty members between the medical
and allied health courses, and across various
departments functioning in the hospital.

The following observations were made about the

faculty for allied health education during the field
visit study of centres of excellence identified by
the National Initiative for Allied Health Sciences
(NIAHS) secretariat:

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

There is no separate faculty available in the

institutes for allied health courses, except
in the case of stand-alone institutes such as
AIIPMR, Mumbai and All India Institute of
Speech and Hearing (AIISH), Mysore to name
a few.

Most of the faculty members are doctors who

teach their respective specialty or retired
professors from prestigious institutes like the
Armed Forces Medical College (AFMC). The
system also comprises allied health faculty
members, though the number of students

opting for the academic field after graduation

or post-graduation is relatively minimal.
There seems to be a good demand for quality
teaching and training faculty.

feedback from the students. At a number of

government institutes, one has to clear an
exam to be selected as a faculty.
A newly inducted faculty member undergoes
a training of trainer (ToT) programme to
understand the expectations of students.

Faculty knowledge upgradation schemes,

such as continuing medical education (CME)
in the case of medical courses, are largely
absent in allied health streams. Information
and knowledge transfer on new technologies
and techniques is imparted through various
seminars and is largely dependent on the
manufacturers from the industry.

ii. Teaching aids

A number of stand-alone institutes seek

visiting faculty from medical colleges on
subjects like anatomy, physiology, etc. as per
their need. Visiting faculty are mainly top
experts working in various hospitals who are
given a token fee and travel expenses.

A permanent faculty is appointed only after an

advertisement laying down specific eligibility
criteria. The selection process includes
advertisement for the post, short-listing
and interview by an expert panel. Initially,
provisional selection is done after which the
selected candidate has to take a number of
demonstration classes. The selected candidate
is confirmed only after getting a positive

The allied health courses are supported by

teaching/learning materials in various forms,
namely printed, audio-visual, counselling,
teleconferencing, practical sessions, clinical
supervision, radio programmes and interactive
sessions through telecommunications.
Planned quality assurance measures for allied
health courses as documented by a number of
institutes include an editorial committee for
development of materials, review by a core
committee, orientation of academic counsellors
(teachers at institutes), monitoring by the
respective board or university through surprise
visits and feedback from the academic counsellors
as well as students

BOX 3: Upgradation of course curricula

During the field visit to centres of excellence as identified by National Initiative for Allied Health Sciences
(NIAHS) secretariat, it was observed that

AYJNIHH, Mumbai undertakes an annual process of upgradation of the course curricula;

CMC revises the curricula every 4 years;

IPHH upgrades their curricula every two years after consultation with the healthcare industry and obtaining
feedback from the hospitals where students are sent for practical training.

78

Estimating imbalances in the Allied Health Workforce

d) Allied health capacity

BOX 4: Futuristic courses

i. Enhancement in the present number of allied

health courses

AIMS has suggested a course of Physician Assistant

(as a 3 years abbreviated course) to support the
physician. Along with the Emergency Medical
Technician (EMT) course, these can address the
shortage of doctors in remote areas. Similarly,
CMC, Vellore has indicated that persons with MSc
(Medical Physics) are needed in large numbers for
cancer centres.

A significant number of institutions are willing to

expand by adding additional allied health courses.
The total number of batches that these institutions
are willing to add is 435, covering 23 courses. The
most common courses that these institutions are
willing to add arethe courses for ECG Technician,
followed by Central Sterile Supply Department
(CSSD) Technician, Emergency Medical Assistant
and Dark Room Assistant. The maximum possible
increase in capacity is for the course for Emergency
Medical Technicians, followed by the courses
for ECG Technicians, Anaesthesia Technicians,
Ventilator Technicians and CSSD Technicians. The
complete details are given in Annexure 3.

iii. Available seat capacity

ii. Futuristic courses

The colleges were probed to identify the possible

courses that they would like to incorporate in the
near future. Addressing the need of the market in
terms of the technology advancement, colleges
identified the courses as indicated in Figure 6. The
course on Telemedicine is the most commonly
desired futuristic course by the institutions.

Given the abundance of data and the varied

quality of education imparted by various colleges
considered for the study, it was decided to calculate
the intake capacity of only centres of excellence
identified by the NIAHS secretariat.

Based on our field visits and research findings,

the intake capacities of the following 18 centres of
excellence were calculated for various specialties
for the different levels of courses:

Post Graduate Institute of Medical Education

and Research(PGIMER), Chandigarh

GMC, Chandigarh

All India Institute of Medical Sciences (AIIMS),

New Delhi

Vardhaman Mahavir Medical College and

Safdarjung Hospital, New Delhi
Maulana Azad Medical College (MAMC), New
Delhi

Figure 6: Possible futuristic courses

79

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Sankara Nethralaya, Chennai (only for the

opthalmology courses)

The results of this review are summarised in Table 2.

Sri Ramachandra Medical

Research Institute, Chennai

e) Professional partnerships and Placement

CMC, Vellore

Sree Chitra Tirunal Institute for Medical

Sciences
and
Technology
(SCTIMS),
Trivandrum
College

and

Manipal College of Allied Health Sciences

(MCOAHS), Karnataka

AIIPMR, Mumbai (only for the Rehab,

occupational therapy and physiotherapy and
audio/speech courses)

AYJNIHH, Mumbai (only for the audio/speech

courses)
All India Institute of Speech and Hearing

DCI (only for the dental courses).

The complete details of seats available at each

institute are given in Annexure 4. Dental hygienists
and dental mechanics were estimated based on
the 22 recognised institutions as reflected in the
Dental Council of India website (www.dciindia.
org).
Most of the colleges lack placement cells, though
some colleges have MoUs with hospitals for
placement of their graduating candidates. It was
evident from the desk review that placement is
not a phase but a continuous process of rapport
building of such institutes with the market drivers

Table 2: Available seat capacities of the centres of excellence for various specialties

Specialty
Diploma

Certificate

Sl. No

Doctorate

AIMS, Kerala
Jawaharlal Institute of Post Graduate
Medical Education and Research (JIPMER),
Pondicherry

PG Diploma

Grant Medical College and JJ Hospital, Mumbai

(AIISH), Mysore (only for the audio/speech

courses)

Masters

KEM Hospital, Mumbai

Degree

1.
2.

Optometry

104

10

3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Occupational Therapy and Physiotherapy

40

245

112

52

77

252

Rehabilitation

Audiology and Speech Language Pathology

Cardiothoracic Related Technology

453

19

107

55

37

Radiography & Imaging Technology

Medical Technology

Dental Assistance Related Technology

Emergency Trauma & Critical Care Technology

Operation Theatre Related Technology
Administrative and Miscellaneous

Total number of seats 4700

80

35

0
3

Medical Laboratory Technology

12

2009

23

28

48
0

26

177
47
10
0

20
96

166

20

21

27
25
0
0
6

121

16

0
8
0

12

10

12
0
0

73

0
2
0
0

39

Estimating imbalances in the Allied Health Workforce

BOX 5: Placement in Allied Health training institutes

At AIIPMR, Mumbai, students usually get placed in the hospitals occupational therapy and physiotherapy
departments.

AIMS hasregistered a s 100% placement of all graduates.

CMC, Vellore alumni get jobs in the private sector, or go overseas.

IPHH has signed memoranda of understanding (MoUs) with major hospitals in Delhi.

The post-BSc courses at SCTIMST produce very few but highly skilled and specialised graduates; naturally,
traditional career paths for such students in these fields are almost non-existent.

Placement as faculty members

AIMS provide a stipend after the second year as

the students help in the hospital for cost effectivity.
Masters students at AIIPMR, Mumbai are absorbed in
the teaching disciplines in its own institutes and other
recently established educational institutions. Students
of AYJNIHH, Mumbai are encouraged by the Institute to
join as faculty members. After BSc, one can become a
tutor at CMC, Vellore. At PGIMER, teaching competence
is checked on the basis of student performance or spot
watching of the class by a senior faculty. Students who
complete MSc and PhD are spot watched for teaching
ability, and deployed.

Additionally, the following findings were specific

to the centres of excellence:
i.

Tie-ups and partnerships

Technology-driven
partnership:
EISE
and J&J have entered into an educational
partnership with the Federation of Obstetric
and Gynaecological Societies of India (FOGSI)
to link up 100 medical colleges in India using
the EDUSAT technology of the Indian Space
Research Organization (ISRO) for medical
education, primarily for the gynaecologists in
medical colleges across India. Presently the
programme is conducted in 10 colleges on the
fourth Sunday of every month.

For the prosthetics and orthotics courses,

there is a requirement of skills in crafting,
leather work and basic engineering skills,
which they upgrade from the engineering
colleges in the vicinity of the Institute.

Tie-ups and partnerships for endorsements:

Most of the courses conducted at EISE and J&J
are endorsed by prestigious surgical bodies.
Employer tie-up: IPHH has signed MoUs with
major hospitals in the National Capital Region
(NCR) of Delhi such as New Delhi Municipal
Council (NDMC) Hospitals, Artemis, Fortis,
Max and Medicity, to name a few. These
hospitals are the major recruiters as well
as providers of inputs to the institutes for
improvements/changes in the curriculum as
per newer developments in the field/market
because of newer technology/demand. These
hospitals also provide practical training to the
students.

ii. Practical-driven courses: Practical sessions are

carried out in hospital so that the students get
hands-on experience.
iii. A feedback-based system is followed for
improvisation in the syllabus, courses, training
curricula, etc.

iv. Incorporation of the latest techniques in the

training modules as a regular feature

Skills development-based tie-ups: Students

from AIIPMR visit the departments in
Karamshi Jethabhai Somaiya Medical College,
Mumbai for subjects related to medical fields.

v. EISE, J&J, AIMS, CMC, etc. have launched a needdriven course involving different stakeholders,
based on the competitive requirements.
81

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

vi. Innovative systems: Students who are not

performing well are encouraged through the
following measures:

Hands-on training on clinical training programmes,

carried out at three levels:

Observation

Carrying out procedures and processes

under strict supervision

Carrying out procedures and processes

under minimal supervision
Repeated posting in those areas where the
students need reinforcement, including individual
tutorials once a week.

Perceptions of Allied Health Professionals

As indicated in the methodology, interviews and focus

group discussions were conducted with students and
AHPs to identify the perceptions of the practising
cadre. The findings are enumerated below.

Though a considerable section (60%) of students

undergoing physiotherapy courses thought

autonomy of the profession was a solution to most

of their problems, 40% suggested increased hiring
in government and multispecialty hospitals, and
felt that PHCs would address the employment gap
and needs.

BOX 6

Nine hours of work=no money. Do you think

anybody would be happy like this? Am working,
atleast pay me accordingly! Give me my right!
Physiotherapy student

a) Review by students pursuing allied health

courses

Although they echoed the feeling of being

neglected and felt that the situation was better
abroad, 77% of students felt that their profession
had sufficient demand in India. Forty-five per cent
felt that there was adequate demand, but due to
the lack of sufficient posts being created, most
of them remained unemployed. Overall, among
the issues raised, 85% felt that their profession
received inadequate salaries and 69% of them
demanded representation by a separate council.

When asked why they entered this profession,

57% of the students said that they wanted to be of
service to humankind, 26% said they wanted to be
associated with the medical profession and 17%
were taken up by the prospect of rehabilitation
and healing without medicines.

Other issues raised by students from various specialties

are given in the figures below.
BOX 7

I cannot recommend this course to anyone as I

myself am not satisfied with the quality of education
we are receiving. Speech therapy student

Figure 7: Issues raised by speech therapy students

82

Estimating imbalances in the Allied Health Workforce

Figure 8: Issues raised by occupational therapy students

BOX 8

We integrate an individual in society considering his mental, social and psychological level and other aspects,
but what do we get in return? Decrementing status and a Grade C tag in terms of pay, job opportunity, future
scope of the profession, respect and dignity. Occupational therapy student

BOX 9

I just think it is better to do a professional course instead of studying. Radiotherapy student

Facts gleaned from discussions with practising

allied health professionals
i

Prosthetics and Orthotics

The course and all the colleges offering it are

completely managed by the Rehabilitation
Council of India (RCI) which falls under the
Ministry of Social Justice and Empowerment,
except Safdarjung Hospital, Delhi and All
India Institute of Physical Medicine and
Rehabilitation (AIIPMR), Mumbai which come
under the MoHFW.

The course has very few job openings in

both public and private healthcare delivery
systems.

University Grants Commission (UGC) scales

have not been defined despite the presence of
teaching cadres.

ii Medical Lab Technologists

This course is handled by a varied list of

regulatory bodies; hence no list of registered
professionals exists. Natures of duties have
not been updated since the early 1970s.

The RCI recognises certificate and diploma

courses at the same level, which needs to be
rationalised.

The demand for enhancing risk allowance was

not acceded to. Those with technical skills end
up doing administrative work, which takes up
most of their time.

Figure 9: Issues among radiotherapy students

83

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Most of the professionals do not get automated

lab training.

which includes refraction and dispensing,

the detection/diagnosis and management of
diseases of the eye and the rehabilitation of
conditions of the visual system. The entire
group suggested establishing a separate
council for this profession and stated that they
should not be considered under the ambit of
AHPs. Detailed documentation on optometry
as provided by Indian Optometry Federation
is given in Appendix 11.

iii Occupational Therapists

Occupational therapists are regulated by the

All India Occupational Therapists Association
(AIOTA) but it is not recognised by the Central
Government. Four national institution and 13
recognised courses exist in the country.

As per a court, they do not come under the

purview of the RCI.

vi Audiology/ Speech Language Pathology

The RCI maintains a live register of this

specialty.

Guidelines of World Council of Occupational

Therapy are followed in the other parts of the
world. In most places, the World Council of
Occupational Therapy guidelines are in use. As
per a court order, they do not come under the
purview of the RCI. The profession is gazetted
only in Bihar and Haryana. Jobs in this sector
do not pay much except for those in private
practice, since their charges are higher.

iv Physiotherapists

This cadre is regulated by the Indian

Association of Physiotherapists (IAP), which
has 35,000 live registered practitioners in
place. There are many more who are not
registered with the Association.

Unregistered practising is illegal.

Audiology and Speech Language Pathology are

usually separate disciplines for the purpose of
specialisation, but this is not followed in the
Indian context.

Around 900 professionals graduate annually,

but posts are inadequate due to the absence
of designated posts in the government system.
Private sector employment opportunities are
more easily available and offer comparatively
better packages.

vii Radiology/Imaging Technology

Bhabha Atomic Research Centre (BARC) is the

regulatory body for this specialty. Colleges
are few, such as AIIMS, LokNayak Jai Prakash
Hospital in Delhi and PGIMER, Chandigarh.

The Government recruits those with a

bachelors qualification at the gazetted level,
while the UGC recruits those with a masters
qualification as faculty.
Salaries for this sector have not been revised
after the 6th Pay Commission.

vii Operation Theatre Technologists

The entry qualification is tenth standard with

two years of experience.

Courses are recognised by the respective

universities. There is no standardisation of
the curricula across the entire country.

v Optometry

The World Council of Optometry (WCO)

classifies optometry as an independent
primary healthcare profession. The Council
defines optometrists as primary healthcare
practitioners of the eye and visual system who
provide comprehensive eye and vision care,

Barely any training is given and those in this

field are hired only on the basis of their prior
experience.
Most of the hospitals have their own in-house
training courses.

b) Demand for allied health professionals in the

country

84

The findings indicate an overallnational shortage

of approximately 64 lakh AHPs, with the highest

Estimating imbalances in the Allied Health Workforce

Figure 10: Heat map showing allied health workforce shortage (based on access and efficiency
adjustments) in India across different states

deficiencies being in the states of Uttar Pradesh, West

Bengal, Maharashtra, Bihar and Andhra Pradesh.
Figure 10 indicates the shortages based on access and
efficiency adjustments in India across various states.

Shortfall at the national level

The national level estimates on the shortfall of
the various categories of AHPs are indicated in
Table 3.

Table 3: Estimates on shortfall of allied health human resources at the national level

Sl. No

Health workforce category

Ophthalmology related

Medical laboratory

2
3
5
6
7
8
9

10

Rehabilitation related

Surgical and intervention

Radiography and imaging

Audiology and speech language

Medical technology related

Dental assistance technology

related
Surgery and anaesthesia
Miscellaneous
Total

Demand

Supply

145236

17678

76884

15214

1862584
205088
23649
10599

239657

2048391
862193

1074473
85

Unadjusted
gap
127558

Efficiency and
access adjusted
gap
136,039

40265

1822319

1841637

4352

19297

20971

7215

3263
3587

197873
61670
7336

236070

208618
70603
8901

237791

6243

2042148

2045143

181511

892962

980045

4050

858143

860086

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

ii

Based on adjusted estimates, the largest gap of

about 23,000 ophthalmology professionals was
found in Uttar Pradesh followed by Maharashtra
(12,600) and a moderate gap of 10,30012,000
workers in Bihar and West Bengal. Andhra
Pradesh was found to have the fifth-largest gap
based on adjusted estimates (9,100).

Other states that have large gaps include

Maharashtra, Bihar, West Bengal, Tamil Nadu and
Andhra Pradesh.

vii A total of 39,300 medical technologists are needed

in Uttar Pradesh. The requirement in the states
of Maharashtra, Bihar, West Bengal and Andhra
Pradesh range between 16,500 and 22,000, taking
into account access and efficiency parameters.

The gap of rehabilitation-related professionals was

the second largest among all the AHP categories
included in this analysis. Based on efficiency and
access adjustments, gaps were found in Uttar
Pradesh, Bihar, West Bengal, Maharashtra and

viii Dental technologists account for the largest gap

among all types of AHPs included in this analysis,
with the maximum need being in Uttar Pradesh
of about 3,37,400 (adjusted). The gaps in other

Andhra Pradesh in large numbers ranging from

2,40,800 to 1,08,100 workers per state.

states like Maharashtra, Bihar, West Bengal and

Andhra Pradesh are significantly less than that in
Uttar Pradesh, ranging from 1,42,900 to 1,90,000
(adjusted).

iii Results based on adjusted indices showed the

largest gap of 34,600 workers for surgical and
intervention technologies in Uttar Pradesh.
Moderate gaps in the range of 18,000 to 19,300
were found in Maharashtra and Bihar. West Bengal
and Andhra Pradesh had gaps in the range of
14,400 to 15,700.

ix Healthcare professionals helping in surgery and

anaesthesia also add significantly to the gap of
AHPs in India. Again, Uttar Pradesh has the largest
gap of 1,42,100. Other states of interest include
Maharashtra, Bihar, West Bengal and Andhra
Pradesh with gaps ranging from 60,000 to 80,000
based on adjusted estimates.

iv Medical laboratory technicians are needed

mostly in Uttar Pradesh of the order of 12,200
professionals (adjusted).
Adjusted estimates
obtained ranged from 6,500 to 4,500 for
Maharashtra and Bihar.
v

x The gap of miscellaneous technologists also

contributes to the gap of AHPs in India, specifically
in Uttar Pradesh (1,68,000 adjusted). The gap in
other states such as Maharashtra, Bihar, West
Bengal and Andhra Pradesh is less than 94,100,
taking into account the efficiency and access

Healthcare workers specialising in the fields of

radiology and imaging are one of the least needed
allied health cadrein India. The greatest need is in
Uttar Pradesh (adjusted estimate 3,600). Other
states with gaps are Maharashtra, Bihar, West
Bengal, Andhra Pradesh, Gujarat, Assam and Delhi.

adjustment factors.

c) Gaps at the state level

Figures 11 to 13 below show the top five states

where the gaps (adjusted and unadjusted) are
the largest. Results for all states by specialisation
categories are given in Annexure 5.

vi Audiology- and speech-related professionals

account for the smallest gap among all types of
AHPs included in this analysis, with 1,500 needed
in Uttar Pradesh based on adjusted estimates.

86

Estimating imbalances in the Allied Health Workforce

Figure 11: Shortfall of allied health professionals in Uttar Pradesh and Maharashtra
Surg & anaes- Surgery and Anaesthesia,
Opth - Ophthalmology

Surg & int tech-Surgica and intervention Technology

Med Labs- Medical lab Technology

Radio & imag- Radiography and imaging Technology

Audio & splang- Audiology and Speech language pathology

Med Tech- Medical Technology

Figure 12: Shortfall of allied health professionals in Bihar and West Bengal

87

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Figure 13: Shortfall of allied health professionals in Andhra Pradesh and Tamil Nadu

3. Policy issues for consideration

the following order: Uttar Pradesh, Maharashtra,
Bihar, West Bengal and Andhra Pradesh (Figure
14). Hence, it is imperative to either set up
institutions or increase the number of seats in
existing colleges in all these five states so that
training for all types of allied health categories can
be covered.

Based on the analysis using adjusted estimates, the

following recommendations were made to help
in informed decision-making for expanding the
infrastructure of healthcare training institutions:

For all categories of allied health specialisation,

there was a consistent gap found in five states in

Figure 14: States with the largest gaps of allied health professionals

88

Estimating imbalances in the Allied Health Workforce

The order of importance, based on the largest to

the smallest need from this gap analysis of AHPs,
is as follows:

institutes of paramedical sciences/regional institutes

of allied health sciences (RIPS/RIAHS).

In order to provide well-regulated quality

education in allied health streams, and to address the
allied health human resource shortages in the country,
some of the key recommendations for consideration
by the MoHFW are enumerated below.

1) Dental assistance-related technologist

2) Rehabilitation therapist

3) Miscellaneous (dietician)

4) Surgery and anaesthesia technician

Recommendation: 1

5) Medical-related technician

The decision by GoI to establish a National Institute

of Allied Health Sciences (NIAHS) with state-of-theart facilities, offering higher-order/postgraduate
courses in various allied health streams is timely
and should be implemented in a time-bound
manner. It should serve as a centre of excellence for
the allied health profession, educational practices
and associated institutions.

6) Surgical and intervention-related technician

7) Ophthalmology technician

8) Medical laboratory technologist

9) Radiography and imaging technologist

10) Audiology and speech language pathologist

We have also recommended the functional and

administrative framework for the NIAHS to function
as a centre of excellence for allied health professions.
The National Institute for Allied Health Sciences will
be set up at Najafgarh, New Delhi, affiliated to a 100bedded hospital in the campus. The details are given
in Appendix 12.

4. Recommendations

The huge shortage of well-qualified human resources

in the health services is one of the major reasons for
the high rates of morbidity and mortality in India.
However, addressing this issue is not an easy task
because of the large number of stakeholders involved.
The section on situation analysis/findings of the study
gives an overview of the extent to which colleges
offering allied health courses have mushroomed
across India under undefined regulatory mechanisms.
A moratorium on further expansion of such colleges is
required till these commercial distortions and fall in
standards are adequately addressed.

a) Mandate of the NIAHS

i.

A proposal was put forward in May 2010 to the

Cabinet for its decision to augment the supply of skilled
paramedical (allied health) human resources and to
promote the quality of paramedical (allied health)
training through standardisation of such education/
courses across the country.

The NIAHS is expected to perform the following

roles as a central body in the field of allied health
education:
To serve as the seat of learning for a limited number
of graduate and postgraduate programmes at its
location

ii. To perform a central coordinating role for running

off-site/long-distance programmes through longterm sponsorships in different parts of the country
As described in the figure above, NIAHS should
undertake the following roles:

It was decided to support human resource

development through support to state government
medical colleges in the form of a one-time grant; by
establishment of a National Institute of Paramedical
Sciences/National Institute of Allied Health Sciences
(NIPS/NIAHS); and by establishment of eight regional

i.

NIAHS as a best practices lab

NIAHS has the opportunity to function as a

test bed for developing a national strategy for
best practices in allied health sciences.

89

The best practices labs goal would be to

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Figure 15: Role of the National Institute of Allied Health Sciences (NIAHS)

enhance patient safety and quality of medical

care through the use of innovative, highimpact training and research.

These best practices can be systemwide

involving many domains, or focus on
innovations in an identified thrust area.

ii. NIAHS as a research body

The role of the NIAHS to promote and

accelerate research in allied health sciences is
critical for the future of the healthcare system
in India.

It is imperative that research and scientific

investigations should include a sustained
effort towards understanding the human
resource landscape of allied health sciences
and include a needs projection.

The research will be funded by intramural

funds as well as funds from central, state and
international grants.

It is recommended that NIAHS be recognised

for granting graduate, postgraduate and
doctorate degrees.

NIAHS should develop the capacities of

the RIAHSs and partners for skills training,
system-based practices and team training.
Career counselling, career path advancement,
and effective placement of the students may
be undertaken through the establishment of a
placement cell within NIAHS.

NIAHS should undertake ToT and faculty

development programmes for standardisation
of training across the country.
NIAHS should ensure that the evaluation
and assessment of students graduating from
NIAHS is done using the standards set by
the National Board of Allied Health Sciences
(NBAHS).

NIAHS will maintain and collate live registers

of all graduating students of different
specialties from all RIAHSs and timely update
information at the national level for further
research on the demandsupply gap and
analysis at the national and regional levels.

iv. NIAHS as a promoter

NIAHS should serve as a champion that

vigorously advocates for careers and
investment in allied health sciences.

NIAHS may be made responsible for designing,

formulating and updating course curricula on

v. NIAHS as a networking body

NIAHS should develop formal relationships

with various local hospitals in the NCR for

iii. NIAHS as an academic institute

As an academic institute, NIAHS should have

the roles of teaching and coordinating courses
at all levels.

an ongoing basis.

90

NIAHS should also institute a communication,

promotion and advocacy division under the
office of the Director. The mandate of this
office would be to publish material for a
scientific audience, lay audience and policymakers on allied health services.

Estimating imbalances in the Allied Health Workforce

participating in training programmes as per

their capacity, as well as with the national
centres of excellence for various specialties.

Recommendation 2

The study also endorses the decision on the

establishment of eight Regional Institutes of Allied
Health Sciences (RIAHSs) that we envision will
serve as regional centres of excellence in allied
health and work in close collaboration with the
national institute of Allied Health sciences (NIAHS).
RIAHSs should primarily focus on undergraduate
degree, diploma and certificate programmes along
with postgraduate degrees and also leverage
existing specialty strengths of the various allied
health cadres in the region.

NIAHS should develop partnerships with

professional associations or networks such
as the RCI. NIAHS should constitute a national
pool of experts who will serve as a technical
resource base for the various functions of
NIAHS. Technical assistance may be sought
from development partners to constitute the
pool as well as orient it to good practices
followed in other parts of the world.

NIAHS should collaborate with the

departments of school education, regional
institutes and the industry. Meaningful
partnerships should be established for
development of the allied health sciences
curricula, which could be incorporated in
school education programmes, especially in
science courses.

It is also imperative to establish regional centres on

the line of NIAHS in various regions of the country to
provide similar opportunities at multiple locations
across India. The government has therefore taken
the initiative to establish eight regional institutes.
However, the study indicates a need to review the
location of RIAHSs in order to address the currently
obtaining skewed distribution of these institutes.

NIAHS should develop a culture of affiliation

and collaboration with the private sector. The
industry can partner NIAHS to support the
allied health educational institutions through
provision of qualified and experienced allied
health staff as guest faculty on a regular basis.
It can also provide opportunities for faculty
and students to explore and practise the latest
updates on healthcare technologies.

Functional overview of RIAHSs

As shown in Figure 16 above, RIAHS should undertake

the following roles:
i.

RIAHS as a research body

RIAHS
should
conduct
state-of-theart research in allied health sciences,
especially with respect to emerging disease
patterns, technological trends, cultural and

Figure 16: Functional overview of RIAHS

91

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

demographic shifts and local epidemiology

pertaining to their respective regions.

The research should be funded by intramural

funds as well as funds from central, state and
international grants.

ii. RIAHS as an academic institute

RIAHS should deliver courses in key allied

health disciplines, with a focus on postgraduate
degrees, undergraduate degrees, diplomas
and certificate programmes. RIAHS should
provide technical support to NIAHS for
designing, formulating and updating course
curricula on an ongoing basis. These will be
directly related to those specialties that are
currently dominant in the region.

Ensure the ongoing evaluation and assessment

of students graduating from RIAHS using the
standards set by NBAHS.

iii. RIAHS as a faculty development and capacitybuilding institute

RIAHS should identify and train faculty in

allied health sciences on an ongoing basis,
develop ToT protocols and build training
capacity.

RIAHS should undertake skills training,

system-based practices and team training.

RIAHS should provide technical experts

to NIAHS for ToT and faculty development
programmes at the national level.

RIAHS should mentor graduating students and

help them to obtain high-quality internship
options and eventually long-term placements.

v. RIAHS as a networking body

RIAHS should continuously network with

regional/state medical and other institutions
as well as state health departments to ensure
a supplydemand balance and practical

Develop formal relationships with various

local hospitals in the region for participating
in the training programmes as per their
capacity, as well as with national centres of
excellence for various specialties.
Develop linkages with other regional institutes
of allied health sciences.
Together, all RIAHS to constitute and orient a
national pool of experts who shall serve as a
technical resource for the various functions of
RIAHS.

Collaborate with the departments of school

education, the regional institutes and the
industry in building meaningful partnerships
for development of the allied health sciences
curricula. This could be incorporated in school
education, especially in science courses.

RIAHS should develop a culture for affiliation

and collaboration with the private sector.
The industry can partner to support the
allied health educational institutions through
provision of qualified and experienced allied
health staff as guest faculty on a regular basis.
It can also provide opportunities for faculty
and students to explore and practise the latest
updates on healthcare technologies.

vi. RIAHS as a quality assurance enabler

RIAHS should maintain updated quality

assurance (QA) data on both certification of
courses and accreditation of institutions to be
fed to NIAHS and eventually to the NBAHS for
continuous QA.

iv. RIAHS as a promoter and placement agency

RIAHS should serve as a champion to

vigorously promote and advocate careers and
investment in allied health sciences, especially
in the local community.

training sites.

92

RIAHS should provide support to other

institutions for instituting QA.

vii. RIAHS as an AHP record-keeper

RIAHSshould maintain live registers of all the

graduating students of different specialties
and feed the data to NIAHS to update
information at the national level, and for
further research on the demandsupply gap
in different regions.

Estimating imbalances in the Allied Health Workforce

as well as a ratio by finding the weighted average of

intake as well as need gap. A modifying factor was
introduced and multiplied with the difference between
the need gap and the intake number, to ensure that
in no case was the number of seats less than the gap
estimated.

Recommendation 3

The phasing plan of the regional institutes and

the planned seat capacity should be based on the
findings of a specialty-wise demandsupply gap
analysis for maximum reach and effectiveness.

Based on a modelling exercise that was conducted

in partnership with GEs Healthy Imagination Group,
certain key gaps in specific specialty areas of the
allied health workforce came to light. It is desirable to
undertake a more detailed demandsupply analysis
in each of these states in conjunction with the state
health leadership before finalising the implementation
plan for the regional institutes.

The factor was also manipulated such that basic

ground rules for capacity building and GoI priority
areas for public sector post creation were adequately
represented (labs, radiology, audiology, etc.). Areas
in which there were large gaps as estimated by the
analysis such as rehab, surgery, anaesthesia related
courses and miscellaneous courseswere duly weighted
with a much higher average seat capacity. (Rehab
courses are inclusive of occupational and physical
therapy courses.)

The number of seats derived from various sources

were then compared with the need gap analysis (in
conjunction with GE) that estimated gaps per specialty
based on population growth trends over the next
ten years proportionally to the base number of seats
as indicated in the Cabinet note (Annexure 6). The
difference was calculated both in terms of real numbers

The top five states with maximum deficiency for

each of the major specialties are indicated below. The
projected capacity of education which can be created
is outlined on the basis of the GE Report (annexure-7)

Table 4: States with maximum estimated deficiency of AHP

Specialization category

States/union territories

Ophthalmology,
Rehabilitation,
Radiography Uttar Pradesh, Maharashtra, Bihar, West Bengal, Andhra
and Imaging, Surgical and Intervention, Medical Pradesh
Technologies, Surgical and Anesthesia, Dental and
Miscellaneous

Medical Laboratory and Audiology and Speech Language Uttar Pradesh, Maharashtra, Bihar, West Bengal, Tamil
Nadu

BOX 10: Growth of Allied Health courses in states

For all categories of allied health specialisation except surgical and intervention, there was a significant gap
found in two states Uttar Pradesh and Maharashtra. Thus, it may be recommended that training institutions
specialising in all categories of interest (except surgicaland intervention) are needed in both these states.
Courses in surgical and intervention are most needed in Madhya Pradesh and Orissa.
Significant gaps of some AHPs were also found in Delhi and Tamil Nadu. Colleges focusing on training
courses for optometrists, blood bank technicians, radiotherapists, dental assistants and hygienists, prehospital trauma technologists and public health education professionals could be set up to help reduce the
gaps in these healthcare areas in these two states.
Training institutions offering courses in the area of rehabilitation such as psychologists, vocational
counsellors for the handicapped, social workers and community-based rehabilitation professionals are
needed the most in the union territories of Andaman and Nicobar, Dadra and Nagar Haveli, Lakshadweep,
Daman and Diu and Puducherry.
Setting up colleges offering dietician-related courses could be of interest in Orissa and Tripura
93

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Based on the modelling exercise, seat capacity as given in Table 5 was calculated and presented to the MoHFW for
consideration.
Table 5: Recommended seat capacity by states based on data modelling study

South

East

Bihar / Jharkhand

North East

Coimbatore

Bhubaneshwar

Patna

Aizawl

North Central
Bhopal

AP & Karnataka

Uttar Pradesh &

Uttarakhand
Lucknow

West

Hill Region and

North
Chandigarh

Zone

Ophthalmology
Rehab related

Surgical intervention
Medical labs

Radiography/imaging

Audiology/speech related

Medical technology related

19

38

31

Hyderabad

Aurangabad

RIPS location

33

25

19

24

26

Total

11

225

251

517

418

443

334

264

321

353

155

3057

35

28
10
1

32

58
20
3

67

47

50

16

17

54

57

38
13
2

43

30
10
1

34

36
12
2

41

40
14
2

46

18
6
1

20

345
117
15

394

Dental related

278

572

463

491

370

292

355

391

172

3385

Total

874

1795

1453

1540

1161

916

1114

1228

539

10620

Surgery and anesthesia related

Miscellaneous

117
134

241
274

195
222

207
235

156
177

123
140

149
170

165
188

72
82

1424
1623

After the preliminary report was submitted to the MoHFW, NIAHS secretariat was asked to design a more equalised
distribution table across all the regional institutes and key specialties across the nation. The calculations also
considered the available seat capacity in the various centres of excellence, factoring it to reach to a reasonably welldistributed seat capacity (Annexure 7). The modified seat capacity by regions is as given in Table 6

94

Estimating imbalances in the Allied Health Workforce

Ophthalmology
Rehab related

Surgical intervention
Medical labs

Radiography/Imaging

Audiology/speech related

Medical technology related

43

89

46

North East

Bihar / Jharkhand
55

Aizawl
61

27

529

380

287

226

275

303

133

2623

61

125

101

107

81

64

78

86

38

741

72
57
63

148
117
130

874 1,795

105
102

233
215
211

68

72

120

127

95

100

105

111

188
174
171

1,453

54
96
76
84

43
76
60
66

52
92
72
81

57

101
80
89

200

151

119

144

159

1,540

1,161

916

1,114

1,228

185
181

Courses also need to be conducted by specialty

at both the national and the regional institutes in a
phased manner based on the demandsupply gap
by region and by epidemiological needs. In addition,
the ability to successfully affiliate/partner with local
institutions of excellence and thus ensure faculty and
infrastructure availability will also determine the rollout of certain specialty courses.

139
136

110
107

133
131

147
144

25
45
35
39

497
877
691
768

70

1,377

539

10,620

65
63

1,272
1,246

partner and undertake courses

Development of infrastructure of NIAHS and

RIAHSs as envisaged in the plan

Recommendation 4

We recommend that the operations of NIAHS be

carried out through a chain of off- site campus,
affiliates and satellite centres. Therefore, the NIAHS
and RIAHS practise and affiliation management
committees should empanel/recognise institutions
based on the accredited list as derived from the
national board. This would enable the system to
leverage the existing teaching and training calibre
in allied health.

Over a period of time, all the courses will be

conducted by NIAHS and RIAHSs, either directly by
them or through partner institutions. Phasing in of
courses will be based on the following concerns:

Immediate availability of resources (faculty, space,

lab, agreeability of the institute to do the course,
availability of the specialty within the facility or in
the partner institution and funds)

58

359

84

Total

Coimbatore

Hyderabad
77

443

41

113

Miscellaneous

72

Total

216

Dental related

Surgery and anesthesia related

Aurangabad

RIPS location

Patna

Bhubaneshwar East

South

North Central
Bhopal

AP & Karnataka

Uttar Pradesh &

Uttarakhand
Lucknow

West

Hill Region
North
Chandigarh

Zone

and

Table 6 Modified (adjusted) seat capacity by states based on seat capacity

NIAHS should operate through a chain of off- site

campus, affiliates and satellite centres to reduce
the allied health human resource gap in the system.
These affiliations should be developed with existing

Standardisation of the courses by NIAHS

Availability of private institutions willing to

95

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

institutions of excellence, and NIAHS should provide

overall leadership. NIAHS, Najafgarh should develop
the budget line to support these clusters of institutions
and also provide technology support as per the need.
The affiliations should be developed as shown in
Figure 17.

will be feasible to leverage the capacity of existing

centres of excellence such as the AIISH for speech
and audiology-related courses, AIIPMR, Mumbai,
for rehabilitation-related courses and Sankara
Nethralaya for optometry-related courses, to name
a few. This will enable NIAHS to gain through the
existing capacities to bridge the gaps.

a) NIAHS off- site campus

b) NIAHS affiliates

Off-site campuses will be private or public

institutions which would mirror the NIAHS. An offsite campus should be part of the NIAHS. It could
be located far from the Najafgarh centre, anywhere
across India. These sites will run specialised allied
health courses under the supervision of NIAHS.
Certification should be granted by the NIAHS.
NIAHS, Najafgarh will maintain constant online
contact with these sites and general subject classes
should be webcast to the various off-site campuses
as per pre-decided timetables. The facilities at offsite campuses should be as recommended by the
NIAHS, Najafgarh.

The NIAHS budget line should provide funding

support to the off-site campuses. The overall
management of these institutions should continue
to be with the mother institutions. A detailed MoU
between NIAHS, Najafgarh and the concerned
institution can govern the administration of the
site.

To address the supplydemand gap immediately, it

Affiliates will be private or public institutions

where allied health education courses are
presently being run. These would typically be the
medical colleges. The affiliate centre will adopt the
NIAHS approved education course, curricula and
teaching protocols and be a shadow NIAHS. The
affiliate will give certifications through the NIAHS.
NIAHS, Najafgarh will maintain online contact
with the affiliates. General subject classes should
be webcast to the various affiliates for optimum
utilisation of faculty. The NIAHS budget line should
provide funding at a pre-agreed rate to the affiliate.
A detailed MoU between NIAHS, Najafgarh and the
concerned institution can govern the affiliation.
NIAHS will gain through expanded capacity
and locus for practical, on-the-job training, e.g.
Vardhman Manhavir Medical College may be an
NIAHS affiliate and run courses on medical lab.
Ram ManoharLohia (RML) hospital, New Delhi,
JIPMER, Puducherry, CMC, Vellore, etc. may all be
NIAHS affiliates.

Figure 17 Models of association with NIAHS/RIAHS

96

Estimating imbalances in the Allied Health Workforce

c) NIAHS satellite centres

college is expected to be established on the basis

of rational consideration by the Practice and
Affiliation Management Committee. The affiliation
of colleges must vest only with the Practice
and Affiliation Management Committee and be
given on academic grounds alone; no extraneous
considerations should be allowed to come into
play. Functions of such institutes are:

Satellite centres will be private or public

institutions where the low-end courses of NIAHS
could be run. These should be institutions where
undergraduate diploma courses will be run under
the supervision of the NIAHS. No degree courses
will be run at the satellite centres. These centres
will linkup with NIAHS (Najafgarh or its off-site
campus) or one of its affiliates for internships and
on-the-job training.

Record-keeping and attendance

Log book inspections

A satellite centre may not receive any direct

funding support from the NIAHS. It would only

receive accreditation as a satellite centre after due

verification and inspection. The satellite centre
will gain legitimacy through the affiliation. NIAHS
will gain capacity for low-end courses through
such engagements, e.g. private institutions such
as IPHH, Mahipalpur may be made into a NIAHS
satellite centre and run diploma courses as
governed by NIAHS.

Duty roster for various work stations

Conduct of an adequate number of

procedures as prescribed in the training
guide issued by NIAHS
Mid-term evaluation

Evaluation of assignments

Conduct of theory classes (special to stream)

Maintenance of discipline and conduct
Coordination of end-term evaluations.

Recommendation 5

The table in Annexure 8 delineates the potential

for partnerships with existing reputed institutions
offering various allied health courses across the
country. It is important to note that this list is
merely indicative and that the specific nature of
each partnership with each institution will have to
be worked out by the NIAHS Board.

NIAHS and RIAHS should be responsible for

continuously evaluating the job potential and need
for new courses and introducing, developing and
promoting such courses across the nation.

Our analysis also reveals that, given the fast-paced

growth in the healthcare sector, there is a potential for
developing cadres of several new and emerging fields
of AHPs.

One critical prerequisite of such collaboration will

be the establishment of basic standards for each
programme, including course curricula, nature
of examinations/assessment, practical versus
didactic teaching hours and hands-on experience
via internships, all culminating in specific skills and
competencies being checked prior to graduation.

As per the Cabinet note, 33 courses have been

enlisted under the purview of the allied health streams,
which were then bundled as indicated in Annexure 9.
NIAHS secretariat undertook the task of identifying
various other courses which come under the ambit
of the allied health system. Some streams in which
potential courses may be considered for roll-out in
NIAHS and RIAHS (in addition to the proposed eleven
streams) are as follows:

Physiotherapy

d) Role of institutes affiliated with NIAHS and

RIAHSs

NIAHS and RIAHSs will have the power to affiliate

or recognise colleges and to withdraw such
affiliation or recognition. The need for a new

97

Occupational health

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Psychology and mental health counselling

xiii. BSc Integrated Allied Health Sciences

Dietetics and nutrition

Physician assistance

Statistical assistance

Hospital
housekeeping/
management
General duty assistance

front

* Note. These courses are currently not running under any

centre of excellence, though there is a great need of these
cadres within the healthcare delivery system. It is therefore
imperative to start these courses at NIAHS/RIAHSs.

Technicians ECG/EEG, ultrasonography,

paramedic, dispensing optics, cath lab, blood
bank, multi-rehabilitation worker, dark room
assistant, CSSD, etc.

Bachelor of Prosthetics and Orthotics

iii.

Bachelor of Rehabilitation Therapy

v.

vi.

vii.

Recommendation 6

The capacity of public sector shoud be augmented

through the provision of employment opportunities
at the state and Central Government institutions by
sanctioning new posts for the allied health cadre in
the healthcare delivery system.

One of the important factors for the success of the

allied health augmentation initiative across the nation
is the ability of the public sector to attract and retain
high-quality professionals in the system. As is evident
from all our research, the best AHPs emerge out of a
handful of national centres of excellence (as stated in
the previous section), but a negligible percentage of
those graduates actually end up working in the public
sector, either as professionals or as faculty.

Diploma in Orthotics and Prosthetics

This necessitates the creation of specific posts

across the public health system with clear job
descriptions, market-based salaries and benefits and
well-drawn-out career paths.

Diploma in Community-based Rehabilitation

Bachelor in Physiotherapy

We compared each position to the latest norms

as prescribed by the Indian Public Health Standards
(2010) and recommended changes, where applicable,
in order to meet the healthcare needs of the population.
The summary is provided in Figure 18 below. The
details are given in Annexure 10

Bachelor in Occupational Therapy

Masters in Occupational Therapy

viii. Masters in Physiotherapy

ix.

Diploma in Dental Hygienist

xi.

Diploma in Medical Records Technology

x.

xii.

Diploma in Home Aid/Home-based care*

xviii. Certificate in Home-Based Care Provider*

desk

Phlebotomy

i.

iv.

xvi.

PG Diploma in Dietetics and Human Nutrition

xvii. PG Diploma/BSc in Medical Counselling*

Based on all of the criteria above, the following

courses may be prioritised for an immediate startup plan at the national and regional levels. This will
initially be done through the collaborative model (offcampus, affiliate or satellite) and eventually be rolled
out through the regional and national institutes. The
NIAHS will accord priority for all postgraduate and
faculty development programmes, where applicable.
Leveraging the existing capacity of 4,700 seats as
mentioned above at Table 2, the list of priority courses
is as follows:
ii.

Diploma in Dietetics and Human Nutrition

xv.

Respiratory care

Home-based care/home aids

xiv.

Diploma in Dental Mechanics

BSc in Medical Records and Health Information

Technology
98

Estimating imbalances in the Allied Health Workforce

BOX 11: Impact of Phlebotomy on Health Systems

Approximately 500 million samples are collected every year in India. Majority of these (~80%) are done using
syringe and needle by personnel who have not been trained on safe and better practices. Studies have indicated
that nearly 68% of all errors in laboratory testing are associated with the pre-analytical phase phlebotomy
(blood collection) being a major component of this phase(1).

The major pre-analytical errors associated with phlebotomy include hemolysis, improper clotting, transcriptional
errors, insufficient volume to perform test, in adequate patient preparation, incorrect specimen collection time,
overfilling/under filling of specimen collection vials, contamination etc. In fact studies have estimated that every
minute:
1. 25,000 30,000 patient samples are hemolyzed thereby leading to seriously erroneous results.
2. 1500 samples have questionable identity.

3. 40 patients need to be re-bled due to insufficient sample volume.

4. About 30 patient samples get contaminated leading to generation of doubtful results.

The primary reasons behind the magnitude of errors and unsafe practices associated with pre-analytical phase
are due to:
1. Extremely poor pre-analytical awareness.

2. Lack of phlebotomy training schools in the country.

3. Limited focus on phlebotomy as a discipline in medical technology and nursing schools with most of the
learning being on-job.
4. Lack of standardized phlebotomy guidelines as part of curricula in medical and para-medical institutions
across the country.

These professionals are important members of the health care team working with physicians, nurses, laboratory
staff, and patients. Their primary role is to collect blood for accurate and reliable laboratory testing. This is
usually accomplished by venipuncture or capillary collection. Training is designed to provide the student with
the theory and hands-on skills required for phlebotomy. They must be skilled in the collection, transportation,
and processing of laboratory specimens, customer service, and safety compliance.
The students of phlebotomy must also learn proper bedside manner which is extremely critical with exact
training on patient care. A phlebotomist must show an exact mixture of skill and empathy.
Reference:

Plebani M, Carraro P. Mistakes in a stat laboratory: types and frequency. ClinChem 1997; 43:1348-51

Figure 18 Percentage of posts recommended to be sanctioned

at all levels of the public healthcare delivery system

99

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

5. Conclusion
The widespread gaps in the availability of AHPs in
India, as discussed in this chapter, are indicative of a
critical shortfall of human resources for health in the
system. Even by the most conservative estimates of
AHPs per population norms, India has a massive gap
in human resources that needs to be addressed on a
priority basis.

There is an opportunity for academicians,

government and researchers alike to contribute
towards enhancing and extending the roles of AHPs
by integrating them seamlessly within the healthcare
delivery mechanism. As this chapter has established,
plugging the gaps in the availability of the right
numbers of trained AHPs will address the healthcare
delivery challenges, especially in semi-urban and rural
settings, at minimal costs.

As the government envisages providing universal

access to healthcare in the country during the 12th
Five-Year Plan period, the availability of skilled AHPs
will emerge as the cornerstone to the success of
Indias public sector health reforms. Globally, studies
conducted on human resources for health have
underlined the need to invest in AHPs. This is critical
to meet the current and future needs of healthcare in
India.

Establishing national- and regional-level institutes

dedicated to nurturing, training and retaining talent in
the allied health space is imperative to get affordable
and accessible healthcare within the reach of the
common man.

100

Estimating imbalances in the Allied Health Workforce

Annexure 1

Sources for statistics on allied health professionals for calculation of the demandsupply imbalance
Category

Professionals

Source of numbers
Demand

Ophthalmology

Rehabilitation

Surgical and
Intervention
Medical
Laboratory

Radiology and
Imaging

Ophthalmologists

Supply

WHO SEARO targets + Presentation

calculations per state
Optometry in India by
Mr. Rajesh Wadhwa

Optometrists

Clinical psychologists, rehabilitation

engineers and technicians,
specialised teachers for education
and training of the handicapped,
vocational counsellors, employment
officers and placement officers for
the handicapped, multipurpose
rehabilitation therapists, rehabilitation
psychologists, rehabilitation social
workers, rehabilitation practitioners
in mental retardation, orientation
and mobility specialists, communitybased rehabilitation professionals,
rehabilitation counsellors/
administrators, prosthetists and
orthotists, rehabilitation workshop
managers

Report The Role of Census of India 2001

Optometry in Vision 2020 Report

IAMR Report on Projection of Human Resource

Requirement in the Field of Rehabilitation of
Persons with Disabilities

Perfusion and cardiac care technologists US Bureau of Labor

Statistics
Laboratory technicians

Estimates from
supply data obtained

Report - Rural Healthcare system in India

Cytotechnicians

US Bureau of Labor
Statistics

Estimates from
supply data obtained

US Bureau of Labor
Statistics

Estimates from
supply data obtained

Radio diagnosis technicians

Report - Rural Healthcare system in India

Nuclear medicine technicians and

radiotherapists

101

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Audiology
and speech
language

Audiologists and speech therapists,

speech pathologists, hearing aid and
ear-mould technologists

Medical

Dieticians

Dental

Dental technicians and dental hygienists US Bureau of Labor

Statistics
Dental assistants

Surgical and
anaesthesia
Miscellaneous

Operation theatre technologists and

pre-hospital trauma technologists
Public health educationists
Sanitary inspectors
Medical records/sanitary inspectors

102

IAMR Report on Projection Estimates from

of Human Resource
supply data obtained
Requirement in the
Field of Rehabilitation of
Persons with Disabilities
US Bureau of Labor
Statistics

Census of India 2001

Report (table in
introduction)

US bureau of labor
statistics

Census of India 2001

report (table in
intro)

US Bureau of Labor
Statistics
US Bureau of Labor
Statistics
US Bureau of Labor
Statistics

Community pharmacy
article on Wikipedia

Estimates from
supply data obtained

Estimates from
supply data obtained
Estimates from
supply data obtained
Estimates from
supply data obtained
Census of India 2001
Report (table in
introduction)

Estimating imbalances in the Allied Health Workforce

1.

Burns & plastic surgery Technology

4.

Cardiac care Technology

2.
3.
5.
6.
7.
8.
9.

10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.

Anaesthesia Technology
Blood bank Technology

Cardiovascular & Thoracic Surgery

Community Based Rehabilitation

Central Sterile Supply Department

CT Scan Technology

Degree Post PG

Degree UG

Diploma

PG Diploma

Level of qualification

Certificate

Discipline

Apprentice

S. No

Annexure 2

Degree PG

Indicative list of the various levels of qualification offered in each discipline

Dental Hygiene

Dental Mechanics

Dialysis Technology

Endoscopic Technology

Hearing aid & ear mould Technology

Hearing Language & Speech Language

Intensive Care Unit Technology

Medical Laboratory Technology

Medical Records Technology

MRI Technology

Neuro electro Physiology

Neuro Technology

Neurosurgery Technology

Operation Theatre Technology

Optometry & Refraction Technique

Orthotics and Prosthetics
Physician Assistant

Physiotherapy & Occupational Therapy

Pre-hospital Trauma Technology

Radiography Technology & Imaging Technology

Radiotherapy

Respiratory Therapy

Sanitary/ health Inspectors

103

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

S. No

Discipline

32.

Medical information Technology

35.

Hemato-technology

33.
34.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.

Level of qualification

Training young deaf and hard Hearing

Cytotechnology

Histotechnology

Perfusion Technology

Clinical linguistic for Speech Language Pathology

Forensic speech Science & Technology
Healthcare Assistant

Medical Technology
Renal Dialysis

Blood Transfusion Technology

Public health Education and Promotion

Rehabilitation Therapy

Orthopaedic assistant & plaster Technique

Paramedical Technology

Nuclear Medicine Technology

Speech language Pathology
Total

104

33

26

12

Estimating imbalances in the Allied Health Workforce

Annexure 3

Enhancement in the present number of allied health courses

S. No

Number of Courses

Cer

1.

ECG Technician

4.

Dark Room Assistant

13

Ventilator Technician

2.
3.
5.
6.
7.
8.
9.

10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.

22.
23.

Discipline

CSSD Technician

Emergency Medical Technician

Anaesthesia Technician
ECHO Technician

EEG/ Neurology lab Technician

Dermatology/ STD/ Leprosy Technician

Laundry Technician

12
9
2
6
7
6
6
8

PFT Technician

10

Ophthalmic Therapist

Bio-Medical Technician
Nursing Orderly (NO)
Manifold Technician
Forensic Technician
Physician Assistant

Chemotherapy Technician

IVF & Reproductive Health Technician

Public Health Engineering
PET Scan Technician

Organ Transplant Technician

Nuclear Medicine Technician

Dip

20

14
14
9
9

11
8

0
1

32

12

11

15

18

Total

12

7
3

Yes

19

10

Deg

18

8
5
1
2
3
1

Institutes that are willing to start a new course in the discipline but have not specified the level

105

Proposed
number of
students

6
9
4
4
6
5
5
5
4
1
4
1
6
2
2
3
2
0
4
1
1
1

2
0
1
1
1
1
0
0
2
2
0
2
0
0
1
1
0
0
0
0

0
0

40

494

30

293

30
29
29
25
25
25
23
22
21
19
18
17
16
15
10
7
6
4
4
3

421
509
464
348
426
307
296
329
247
286
406
230
240
223
300
111
100
114
54
33
39

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Annexure 5

GE analysis on shortfall of allied health workforce in India

Table 1: Ophthalmology
States

Ophthalmologists
Accessefficiency
adjusted

Arunachal Pradesh
Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra and Nagar Haveli
Lakshadweep
Daman and Diu
Puducherry
India

Optometrists

Unadjusted

23

19

516

432

Accessefficiency
adjusted
124

2464

238

204

1885

10048

51

43

268

525

44

35

15

31

22

110

2749

1979
591

Unadjusted

3062
86

168

9728
2836
241
65

139

760

686

3925

3672

1686

1556

8651

8208

2060

1882

10597

9986

581

3155

68

65

26

24

1139

1073

1457

1231

1060

908

614

1329

1232

459

413

479

448

335

334

119

101

229

208

51

349
135

5803
7660
5556
6825
2446
1673
2370
624

1180

338
129

5579
6885
5036
3041
6495
2341
1672
2213
563

1107

1310

1174

3783

3590

19243

18586

20

104

103

511

470

1201

1036

179

157

21
6

25

25

22126

20207

106

6775

42

2622
6277
932
30
31
6

24

124

113913

6311
2484
5713
855
23
29
5

23

123

107351

Estimating imbalances in the Allied Health Workforce

Table 2: Rehabilitation

Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra
and
Nagar
Haveli Haveli Haveli
Lakshadweep
Daman and Diu
Puducherry
India

68

58

30

22

1530

34399

1496

871

871

855

840

33675

257

246

123

114

116824

116014

2998

2913

77
7
2
4

69
6
1
3

36
3
1
2

30
2
0
1

36773
3289
1179
2168

36201
3219
1125
2096

99

91

46

39

46866

46223

4116

4088

664

642

219

204

103

91

102321

101198

148

140

70

64

67850

67283

191

165

268
139
80

125757

124207

121

63

49

67881

66562

76
43

30

59
55
14

1
3

2884

28
7

27
21
24
5

80788
28676
18986
28320
7615

79949
28410
18983
27922
7462

62

31

28

31028

30678

21

21

72

37090

13851

23
1

30

37382

91961

14036

138

81

34

93927

12

157
1

38

65

14

155

491

86

27

171
67

1609

109

43
16

1626

126

162

60

248

173
62

79
72

67
57

469

234

217

3
1
0
1
3

2661

11
1
0
0
0
2

1347

81063
76302

224423
11266
411

79886
74871

222755
11071
392

1192

1190

71

70

0
0
2

1173

381
274

1409

1353792

107

Unadjusted

Access
efficiency
adjusted

Unadjusted

Specialised. Teachers for Vocational Counsellors, Employment

Education and Training for Officers and Placement Officers for
the Handicapped
the Handicapped
Access
efficiency
adjusted

Unadjusted

Access
efficiency
adjusted
Arunachal Pradesh

Rehabilitation
Engineers and
Technicians
Unadjusted

Clinical
Psychologists

Access
efficiency
adjusted

States

374
273

1408

1337147

854
860
870
871
871
870
859
872
871
848
871
860
840
832
844
863
853
867
872
864
869
868
848
865
843
836
868
872
872
872
872
872
872

30166

839
849
869
869
870
869
846
871
871
826
871
849
810
793
818
857
836
861
872
856
866
865
825
858
815
804
864
871
872
872
872
872
872

29839

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Table 2: Rehabilitation contd

Arunachal Pradesh
Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra and Nagar Haveli
Lakshadweep
Daman and Diu
Puducherry
India

Unadjusted

Rehabilitation Practitioners in
mental retardation

Access
efficiency
adjusted

Unadjusted

Rehabilitation Social
workers

Access
efficiency
adjusted

Access
efficiency
adjusted

Unadjusted

Rehabilitation
Psychologists

Unadjusted

Multipurpose
rehabilitation
therapists
Access
efficiency
adjusted

States

2360

2359

4505

4505

377

368

2339

2318

4490

4474

36

32

4503

105
116
10
3
6

97

109
9
3
6

148

141

13

13

326

313

218

211

292

269

400
211
119
257
92
62
90
24
45

382
196
116
248
89
62
85
22
42

256

243

239

222

35

33

99

722
1
4
1
0
1
5

4299

95

703
1
4
1
0
1
5

4109

2337
2345
2359
2359
2359
2359
2343
2360
2360
2329
2360
2345
2319
2308
2324
2349
2335
2354
2361
2350
2357
2356
2329
2351
2322
2314
2356
2360
2361
2361
2361
2361
2361

82164

2318
2331
2357
2357
2358
2357
2326
2360
2359
2300
2360
2331
2278
2256
2290
2341
2313
2347
2361
2340
2353
2351
2298
2342
2285
2270
2351
2360
2361
2361
2361
2361
2361

81730

108

4488
4494
4504
4505
4505
4504
4493
4506
4505
4482
4505
4494
4474
4466
4479
4497
4487
4501
4506
4498
4503
4502
4482
4499
4477
4471
4502
4506
4506
4506
4506
4506
4506

157360

4474
4483
4503
4504
4503

10
1
0
0

4
7
0
0
0

4480

13

10

4505

4505

4460

30

24

4483

21

18

4428

23

14

4505
4444
4453
4491
4471
4495
4506
4490
4500
4499

36
17
11

29
11
9

23

19

9
8
2
4

7
6
1
3

4459

22

17

4449

20

13

4498

4492
4438
4505
4506
4506
4506
4506
4506

157036

69
0
0
0
0
0
0

384

61
0
0
0
0
0
0

305

Estimating imbalances in the Allied Health Workforce

Table 2: Rehabilitation contd

Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra and Nagar
Haveli
Lakshadweep
Daman and Diu
Puducherry
India

4119

4118

686

686

20

15

4111

4103

681

2
4
0
0
0
6
0
1

15
0

11
18

-2

1
0
0
0
3
0
0
9
0
8
9

-2

7
12
5
4
4
1
2

10
4
8

-1

7
3
4
1
0
1
4
3
0

37

28

1
0
0
0
0
0

186

0
0
0
0
0
0

93

4110
4113
4118
4118
4118
4118
4112
4119
4119
4107
4119
4113
4104
4100
4106
4115
4110
4116
4119
4115
4118
4117
4107
4115
4105
4102
4117
4119
4119
4119
4119
4119
4119

143994

4103
4108
4117
4118
4118
4118
4106
4119
4118
4097
4119
4108
4089
4081
4093
4112
4102
4114
4119
4111
4116
4115
4096
4112
4091
4086
4115
4119
4119
4119
4119
4119
4119

143835

109

681
683
686
686
686
686
682
686
686
679
686
683
677
675
678
683
681
684
686
684
685
685
679
684
678
676
685
686
686
686
686
686
686

23910

AccessEfficiency
Adjusted

AccessEfficiency
Adjusted

Unadjusted

Rehabilitation
workshop
managers

Unadjusted

Prosthetists
and orthotists

Unadjusted

AccessEfficiency
Adjusted

AccessEfficiency
Adjusted
Arunachal Pradesh

Rehabilitation
counsellors/
administrators

AccessEfficiency
Adjusted

Community based
rehabilitation
professionals
Unadjusted

Orientation
and mobility
specialists
Unadjusted

States

1125

1125

677

178

151

1124

1123

685

677
680
685
685
685
679
686
686

31
45
3
60

39

1
0
6

680

100

664

99

671
682

41
36
8

81
33
41
82
33
33
23
3

19

12

42

31

673

103

670

86

682

30

51
33

684

102

74

686
684

117

110

681

-1

169

676
683

-2

140

668

26

673
686

63
38

667

335

279

686

-1

684
686
686
686
686
686

23818

13
2
0
0
2

1797

7
2
0
0
2

1239

1124
1124
1125
1125
1125
1125
1124
1125
1125
1124
1125
1124
1123
1123
1123
1124
1124
1125
1125
1125
1125
1125
1124
1125
1123
1123
1125
1125
1125
1125
1125
1125
1125
3354

1123
1124
1125
1125
1125
1125
1123
1125
1125
1122
1125
1124
1121
1120
1122
1124
1123
1124
1125
1124
1125
1125
1122
1124
1121
1121
1125
1125
1125
1125
1125
1125
1125

39334

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Table 3: Surgical and Intervention related technology

States

Arunachal Pradesh
Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra and Nagar Haveli
Lakshadweep
Daman and Diu
Puducherry
India

Perfusion technology
Access-Efficiency
Adjusted

223

Cardiac care technology

Unadjusted

221

5014

4973

Access-Efficiency
Adjusted

12

-148

22

-8

16781

1197

478

474

27

5293

438

433

174

171

318

314

-4

257

16827
5325

Unadjusted

330
5

27
10
-6
-3

14

-14

40

6780

6744

432

14780

14717

980

296

18176

18088

1188

736

5401

5385

356

97

96

594

593

235

235

9782

9750

13647

13536

9857

9783

11671

11624

4098

4075

4136

4121

2723

2723

1106

1097

2029

2019

11732

11665

32342

4482

55

132

213
64

-30

23

194767

110

64

49

13

202

195710

260

535

23

39

202

397

107

171
10

39

284

117

532

55

10

771

-17

2272

60

171

566

12

399

32247
1622

61

771

-5

126

10990

1633

15

680

-40

740

4462

11071

297
651
99
2
3
3

16

12908

130
-32
6

-3

0
2

14

3105

Estimating imbalances in the Allied Health Workforce

Table 4: Medical Laboratory

States

Arunachal Pradesh
Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra and Nagar Haveli
Lakshadweep
Daman and Diu
Puducherry
India

Laboratory technician
Access-efficiency
adjusted

30

Cytotechnician

Unadjusted

633

15

318

Access-efficiency
adjusted

27

617

Unadjusted

27

615

3093

2741

2064

2062

68

38

59

59

840

591

53

16

11

-12

32

654
54
22
39

652
54
21
39

1101

821

833

831

2512

2023

1815

1811

3039

2365

2232

2227

10

103

90

37

30

1753

1506

1932

1077

1422

849

911

784

1976

1611

663

490

732

616

556

555

160

94

336

256

12
73
29

1200
1679
1213
663

1433
508
334
503
136
249

12
73
29

1198
1672
1208
662

1430
507
334
502
135
249

1885

1373

1441

1437

5864

5138

3968

3963

760

607

1642

1019

249

164

-4

34

33

41

40

32498

25257

111

550

1361
201
7

21
7
1
5

25

24038

549

1356
200
7

21
7
1
5

25

23981

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Table 5: Radiology and imaging related technology

States

Arunachal Pradesh
Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra and Nagar Haveli
Lakshadweep
Daman and Diu
Puducherry
India

Radio diagnosis
Accessefficiency
adjusted

Nuclear medicine

Unadjusted

21

466

19

433

Accessefficiency
adjusted

Radiotherapist

Unadjusted
2

48

46

1677

1643

171

169

45

42

512
40
15
28

488

53

36

12

25

51
4
1
3

656

630

67

65

1447

1399

148

144

1771

1707

182

176

532

517

54

53

59
23

969

1282
931

57

22

945

99

1201

133

876

96

1
6
2

97

380

41

39

104
197

28

98

11

190

20

-9

-10
-2
-3
-4

-2

-86

22

41

-43
7
7

28

19

20

-1

10

328

323

88

17

17

5
5
1
4

21

19053

148

16

1
2

21

18354

1956

112

-1
-9

44

104
15
0
2
1
0
0
2

1898

-116
-13
-7

19

-80

-5

3144

156

-1

-26

3214

108

-3

-5

-16

991

-8

-54

112

1050

-6

116
45

-6

-42

-1

1084
424

-41

-7

1132
438

-40

396

279

-4

53

92

114

279

-3

-77

-176

117
42

-1

-33

-70

1107
397

Unadjusted

126

1144
408

Accessefficiency
adjusted

-13
-11
-17

-42

-119

-1

-2

-5

1
0
0
0
1

-38

-4

-15
1

-1

0
0
1

-955

Estimating imbalances in the Allied Health Workforce

Table 6: Audiology and speech language

States

Arunachal Pradesh
Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra and Nagar Haveli
Lakshadweep
Daman and Diu
Puducherry
India

Audiologists and speech

therapists
Access
efficiency
adjusted

Unadjusted
0

-3

-14

-77

-2

-9

153
20
0

-3
-2

Speech pathologist
Access
efficiency
adjusted

82

Unadjusted
6

133

12

12

143

-6

13

-7

-9

135
453

-30

Hearing aid and ear mould

technology

Access
efficiency
adjusted

Unadjusted
3

64

61

451

224

220

13

142
5
8

70
6
2
4

67
5
2
4

32

-25

182

181

89

86

92

-7

397

395

195

190

-33

489

485

239

233

-1

4
1

80

103

-3

-1

-167

71

-2

32
36

16
6

30

32

263
366

-106

265

145
314

111

36

73

16
6

262
362
262
145
312
111
73

8
3

130
177
128
71

154
55
37

8
3

127
169
123
70

150
54
37

51

-53

315

313

154

149

131

870

867

429

423

11
28

-5

-106

-1

-3

4
2
0
0
0
3

1065

55

-3

20

278

30

121
297

-13

44
2

-1

-399

5261

113

29
54

120
294
43
2
5
1
0
1
5

5227

54

-16
-12

109

19
1

110

14
27
59

144
21
1
2
1
0
1
3

2575

52
14
26
58

138
21
1
2
1
0
1
3

2507

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Table 7: Medical technology

States
Arunachal Pradesh

Dietician

Access-Efficiency Adjusted
270

Assam

6076

Bihar
Jharkhand

Mizoram

580

572

210

Nagaland

384

Odisha/Orissa
Sikkim

Goa

Andhra Pradesh

22085

21925

16555

Karnataka

11959

Kerala

6564

Tamil Nadu

14184

Chhattisgarh

5029

Delhi

3317

Haryana

4977

Himachal Pradesh

1342

Jammu and Kashmir

2466

Madhya Pradesh
Punjab

Uttarakhand

209

Dadra and Nagar Haveli

67

Lakshadweep

13

Daman and Diu

48

Puducherry

246

India

237791

114

11837
16351
11823
6534

14097
5002
3317
4936
1326
2446

39163

73

Chandigarh

284

39336
1983

Andaman & Nicobar

719

14128

13436

Uttar Pradesh

115

14249
5447

Rajasthan

377

17847

11896

Maharashtra

204

17963
286

Gujarat

521

8170

722

West Bengal

6408

8236
118

Tripura

6001

20385

530

Meghalaya

266

20469
6467

Manipur

Unadjusted

5411

13288
1962
71

208
66
12
48

246

236070

Estimating imbalances in the Allied Health Workforce

Table 8: Dental related technology

States

Arunachal Pradesh
Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra and Nagar Haveli
Lakshadweep
Daman and Diu
Puducherry
India

Dental technician
Access
efficiency
adjusted

207

4655

Dental assistant

Unadjusted
205

4614

Access
efficiency
adjusted

1338

30156

Dental hygienist

Unadjusted
1335

30101

15633

15587

100604

100542

444

440

2869

2864

4946
406
162
295

4913

31925

401

2633

158

1054

291

1915

31881
2626
1049
1909

Access
efficiency
adjusted

789

Unadjusted
787

17778

17745

1552

1548

59312
18821
1691
621

1129

59275
18795
1688
619

1126

6298

6261

40628

40578

23952

23922

13730

13666

88494

88408

52172

52120

16883

16795

108853

108735

64175

64103

5001

32343

32321

90

552
219

9088

12673
9154
5017

89

159

56
51
10
37

188

181792

16247
24555
6637

1874

29952

159

24747

1018

30047
1517

69884

2530

10830

4164

59175

3827

10897
10282

81951

9079

3783

1885

58513

12561

3806
1027

1412

9055

10794

2531

3557

218

10842
3843

587

550

12155
70310

4144

37

24525
6626

12141

14590
9579

14476
3913
7166

19055
41162
14578
9578

14458
3906
7158

1023

1022

603

603

235

1172248

115

16246

41200

113951

1207

180842

24727

19068

34825

114028

62

188

69820

34886

48223

193285

332

10

59074

48313

34471

193413
367

51

81800

34497

831

41397

9796

55

58470

832

345

2096

41451

66434

1506

1410

346

2097

70220

26838

10200

586

3554

26812
66324
9781
365
331
62

235

1207

1170973

15823
39166
5775
216
196
37

139
711

691103

15806
39100
5766
215
195
37

139
711

690333

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Table 9: Surgical and anesthesia related technology

States

Arunachal Pradesh
Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra and Nagar Haveli
li
Lakshadweep
Daman and Diu
Puducherry
India

Operation theatre technology

Accessefficiency
adjusted

25

Pre-hospital trauma technology

Unadjusted

547

21

475

2043

1963

54

47

617

560

47

39

17

11

33

26

Accessefficiency
adjusted

956

Unadjusted

955

21551

21538

1882

1880

71813
22800
2050
754

1369

71798
22790
2048
753

1368

792

729

29013

29002

1750

1640

63186

63166

2142

1989

77727

77699

10

71

68

27

26

1178

1122

1533

1339

1113

983

638

609

1381

1298

478

439

496

470

343

342

125

110

238

220

420

2539
1008

41772
58548
42274
23094
49899
17668
11592
17536
4742
8680

420

2539
1008

41762
58512
42250
23089
49884
17663
11592
17528
4739
8676

1366

1250

50212

50190

3910

3745

138068

138038

21

730

730

531

496

1259

1118

187

168

21
6

25

25

23015

21374

116

19163
47456
6997
263
237
45

168
861

837071

19157
47430
6993
262
237
45

168
861

836769

Estimating imbalances in the Allied Health Workforce

Table 10: Miscellaneous

States

Medical records
Access
efficiency
adjusted

Arunachal Pradesh
Assam
Bihar
Jharkhand
Manipur
Meghalaya
Mizoram
Nagaland
Odisha/Orissa
Sikkim
Tripura
West Bengal
Goa
Gujarat
Maharashtra
Andhra Pradesh
Karnataka
Kerala
Tamil Nadu
Chhattisgarh
Delhi
Haryana
Himachal Pradesh
Jammu and Kashmir
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
Uttarakhand
Andaman & Nicobar
Chandigarh
Dadra and Nagar Haveli
Lakshadweep
Daman and Diu
Puducherry
India

785

Public health education

Unadjusted

782

17692

17626

1544

1537

59127
18748
1684
617

1123

Access
efficiency
adjusted
300

6771

Unadjusted

300

591

-176

-610

1678

644

644

612

237

1116

430

7160
237
430

23862

23803

9116

9112

51987

51885

19853

63943

63801

24421

344

2090
829

34385
48102
34736
19000
41054
14541
9555

14422
3896
7140

342

132

2087

798

827

317

34333

13124

47922

18395

34616

13282

18973

7256

40977

15678

14517

5551

9554

3642

14385

5510

3882

1490

7123

2727

6047
238
-70

-186
-199

24413

2900

-5058

317

13121

10

2969

2153

-2153

7254
5550
3642
5507
1489
2726

-1149
950

1141
1651

195
37

138
710

688578

194

74

37

14

138

53

710

271

687059

263002

117

74
14
53

271

262908

1635

-5099
2084

88

82

-224

944

285

229

82

229

2197

-544

-1658

601

6019

14902

-7920

386

-119

601

213

54

15673

13275

10649

215

-75

-12135

43371

2198

-11

-2039

43380

5734

-181

18384

113512

5752

-567

-2930

-65

137

113664

6021

14910

-467

2840

798

15770

38871

-425

19846

132

15776

15735

-2699

-2618

41186

39002

1888

683

41293
15767

-229

-5392

22558

591

-54

Unadjusted

-1674

22563
7164

Access
efficiency
adjusted

6767

59053
18695

Sanitary inspector

841

-757
-25
-63
-4
-2

16

116

28466

-906
-666
-960

-8106
-1028
-161
78

-39
-7

11

111

-57005

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Original seat capacity based on Cabinet note

S.No

Zone / states

Hill Region and North

4
6

10

Zonetotal

Uttar Pradesh &

Uttarakhand
North Central

11
12
13

West

Zonetotal

14

Zonetotal

18

AP & Karnataka

20

South

23

Zonetotal

27

Bihar / Jharkhand

28

Delhi

17935

Zonetotal

Location of RIPS /No.

of seats

No. of seats
available
as per
population

Chandigarh (1,180)

155
90

330

27368

Chandigarh

350

1368

20

235

89987

Uttar Pradesh

197271

Uttarakhand

9800

Rajasthan

66750

Madhya Pradesh

71050

Chattisgarh

23929

1180
Lucknow (1,180)

1120
60

Bhopal (1,180)

485
520
175

368800

Maharashtra

111118
58232
1714

2360
Maharashtra
(1,180)

755
400
15

259

Dadar& Nagar
Haveli

337

171660

Andhra Pradesh

83964

Tamil Nadu

67012

58804

Kerala

East

26

25020

Karnataka

24
25

Haryana

Daman & Diu

17

22

6728

Goa

16

21

11568

Gujarat

15

19

Jammu & Kashmir

Punjab

Population ('000)
as on 1st March
2010*

Himachal Pradesh

States

Annexure 6

34317

Puducherry

1331

Lakshdweep

75

1180
Hyderabad
(1,180)

690
490

Coimbatore (1,180)

765
390
20
5

245503

2360

West Bengal

88669

Bhubaneshwar (1,180)

Bihar

96389

Patna (1,180)

Orissa

40389

Andaman &
Nicobar Islands

480

Jharkhand

31040

256967

118

800
375
5

290

890

2360

Estimating imbalances in the Allied Health Workforce

S.No

29

Zone / states

North East

29

Population ('000)
as on 1st March
2010*

Assam

30191

Tripura

3574

Meghalaya

30
32

2421

Mizoram

33

993

Nagaland

34
All India

Zonetotal

Location of RIPS /No.

of seats

2591

Manipur

31

35

States

2223

Sikkim

605

Arunachal Pradesh

1227

43825

Total

1176742

* Source: Census of India 2001 Population Projection for India and States 20012026

119

Aizawl(1180)

No. of seats
available
as per
population
805
70
65
95
30
60
20
35

1180

10620

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Annexure 8

Possible partnerships for conducting the allied health courses

S.No

Course

Off campus

Affiliate

Satellite

OPTOMETRY
1

Bachelor of
Optometry &
Ophthalmic
Technique

Guru Nanak Eye

Hospital, Delhi

L V Prasad Eye
Institute

Elite School of
Optometry - Sankara
Nethralaya, Chennai

Dr RP Centre for Ophthalmic Sciences, All

India Institute of Medical Sciences, New Delhi

Jawaharlal Institute of Postgraduate Medical

Education & Research (JIPMER), Puducherry

Diploma in
Optometry
& Refraction
Technique

Diploma in
Ophthalmic
Technician/
Ophthalmic
Assistant

Certificate in
Dispensing
Optics

Certificate in
Contact Lens
Training

Andhra Medical
College, Andhra
Pradesh

Vardaman Mahavir Medical College ,

Safdarjung Hospital , New Delhi
PGIMER, Chandigarh

Amrita Institute of Medical Sciences- Schools

and Research Centres , Kerala
Birla Inst. Of Tech. & Sciences (BITS) , Pilani
Sri Ramachandra College of Allied Health
Sciences, Chennai

Dr RP Centre for Ophthalmic Sciences, All

India Institute of Medical Sciences, New Delhi
Vardaman Mahavir Medical College ,
Safdarjung Hospital , New Delhi

Jawaharlal Institute of Postgraduate Medical

Education & Research (JIPMER), Puducherry
PGIMER, Chandigarh

Amrita Institute of Medical Sciences- Schools

and Research Centres , Kerala
Birla Inst. Of Tech. & Sciences (BITS) , Pilani
Sri Ramachandra College of Allied Health
Sciences, Chennai

Gandhi Medical
College, MP

Elite School of
Optometry - Sankara
Nethralaya, Chennai
Arvind Eye Hospital
& PG Institute of
Ophthalmology,
Madurai

Elite School of
Optometry - Sankara
Nethralaya, Chennai
Elite School of
Optometry - Sankara
Nethralaya, Chennai

120

All India
Institute of
Optometrical
Sciences,
West Bengal

Nagar School
of Optometry,
Gujarat
Lotus college
of Optometry,
Maharashtra
Dr MGR
Medical
University ,
Tamil Nadu

S.No

Course

Off campus

Affiliate

Satellite

PROSTHETICS AND REHABILITATION

6

Bachelor of
Prosthetics &
Orthotics

Bachelor of
Rehabilitation
Therapy

Diploma in

Community Based
Rehabilitation (CBR)

Diploma in Orthotics
and Prosthetics

10

Bachelor in
Physiotherapy

11

Masters in
Physiotherapy

All Indian Institute of

Physical Medicine and
Rehabilitation , Mumbai

Institute for the Physically

Handicapped, New Delhi

MANOVIKAS, Special
School for Mentally
Handicapped

Christian Medical
College(CMC) , Vellore

All Indian Institute of

Physical Medicine and
Rehabilitation , Mumbai

Pt. DeendayalUpadhyay
Institute for the Physically
Handicapped

National Institute
for Orthopaedically
Handicapped, West
Bengal

Government Prosthetics
& Orthotics College,
Gujarat

Spastic Society of Tamil

Nadu, Chennai

Holy Cross College,

Tamil Nadu

Shanta Memorial
Rehabilitation Centre,
Bhubaneshwar

Sri Ramakrishna
Mission Vidyalaya,
Coimbatore

Department of
Rehabilitation,
Safdarjung Hospital

CMC, Nellore

Kasturba Medical
College, Karnataka

Amar Jyoti Institute of

Physiotherapy

Dr MGR Medical
University , Tamil Nadu

N.I.M.H. Northern Regional

Centre (NRC), New Delhi

Indian Institute of Cerebral

Palsy, Kolkata

Govt Institute of
Rehabilitation Medicine,
Chennai
Pt. DeendayalUpadhyay
Institute for the Physically
Handicapped
JamiaHamdard Faculty of
Medicine
JamiaHamdard Faculty of
Medicine, New Delhi

Manipal College of Allied

Health Sciences, Karnataka
Sri Ramachandra College
of Physiotherapy, Chennai

121

Swami Vivekanand
National Institute of
Rehabilitation Training
and Research , Orissa
Spastic Society of
Northern India, New
Delhi

Manipal College of Allied

Health Sciences
Swami Vivekanand
National Institute of
Rehabilitation Training
and Research , Orissa

Padmashree Dr DY Patil
College of Physiotherapy,
Pune
MGM Institute of Health
Sciences, Maharashtra

Viklang Kendra Rural

Research Society,
Allahabad

Schieffeline Leprosy
Research and Training
Centre, Vellore

Institute Of Post
Graduate Medical
Education and Research
, Kolkata

Dr MGR Medical
University, Tamil Nadu

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward
S.No
12

Course
Bachelor in
Occupational
Therapy

Off campus

13

Master in
Occupational
Therapy

Affiliate

All Indian Institute of

Physical Medicine and
Rehabilitation, Mumbai

Christian Medical College,

Vellore

PtDeendayalUpadhyay
Institute for the Physically
Handicapped , New Delhi

Manipal College of Allied

Health Sciences, Karnataka

All Indian Institute of

Physical Medicine and
Rehabilitation , Mumbai

National Institute for

the Orthopaedically
Handicapped, West Bengal

Manipal College of Allied

Health Sciences, Karnataka

National Institute for

the Orthopaedically
Handicapped, West
Bengal

Satellite

Dr MGR Medical
University, Tamil Nadu

LokmanyaTilak
Municipal Medical
College, Mumbai

Swami Vivekanand
National Institute
of Rehabilitation
Training and Research
(SVNIRTAR), Orissa

King Edward Memorial

Hospital and Seth
GordhandasSunderdas
Medical College
Mumbai
Swami Vivekanand
National Institute
of Rehabilitation
Training and Research
(SVNIRTAR), Orissa

King Edward Memorial

Hospital and Seth
GordhandasSunderdas
Medical College, Mumbai

Dr MGR Medical
University, Tamil Nadu

CARDIOTHORACIC
14

Diploma in Cardiac
Care Technology

15

Bachelor in
Cardio-pulmonary
Perfusion
Technology

Sree Chitra Tirunal

Institute for Medical
Sciences and Technology,
Kerala

Dr.K.R.Adhikary College
of Optometry and
Paramedical Technology,
West Bengal

Narayan Hrudayalaya
Institute of Cardiac
Sciences, Bengaluru

Dr MGR Medical
University, Tamil Nadu

122

Amrita Institute of
Medical SciencesSchools and Research
Centres , Kerala

National Heart Institute,

New Delhi
Fortis Escorts Heart
Institutes and Research
Centres
Apollo Group of
Hospitals

National Heart Institute,

New Delhi
Fortis Escorts Heart
Institutes and Research
Centres
Amrita Institute of
Medical SciencesSchools and Research
Centres, Kerala

EMS Memorial Co-

EMS Memorial Cooperative Hospital
and Research Centre,
Perinthalmanna

Narayan Hrudayalaya
Institute of Cardiac
Sciences , Bengaluru

Apollo Group of
Hospitals

Malabar Institute of
Medical Sciences Ltd,
Kerala

Estimating imbalances in the Allied Health Workforce

S.No
16

17

Course
BSc in Respiratory
Technology

MSc Medical Lab

Technology

Off campus

18

Bachelor of Medical
Lab Technology

19

Diploma in Medical
Lab Technology

20

21

PG Diploma
Histotechnology

PG Diploma
Cytotechnology

Affiliate

Amrita Institute of Medical

Sciences- Schools and
Research Centres, Kerala

Manipal College of Allied
Health Sciences, Karnataka

Christian Medical
College, Vellore

Amrita Institute of Medical

Sciences- Schools and
Research Centres, Kerala

Manipal College of Allied
Health Sciences, Karnataka
Christian Medical College,
Vellore

Satellite

Symbiosis Department
of Health Sciences , Pune

Christian Medical
College, Vellore

Birsa Institute of
Technology (Trust),
Ranchi

Manipal College of
Allied Health Sciences,
Karnataka

Nizams Institute of
Medical Sciences,
Hyderabad

MEDICAL LAB TECHNOLOGY

Sri Ramachandra College

of Allied Health Sciences,
Chennai
PGIMER, Chandigarh

JIPMER , Puducherry

Dr MGR Medical
University, Tamil Nadu

Manipal College of Allied

Health Sciences, Karnataka
Vardaman Mahavir

Medical College,
Safdarjung Hospital, New

Delhi
Christian Medical College,
Vellore
King Edward Memorial
Hospital and Seth
GordhandasSunderdas
Medical College, Mumbai

Christian Medical College,

Vellore

Tata Memorial Hospital,

Mumbai

Christian Medical College,

Vellore

123

PGIMER, Chandigarh

Government Medical
College, Chandigarh
Religare

Dr Lal Path Labs

B J Medical College, Pune

JJ Hospital, Mumbai

Jaipur Golden Hospital,

New Delhi
Narayan Hrudayalaya
Institute of Cardiac
Sciences, Bengaluru

Dr MV Shetty College
of Medical Laboratory
Technology, Mangalore
Birsa Institute of
Technology (Trust),
Ranchi

EMS Memorial Cooperative Hospital

and Research Centre,
Malappuram, Kerala

Asian Institute of Health

Sciences, Maharashtra
Shri Mool Chand
Kharaiti Ram Hospital,
New Delhi

New Delhi Tuberculosis

Centre, New Delhi

BhartiyaVidyapeeth
University, Pune

Maharashtra University
of Health Sciences

Maharashtra University
of Health Sciences

Ruxmaniben Deepchand
Gardi Medical College,
Ujjain
Apollo Institute of
Hospital Management &
Allied Sciences, Chennai
Apollo Institute of
Hospital Management &
Allied Sciences, Chennai

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward
S.No
22

Course
PG Diploma
Hematotechnology

Off campus

Affiliate

PGIMER, Chandigarh

23

PG Diploma
in Molecular
Diagnostic
Techniques

Manipal university,
Karnataka

Satellite

Vardaman Mahavir
Medical College ,
Safdarjung Hospital ,
New Delhi

Maharashtra University
of Health Sciences

Centre for Genetics

Disorders, Faculty of
Science, Banaras Hindu
University, Varanasi

ApeejaySvran Institute
For Biosciences &
Clinical Research,
Gurgaon

King Edward Memorial

Hospital and Seth
GordhandasSunderdas
Medical College, Mumbai

RADIOGRAPHY & IMAGING TECHNOLOGY

Apollo Institute of
Hospital Management &
Allied Sciences, Chennai

Bharathidasan
University,
Tiruchirappall, Tamil
Nadu

24

MSc Radiotherapy

PGIMER, Chandigarh

Amrita Institute of
Medical SciencesSchools and Research
Centre , Kerala

Christian Medical
College, Ludhiyana

25

Bachelor of
Radiography &
Imaging technology

PGIMER, Chandigarh

University College of
Medical Sciences and
GTB Hospital, New Delhi

St. Thomas Hospital,

Kerala

Guru Gobind Singh

Indraprastha University,
New Delhi

Rajeev Gandhi College,

Bhopal

26

Bachelor of
Radiotherapy
Technology

27

Diploma in
Radiography
Technology &
Imaging Technology

AIIMS, New Delhi

Amrita Institute of Medical

Sciences- Schools and
Research Centres, Kerala
Dr MGR Medical
University, Tamil Nadu
Dr MGR Medical
University, Tamil Nadu

St.John`s National
Academy of Health
Sciences, Karnataka

JIPMER, Puducherry

PGIMER, Chandigarh

Christian Medical College,

Vellore
King Edward Memorial
Hospital and Seth
GordhandasSunderdas
Medical College, Mumbai

124

Nizams Institute of
Medical Sciences,
Hyderabad

AIIMS, New Delhi

CMC, Vellore

Sree Chitra Tirunal

Institute for Medical
Sciences and Technology,
Kerala
Nizam`s Institute of
Medical Sciences,
Hyderabad

Chatrapati Shahuji
Maharaj Medical
University, Lucknow
Dr. B R Ambedkar
Medical College
Hospital, Karnataka

Tripura Institute of
Paramedical Sciences,
Agartala

Symbiosis Department
of Health Sciences, Pune
Dr NTR University of
Health Sciences, Andhra
Pradesh
Apollo Institute of
Hospital Management &
Allied Sciences, Chennai

Estimating imbalances in the Allied Health Workforce

S.No
27

28

Course

Off campus

Diploma in
Radiography
Technology &
Imaging Technology

PG Diploma in
Radiotherapy &
Imaging technology

Affiliate

Christian Medical College,

Vellore

King Edward Memorial

Hospital and Seth
GordhandasSunderdas
Medical College, Mumbai
Nizam`s Institute of
Medical Sciences,
Hyderabad

Apollo Institute of Hospital

Management & Allied
Sciences, Chennai

Satellite

Sree Chitra Tirunal

Institute for Medical
Sciences and Technology,
Kerala

Apollo Institute of
Hospital Management &
Allied Sciences, Chennai

Dr MGR Medical
University , Tamil Nadu

Madurai Kamraj
University, Tamil Nadu

Sri Ramachandra College

of Allied Health Sciences,
Chennai

Holy Cross College,

Tiruchirappalli (Tamil
Nadu)

Nizam`s Institute of
Medical Sciences,
Hyderabad

Lokmanya Institute of
Healthcare Technology,
New Delhi

AUDIOLOGY & SPEECH LANGUAGE PATHOLOGY

29

Bachelor of
Audiology & Speech
Language Pathology

30
31

Diploma in Hearing
Aid and Ear Mould
Technology
Diploma in Hearing
Language & Speech

All India Institute of

Speech and Hearing
(AIISH), Mysore

Ali Yavar Jung National

Institute for the Hearing
Handicapped (AYJNIHH),
Mumbai

Kasturba Medical College,

Manipal, Karnataka
Institute of Health
Sciences, Orissa

All India Institute of

Speech and Hearing
(AIISH), Mysore

Ali Yavar Jung National

Institute for the Hearing
Handicapped (AYJNIHH),
Mumbai

National Institute for the

Visually Handicapped
Regional Centre, Chennai,
Tamil Nadu

AWH Special College

(Association for Welfare
of the Handicapped
Special College),
Kozhikode (Kerala)
Dr MV Shetty College
of Speech and Hearing,
Mangalore (Karnataka)
CMC, Vellore

PGIMER, Chandigarh

125

Medical Trust Institute

of Medical Sciences,
Kochi (Kerala)

Dr S R Chandrasekhar
Institute of Speech and
Hearing (Dr SRCISH)
Bangalore, Karnataka

JM Institute of Speech
and Hearing, Patna
(Bihar)

Naseema Institute of
Speech and Hearing
(NAISH Institute),
Bangalore (Karnataka)

Sweekar Rehabilitation
Institute for
Handicapped,
Secunderabad (Andhra
Pradesh)
-

JM Institute of Speech
and Hearing, Patna
(Bihar)
Holy Cross College,
Tiruchirappalli, Tamil
Nadu

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward
S.No

Course

Off campus

Affiliate

Satellite

MEDICAL TECHNOLOGY
32

Diploma in Dialysis
Technology

Apollo Institute of Hospital

Management & Allied
Sciences, Chennai
Amrita Institute of Medical
Sciences- Schools and

Research Centres(Amrita
School of Medicine), Kerala

33

Diploma in Neuro
Electro Physiology

Sree Chitra Tirunal

Institute for Medical
Sciences and Technology,
Kerala

Bangur Institute of
Neurology, Kolkata

DENTAL
34

Diploma in Dental
Hygienist

35

Diploma in Dental
Mechanic

Dr DY Patil Dental College

& Hospital, Mumbai and
Pune

CMC, Vellore

Dr D Y Patil Dental College

& Hospital, Mumbai and
Pune
King George Medical
College, Lucknow

King George Medical

College, Lucknow

Christian Dental College,

Ludhiana

Manipal College of Dental

Sciences, Manipal

Institute of Post
Graduate Medical
Education And Research
(IPGMER), Kolkata
Manipal College of
Allied Health Sciences,
Karnataka

Sri Ramchandra Medical

College, Chennai
Govt Medical College,
Kozhikode
CMC, Vellore

Amrita Institute of
Medical SciencesSchools And Research
Centres(Amrita School
of Medicine), Kerala

Lissie Medical &

Education Institute,
Kochi

Govt Medical College,

Thiruvananthapuram
Malabar Institute of
Medical Sciences Ltd,
Kerala

Symbiosis Institute Of
Health Sciences (SIHS),
Pune
Rabindranath Tagore
International Institute
of Cardiac Sciences
(RTIICS), Kolkata

Sri Ramchandra Medical

College, Chennai
Modern Dental College
and Research Centre,
Indore

Jaipur Dental College,

Jaipur

Amrita School of
Dentistry, Kerala

Faculty of Dental
Sciences, Institute of
Medical Sciences, BHU,
Varanasi

Sardar Patel Institute

of Dental and Medical
Science, Lucknow

126

Sardar Patel Institute

of Dental and Medical
Science, Lucknow

Modern Dental College

And Research Centre,
Indore

Santosh Dental College,

Ghaziabad

Jaipur Dental College,

Jaipur

Santosh Dental College,

Ghaziabad
Faculty of Dental
Sciences, Institute of
Medical Sciences, BHU,
Varanasi
Seema Dental College,
Rishikesh

Estimating imbalances in the Allied Health Workforce

S.No

Course

Off campus

Affiliate

Satellite

EMERGENCY TRAUMA AND CRITICAL CARE

36

37

38

Certificate course

for Pre Hospital
Trauma Technology/
Certificate course
for Emergency
Trauma and Critical
Care Technology
(ETCT)

Government Medical
College, Chandigarh

Manipal College of
Allied Health Sciences,
Karnataka

CMC, Vellore

Apollo Institute of Hospital

Management & Allied
Sciences, Chennai

Chettinad Academy of
Research and Education
(CARE), Kanchipuram

Dr. M G R University, Tamil

Nadu

Institute of Post
Graduate Medical
Education And Research
(IPGMER), Kolkata

Vardaman Mahavir
Medical College,
Safdarjung Hospital, New
Delhi

Diploma in Pre
Hospital Trauma
Technology
(PTT)/ Diploma in
Emergency Trauma
And Critical Care
Technology (ETCT)

BSc in Critical Care

Therapy

CMC, Vellore

Max Institute of Medical

Excellence

Vardaman Mahavir

Medical College, New Delhi

Sri Ramchandra Medical

College, Chennai
School Of Emergency &
Trauma Care BijuPatnaik
Institute of Medical
Science & Research, Orissa

Sri Ramchandra Medical

College, Chennai

Symbiosis Institute of
Health Sciences, Pune

Nizams Institute of
Medical Sciences,
Hyderabad

Department of
Emergency and Trauma
Care Management,
Coimbatore (Tamil
Nadu)

Apollo Institute of
Hospital Management &
Allied Sciences, Chennai

Department of Critical
Care and Emergency
Medicine, Sir Ganga Ram
Hospital, New Delhi
Department of Critical
Care and Emergency
Medicine, Sir Ganga Ram
Hospital, New Delhi
RG Kar Medical College,
Kolkata
Rabindranath Tagore
International Institute
of Cardiac Sciences
(RTIICS), Kolkata

Vinayak Mission
University , Tamil Nadu

Madras Institute of
Orthopaedics and
Traumatology Academy
of Allied Health Sciences,
Chennai

OPERATION THEATRE
39

Diploma in OT
Technology

Apollo Institute of Hospital

Management & Allied
Sciences, Chennai

Sree Chitra Tirunal
Institute for Medical
Sciences and Technology,

Kerala
The Sankara Nethralaya
Academy, Chennai
NarayanaHrudayala
Institute of Medical
Sciences, Karnataka

127

Max Institute of Medical

Excellence, New Delhi
Lokmanya Institute of
Healthcare Technology,
New Delhi

Sri Ramachandra College

of Allied Health Sciences,
Chennai

Government Medical
College, Kozhikode

J & J Ethicon Institute of

Surgical Education
Amrita Institute of
Medical SciencesSchools and Research
Centres(Amrita School
of Medicine), Kerala
PGIMER, Chandigarh

Malabar Institute of
Medical Sciences, Calicut

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward
S.No
40

Course
BSc in OT
Technology

Off campus

Affiliate

Madras Institute of
Orthopaedics and
Traumatology Academy
of Allied Health Sciences,
Chennai

Government Medical
College, Chandigarh

K S Hegde Medical
Academy, Mangalore

Vardaman Mahavir
Medical College,
Safdarjung Hospital,
New Delhi

JIPMER, Puducherry

Apollo Institute of
Hospital Management &
Allied Sciences, Chennai

Indraprastha Apollo
Hospital, New Delhi

National Institute of
Health and Family
Welfare, New Delhi

PGIMER, Chandigarh

Satellite

Rajiv Gandhi University

of Health Sciences,
Bengaluru

MISCELLANEOUS
41

Diploma in Medical
Records Technology

42

43

Bachelor Public
Health Education
Promotion

Diploma Sanitary
Inspector

Sree Chitra Tirunal

Institute for Medical
Sciences and Technology,
Kerala

The Sankara Nethralaya

Academy, Chennai

Gandhigram Institute of
Rural & FW Trust, Tamil
Nadu

All India Institute of Local

Self-Governance, Mumbai

NarayanaHrudayala
Institute of Medical
Sciences, Karnataka

Institute of Public Health,

Bangalore

Industrial Training
Institute, New Delhi

128

JamiaHamdard
University, New Delhi

The Tamil Nadu Dr MGR

Medical University,
Tamil Nadu
Madhya Pradesh
Paramedical Council

Mysore Medical College

Amrita Institute of
Medical SciencesSchools and Research
Centres(Amrita School
of Medicine), Kerala

Apollo Institute of
Hospital Management &
Allied Sciences, Chennai
The Tamil Nadu Dr MGR
Medical University ,
Tamil Nadu
Mysore Medical College
& Research Institute,
Karnataka
All India Institute of
Hygiene and Public
Health, West Bengal

Central Health
Education Bureau, New
Delhi

Estimating imbalances in the Allied Health Workforce

Allied Health Course Bundling

SL
No

Course

Duration

Annexure 9

OPTOMETRY
1.
2.
3.
4.
5.
6.
7
8
9

10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

25.

Bachelor of Optometry & Ophthalmic Technique

Diploma in Optometry & Refraction Technique

3 years plus 6 months internship (semester system) + yearly

exam
2 years plus 6 months internship (yearly exam system)

PROSTHETICS AND REHABILITATION

Bachelor of Prosthetics & Orthotics

Bachelor of Rehabilitation Therapy

Diploma in Community Based Rehabilitation

(CBR)
Diploma in Orthotics and Prosthetics

3 years plus 6 months internship (yearly exam system)

4 years plus 6 months internship

1 year plus 23 months internship (yearly exam system)

2 years plus 6 months internship (yearly exam system)

SURGICAL & INTERVENTION TECHNOLOGY

Bachelor of Cardio-pulmonary Perfusion

Technology
Diploma in Cardiac Care Technology

3 years + 6 months internship (semester system)+ yearly exam

2 years + 6 months internship (semester system) + yearly exam

MEDICAL LAB TECHNOLOGY

MSc Medical Lab Technology

2 years + 6 months internship (semester system) + yearly exam

Bachelor of Medical Lab Technology

3 years + 1 year internship (semester system) + yearly exam

Diploma in Medical Lab Technology

2 years + 6 months internship

PG Diploma Histotechnology

1 year + 6 months internship

PG Diploma Cytotechnology

PG Diploma Hematotechnology

PG Diploma in Molecular Diagnostic Techniques

1 year +6 months internship

1 year + 6 months internship

1 year + 6 months internship

RADIOGRAPHY & IMAGING TECHNOLOGY

MSc Radiotherapy

Bachelor of Radiography & Imaging Technology

Bachelor of Radiotherapy Technology

Diploma in Radiography Technology & Imaging

Technology
PG Diploma in Radiotherapy & Imaging
Technology

2 years + yearly exam system

3 years Semester system+ yearly exam+ 6 months internship

3 years (6 months internship)(yearly exam system)
2 years (yearly exam system) 6 months internship
2 years, yearly exam system+ 6 months internship

AUDIOLOGY & SPEECH LANGUAGE PATHOLOGY

Bachelor of Audiology & Speech language

Pathology

3 years + 6 months internship (yearly exam system)

Diploma in Hearing Language & Speech

1 year yearly exam system

Diploma in Hearing Aid and Ear Mould

Technology
Diploma in Dialysis Technology

Diploma in Neuro Electro Physiology

1 year

MEDICAL TECHNOLOGY

2 years + 6 months internship (yearly exam system)

2 years + 6 months internship

129

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward
SL
No

Course

Duration
DENTAL

26

Diploma in Dental Hygienist

2 years + yearly exam system

27

Diploma in Dental Mechanic

29

Diploma in pre hospital trauma technology (PTT)

28
30
31
32
33

SURGERY AND ANAESTHESIA

Diploma in OT Technology

Certificate Course for Pre Hospital Trauma

Technology
Diploma in Medical Records Technology

Bachelor Public Health Education Promotion

Diploma Sanitary Inspectors

2 years + yearly exam system

2 years, 6 months internship

2 years semester system with 6 months internship + yearly exam

9 months 3 months internship + yearly exam

MISCELLANEOUS

2 years course, 6 months internship

3 years

2 years (yearly exam system)

130

Estimating imbalances in the Allied Health Workforce

References*

4. Ray AS, Bhaduri S. The political economy of rural

health care in India. New Delhi: Voluntary Health
Association of India; 2001.

1. Zurn P, Dal Poz M, Stilwell B, Adams O. Imbalances

in the health workforce. Geneva: World Health
Organization; 2002.

5. Ministry of Road Transport & Highways. [Internet],

2011 [cited 10 Jan 2012 ]

2. Katrak H. Measuring the shortage of medical

practitioners in rural and urban areas in developing
countries: A simple framework and simulation
exercises with data from India. International
Journal of Health Planning and Management2008;
23:93-105.

6. National Rural Health Mission. Bulletin on Rural

Health Statistics in India. [Internet], 2012 [cited
10 Jan 2012 ]; Available from: http://www.
nrhmassam.in/pdf/guideline2

7. Human Resources for Health in India.Indias Health

Workforce Size, Composition and Distribution.
[Internet], 2008 [cited 10 Jan 2012 ]; Available
from: http://www.hrhindia.org/assets/images/
Paper-I.pdf.

3. Deshpande K, Shankar R, Diwan V, Lonnroth K,

Mahadik VK, Chandorka RK. Spatial pattern of
private health care provision in Ujjain, India: A
provider survey processed and analysed with a
Geographical Information System. Health Policy
2004;68(2): 211222.

131

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

132

Chapter 4

Standardising Allied Health Education

1. Introduction
The education system in allied health has dramatically
evolved over the years. Recent advances in technology
are also driving the need for allied health educators
to become well versed with content-specific applied
pedagogical concepts. There have been changes in the
methods of instruction, processes of assessment, class
size and methods for preparation of class lectures.
These, coupled with lack of incentives for the faculty,
may result in faculty members themselves being the
primary barrier to change. In 2009, the World Health
Organization (WHO) report on the health workforce
underscored the importance of standardised formal
education in reforming healthcare delivery in
developing countries.(1)

Most of the successful models in the education

system are derived from the industrial concept and
thus they also give rise to alternate models of business
generation, which is essential for the long-term
sustainability of institutes.
Over a period of ten months, the National
Initiative for Allied Health Sciences (NIAHS)
secretariat attempted to catalogue discrepancies in
the formal education imparted to aspiring allied health
professionals (AHPs) by a literature review spanning
over more than 180 peer-reviewed publications.
The review indicates several lacunae in the present
education system.

A literature review indicates that many associated

factors drive the sustainability of institutions imparting
higher education within the healthcare system. Some
of them are listed below:
i.

The necessary competencies required out of

graduates become explicit when the framework
for qualification and competence is defined and
made official.

In India, regulation of higher education is

fragmented, and done by several agencies. Higher
education falls within the jurisdiction of the University
Grants Commission (UGC) and professional institutions
are coordinated by the All India Council for Technical
Education (AICTE). Allied health education is, at
present, outside the ambit of regulatory bodies.

The market
A growing number of single- and multisuperspecialty tertiary-care hospitals

Rapid expansion of hospitals and medical colleges

all over India

Emerging technologies and development in

medical services such as emergency medicine,
clinical waste management to name a few, will
generate specific educational requirements, i.e.
education and training for allied health personnel.

Over the years, the allied health professionals

experienced a transition from on-the-job training to
education in formal institutions such as colleges and
university settings, which led to the mushrooming of
such colleges across the nation. Many allied health
fields instituted additional and better training, and
have adopted educational requirements that include
formal academic degrees, although the entire system
lacks standardisation. The literature review indicates

ii. Customer expectations of quality healthcare

services

To bridge the gap, specialists in the allied health

sciences will become vital as the number of singleand multi-superspecialty hospitals increases.

133

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

mainly hospitals. There are very few opportunities for

higher education in these fields and career paths are
poorly defined. The quality of the graduating students
depends largely on the entry-level qualification, type
of course delivery, exposure to practical work, faculty,
culture of the training organisation and system of
examination.

that content and revision of curricula has been sporadic

and the standard of education imparted has remained
unmonitored. The training and teaching methods
across medical colleges excludes non-medical public
health strategies and does not factor in the latest
technological advances in medicine. Furthermore, no
scientific study has been undertaken to determine
the exact numbers of service providers, teachers and
researchers that are required.(2)

In the absence of a regulatory framework, nonstandardised curricula and indiscriminate awarding

of degrees have emerged as major impediments to
students seeking to pursue higher studies, according
to a recent Confederation of Indian Industry (CII)
study (conducted by Technopak).(3) The ripple effect
of this ad-hoc education system makes it difficult for
the health sector to recruit a quality workforce with
uniform skills, leaving fresh crops of graduates to
fend for themselves or learn skills on-the-job. Thus, a
standardised course is required to equip professionals
with knowledge and skills before they are inducted
into the workforce.

There is also a marked difference between the

public and private sectors with respect to the training
offered in various allied health courses, as well as
the content of these courses. The private sector has
traditionally placed emphasis on revenue-producing
courses and those with a shorter duration, while public
sector institutions often provide hospital-oriented
courses on a need basis. There is a lack of standardised
evidence-based training. Most universities have
their own training programmes, which have been
fashioned on the need expressed by the health sector,
BOX 1: Findings of the CII study by Technopak

The absence of uniform standards and quality control mechanisms in paramedical (allied health)
practice has led to an inappropriate mix of health personnel.
Mechanisms for the exchange of information on paramedical (allied health) education and training are
lacking.
Ethics and standards are neither enforced nor uniform. Inadequate attention is given to the
development of technical expertise and soft skills. These roadblocks have led to a paramedical (allied
health) workforce with a varied perspective and understanding of their individual roles in a healthcare
set-up, which thereby poses a major challenge in maintaining a quality and effective healthcare delivery
environment.
No specific data are available on the number of allied health workers as there is no council.
Technopak estimates an immediate requirement of an additional 2,64,500 paramedics in the country
to meet the backlog and match the current global average of at least three paramedics (laboratory
health workers) per 10,000 persons. There is an approximate requirement of a 10-fold increase in the
current output, which can be met both by increasing the capacity of current institutions and by setting
up new ones.(3)

134

Standardising allied health education

2. Current state of educational

framework in allied health sciences
The NIAHS secretariat, instituted by the Ministry of
Health and Family Welfare, is one of the first formalised
attempts by the Government of India to understand the
challenges plaguing this sector and develop a strategic
framework to augment the allied health capacity in

India. Our research on allied health system, including

a primary survey conducted via facility walk-throughs
and in-depth stakeholder consultations, indicates the
following finding in Table 1.

KEM

IPHH

EISE(J&J)

AIIPMR

AYJNIHH

MCOAHS

CMC-Vellore

SCTIMST

GMC-(Ch)

JJ Hospital

SRU

Safdarjung

S.No.

PGI (Ch)

Table 1: Situation analysis of allied health education system

Attachment with
hospital /skills lab

Separate demo lab

Components

Infrastructure

Separate
infrastructure
for allied health
courses

Defined admission
criteria

Defined career
pathways

Live registers

Inputs

Defined intake
capacity

Standardised
curricula

Curricula
upgradation

Standardised
training duration
(internship)

Dedicated
placement cell

Use of simulators

Technology-based
mode of teaching

Skills assessment

135

KEM

IPHH

EISE(J&J)

AIIPMR

AYJNIHH

MCOAHS

CMC-Vellore

SCTIMST

GMC-(Ch)

JJ Hospital

SRU

Safdarjung

S.No.

PGI (Ch)

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Common faculty
(medical)

Defined guidelines
for promotion (AH
faculty)

Components

Faculty
Defined
qualification for
faculty

Dedicated faculty
(AH specialists)

Assessment
of teaching
competence

Faculty
development
programme

Regulation and management

Accreditation of
institution

Certified courses

Registration and
licensing

Quality assurance
protocols

Central funding

Autonomous

State funding

Private funding

State controlled

The literature search and field visits also indicate

that there are two streams of education in India;
well-established private institutes offering highquality as well as expensive education; and a vast
number of publicly financed institutes run by local
authorities, most of which offer affordable education
and hence the indifferent quality. Private institutes
suit urban candidates, whereas publicly financed
institutes remain the only option for both the urban

136

and rural poor, irrespective of the capability and

calibre of potential students. This divide in the access
to education has serious implications on the overall
social development of the country.
The success of the stand-alone models of excellence,
such as Indian Institutes of Technology (IITs), Indian
Institutes of Management (IIMs), Indian Institute of
Science (IISc), is associated with the determination
to provide exceptionally high-quality education to

Standardising allied health education

e) Faculty shortages and development

the candidates. They have the advantage of being

associated with premier institutes; for example, four
out of five IITs in the 1950s were set up in collaboration
with the institutes in major industrialised nations such
as the USA, Germany, Russia and the UK, which enabled
them to absorb the best teaching methods, curriculum
offerings, experiences and practices across the world.
This exposure ensures that their programmes are
relevant to the need of the global economy and are
of a quality that is comparable with the best at the
international level.

Marked differences were found in the duration of

courses offered and the work environment at hospitals
in rural and urban settings. Most of the courses have
been initiated on a need basis for better employability
of students and for developing faculty.
As per the statistics from the human resource
department of the Ministry of Health and Family
Welfare (MoHFW), presently there are 355 medical
colleges (161 government and 194 private) providing
undergraduate and postgraduate training in India. As
per the Medical Council of India (MCI)s Postgraduate
Medical Education Regulations of the year 2000,(4)
postgraduate courses require extra staff in the
departments of anatomy, physiology, biochemistry,
pharmacology, pathology, microbiology, community
medicine, radiodiagnosis, radiotherapy, anaesthesia
and forensic medicine (four additional teaching
faculty in each of these departments, in addition to
those required for undergraduate education). In most
medical colleges, doctors teach allied health sciences
while very few allied health staff are involved in
actual teaching. The paucity of qualified allied health
specialists overburdens the medical fraternity. This
creates a behavioural problem since doctors have been
seen to have a patronizing attitude towards AHPs.

However, the situation is gloomy when it comes

to the allied health institutes catering to the masses.
These are marked by indifferent quality, unrevised
curriculum contents and poor practices.
The
inadequacy or underutilisation of resources such as
trained faculty and infrastructure are hindrances in the
pathway of reforms. Infrastructure such as laboratories
and high-end technologies still remain underutilised
due to multiple reasons in many institutions. Most of
the budget for higher education is spent on salaries
alone, which makes it mandatory to utilise the
human resource effectively. The majority of students
completing their education in these establishments
either end up unemployed or else are under qualified
as per the criteria of the job. This implies the existence
of huge gap between education and employment in
India. Moreover, the resistance to change and limited
freedom to innovate has been an issue in the academic
fraternity, though with the advent of the concept of the
autonomous institutes, this issue has been rectified to
an extent.

a) Plethora of allied health courses

There are innumerable allied health courses, ranging
from short term (up to 36 months) to certificate,
diploma, graduate and postgraduate diplomas,
postgraduate degree or doctorate level. There are two
problems concerning the grouping of such occupations
into
meaningful
categoriesstandardisation
of occupational titles and the classification of
occupations.

Based on the literature review and findings from

the field visits enumerated in Table 1, this chapter
identifies the following areas for consideration related
to the allied health educational framework:

The literature review indicates that the

nomenclature differs for similar courses across the
country. Various professions defined by different
sources have been compiled and delineated in
Appendix-1. A list of 139 courses of existing, emerging
and essential cadres in the Indian healthcare system
has also been compiled by NIAHS Secretariat, which

a) Plethora of allied health courses

b) Management and autonomy of institutes

running such courses
c)
Curricula
and
methodology

skills-based

training

d) Importance of attachment to a tertiary-care

training facility
137

High Level Expert Group Report on Universal Health Coverage for India

b) Management and autonomy of allied health

colleges
Higher education worldwide achieves higher efficiency
gains by increasing institutional autonomy and
accountability for institutions imparting such courses.
The literature search also highlighted the importance of
autonomy for developing world class universities and
innovations.(6)Autonomous bodies are set up whenever
it is felt that certain functions need to be discharged
outside the governmental set-up with some amount of
independence and flexibility, and without day-to-day
interference of the governmental machinery. These are
set up by the ministries/ departments concerned with
the subject matter and are funded through grants-inaid, either fully or partially, depending on the extent
to which such institutes generate internal resources of
their own. These grants are regulated by the Ministry
of Finance through their instructions as well as the
instructions relating to powers for creation of posts.
They are mostly registered as societies under the
Societies Registration Act and, in certain cases, they
have been set up as statutory institutions under the
provisions contained in various Acts.(7)

may be revised as more professions emerge in the near

future, spanning diagnostic, curative, non-direct care,
rehabilitative and community-based care. The details
are delineated in Appendix-2

The absence of a defined role of an AHP in the Indian

healthcare setting makes it imperative to understand
the specific job description, competencies and skills
required, career opportunities and associated details
pertaining to each allied health cadre. In view of this,
NIAHS secretariat undertook an international review
of the various professions under the allied health
ambit.
Table 2 indicates the 28 professions and
professionals listed by the US Department of Labour.
A detailed description of all the professions is given in
Appendix-3.

The allied health profession may be uniquely

placed to work across the boundaries of health and
social care and indeed more widely to ensure an
integrated service to patients and service users.(5)
The literature review indicates that some universities
such as the Sri Ramachandra University (SRU) and
Maharashtra University of Health Sciences (MUHS)
have taken a step ahead to introduce an integrated
course to serve the need of the population. Various
courses conducted by the identified centres of
excellences are givenin Appendix-4.

The UGC document on the XI Plan profile of higher

education in India clearly states that

The only safe and better way to improve the

quality of undergraduate education is to delink most
of the colleges from the affiliating structure. Colleges
with academic and operative freedom are doing better
and have more credibility. The financial support to
such colleges boosts the concept of autonomy.(8)

Most of the degree and postgraduate courses were

started for better employability of the students and for
developing trained faculty. Some institutions expose the
students to a wide range of experiences, from the most
modern hospitals to small hospitals in remote areas to
settings like rural region. Thus, the students are able
to work in basic hospitals and in advanced facilities,
in urban as well as rural conditions. Graduates thus
work in a wide range of settings, including public and
private hospitals, trauma centres, diagnostic centres,
rehabilitation centres, community health settings,
community home-care services, residential aged-care
facilities, to name a few.

138

Standardising allied health education

BOX 2: Role of central and state governments

In India, presently there are 16,885 colleges of higher education with 9.954 million students enrolled for various
courses offered by the Indian education system. The central government sets standards for higher education and
research institutes, and ensures that they are maintained and followed. It is also accountable for regulating all the
components of higher education. State governments are responsible for creating facilities for the establishment
of institutions, maintenance of established units and ensuring that higher education is accessible to all. The
education department of the state government is responsible for the administrative functions associated with
the universities in the concerned states (Figure 1).(9)
Figure 1: Components of standards for the higher education system in India

Along with running traditional courses, one of the

significant things that most autonomous colleges have
done is the introduction of new courses, which are in
demand in the employment market. Autonomy allows
the freedom required to decide the own course of action,
be it admissions, curriculum, hiring of faculty, starting
new programmes or closing old programmes, and so
on by the institute. Of course, autonomy can only be in
conjunction with accountability, where performance
assessment can be done in line with norms followed by
set guidelines of the higher academic authority. Briefly,

institute has the right to decide what to teach, how to

teach and whom to teach. Such autonomous bodies,
university-level institutions, or even simply other
central institutions exist in the present education
system of our country. Many of them are designated as
Institutes of National Importance (INI) and set by an
act of Parliament. They receive special recognition and
funding. The Department of Higher Educations list
includes 39 such institutions(10). Details of INI(s) are
given in Appendix-5.

139

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

BOX 3: Structure of universities

The typical pattern of a university in India is that of universities funded by state governments and supported
by the central government for developmental programmes through the UGC or AICTE. The other types of
universities in the existing education system are the central university; unitary, federal and affiliated university;
institute of national importance, deemed university and open universities. Institutes of higher education
comprise unidisciplinary and multidisciplinary universities, and institutes of national importance include those
such as AIIMS, Indian Institutes of Management (IIMs) and others.

Others include deemed universities such as Birla Institute of Technology and Science (BITS), Indian Institute of
Science (IISc) and specialised universities. There has been considerable growth of the university system in the
country since the Independence, with the number of universities increasing from 18 in the year 1947 to nearly
300 now.(11)
Universities of higher education in India fall under the following categories on the basis of their structural
patterns (Figure 2).
Figure 2: Type of universities on the basis of structural pattern

Source: Pillai C R , Murthy CRK, Sagar M, Ramanujam PR, Sudha Rao K. Management of higher education: institutional level. IGNOU [Internet].
2008 Oct 7.

140

Standardising allied health education

Universities can be further categorised according to their roles and functions. Figure 3 below depicts the various
types of universities categorised on the basis of their functions and roles.
Figure 3: Types of universities on the basis of their functions

Source: Pillai C R , Murthy CRK, Sagar M, Ramanujam PR, Sudha Rao K. Management of higher education: institutional level. IGNOU [Internet].
2008 Oct 7.

i.

Management of institutes

courses (six months to two years) offered by the

college. All private medical colleges and a number of
state medical colleges fall under this category. The
courses are directed by the respective department
heads and there is no formal institutional structure
dedicated to allied health education. In some cases, it
was noticed that a separate entity has been showcased
for allied health courses, but the organogram is skeletal
and the faculty are part-time office bearers from the
main medical college. The advantage in this model is
that some surplus capacity is utilised for allied health
education. The disadvantages are that quality checks
are not in place, the growth and development of the

Field visits and the literature review indicate that

many institute management models exist across the
country, some of which are given below:

Medical colleges conducting certain courses

utilizing their existing infrastructure and
capacity in some of the departments, without
a formal structure of a separate college or
institution within their system:

In this model, medical colleges or some departments

such as laboratory, radiodiagnosis, operation theatre,
dental department, etc. conduct certificate/ diploma

141

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

discipline remains undetermined and the entire

education is designed to produce people with just
enough skills to assist the physicians at minimum cost.
e.g. G.S. Medical College, Mumbai.

formal structure, e.g Institute of Public Health and

Hygiene, New Delhi.

Multispecialty and superspecialty private

hospitals conducting specific courses:

This model mostly revolves around the agenda of

getting additional working hands in the hospital,
and also serves as a source of revenue. The faculty is
mostly part time. The quality of the courses varies,
with some of the bigger corporate hospitals producing
better-quality technicians. These courses usually offer
certificates or diplomas from the hospital. Since there
are no regulatory frameworks in most of the states,
the courses are autonomously run and managed, e.g.
Apollo Hospitals Education and Research Foundation.

In this model, the course is well defined, and the

practical training and contact programmes are
conducted in a proper manner in reputed institutions.
At the end of the course, a degree or diploma is offered.

A medical college or a university having an

institution for allied health sciences with
complete organisational infrastructure and
functional autonomy:

There are a number of highly advanced and wellestablished institutions like Manipal College of Allied
Health Sciences (MCOAHS), Post Graduate Institute
of Medical Education and Research (PGI) Chandigarh,
Jawahar Institute of Postgraduate Medical Education
and Research (JIPMER), Sri Chitra Tirunal Institute for
Medical Sciences and Technology (SCTIMST), All India
Institute of Medical Sciences (AIIMS), in which stateof-the-art technology is used for teaching and training.
BSc/MSc programmes are available, as well as PhD
programmes in a few cases.

Stand-alone allied health academies, utilizing

the hospital and medical college infrastructure
through MoUs or informal arrangements:

These institutes have been in existence for more than

two decades and, over the years, have developed
the reputation of being pioneers in the field. They
mostly produce personnel in the diagnostic fields
such as laboratory technicians and radiographers. A
certain percentage of people are trained in operating
machines, such as those for ECG, EEG, cardiopulmonary
machines, CT scan, MRI, haemodialysis, and so on.
They have in fact been filling up the demand as per
their own needs in their own way; e.g. Sardar Bhagwan
Singh Post Graduate Institute of Biomedical Sciences &
Research, Dehradun.

Distance-learning mode with attached

programme study centres in large institutions,
as run by national open schools such as the
Indira Gandhi National Open University
(IGNOU):

ii. Financing of higher education in India

Financing for higher education in colleges and

universities is through multiple sources such as
fees, government grants, philanthropy, sale of
publications, among other sources. The central and
state governments ensure the availability of funds to
the universities through agencies such as the UGC and
AICTE for the development and maintenance of the
education system in the country. The types of grants
provided to the institutions / universities are depicted
in Figure 4 below.

Stand-alone academies having no associated

hospital or medical college:

These are small institutions in large and small towns,

which mostly produce people in streams such as
laboratory technicians, radiographers, sanitary
inspectors, etc. The educational infrastructure is
skeletal and many have tie-ups with private hospitals
for on-the-job training, which is again without any

142

Standardising allied health education

Figure 4: Types of grants to institutions and universities for higher education

Norms vary across the states

To initiate new programmes and

activities

Development grant

Maintenance grant

For day-to-day functioning of

the institutions

Provided through national agencies

such as UGC, AICTE

Can be one-time grant which is a

non -recurring expenditure such
as for construction of building,
procurement or recurring grant such
as salaries of staff

Issues with the funding mechanism

The literature review indicates that state

grants have multiple drawbacks such as
unequal distribution, non-specificity of rules
and regulations, inadequacy of the quantum of
assistance and lack of feedback on the utilisation
of grants.

government according to a prescribed formula. In

addition, universities also collect fees from students
and a few universities receive some financial support
from trusts, philanthropists and industry. Government
and private colleges receive funds from the respective
governments in the form of grants-in-aid for
maintenance and development purposes. The system
of grants-in-aid is mainly based on a flat percentage
increase on the previous years budget, and does not
take into account the changing academic and research
needs of the institution, or changes in the price of
supplies and increase in student enrolment. The role
of non-governmental sources in financing higher
education continues to be limited.

The grants and funding provided by central

organisations are also incongruent. For example,
most of the fund flow by UGC provides for building
up of the physical facilities only. Many grants
are provided for conducting research activities
in several institutes, though there is no clear
mechanism to detect and avoid duplication and
overlapping of such studies.
The poor management system of universities and
institutes leads to underutilisation or misuse of
the available resources.

To sum up, central universities receive funds from the

UGC as development (plan) grants and maintenance
(non-plan) grants. Institutions of national importance
such as the IITs and IGNOU receive their grants
directly from the Ministry of Human Resource
Development (Department of Education), Government
of India. State universities are funded by the state
governments in the form of block/maintenance grants
as well as development grants. State universities also
receive development grants from the UGC, provided a
matching component is given by the respective state

iii. Harnessing publicprivate partnerships(12)

Publicprivate partnership (PPP) is an approach
through which services are delivered by the private
sector (non-profit/for-profit organisations) while
the responsibility for providing the services rests
with the government. This arrangement requires the
government to either enter into a contract with the
private partner or pay for the services (reimburse)
rendered by the private sector.

143

PPP provides an opportunity for private sector

participation in financing, designing, constructing, and
operating and maintaining public sector programmes
and projects. There are potentially four models that
could exist under PPP (Figure 5).

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Figure 5: Models of publicprivate partnership

Benefits
The potential benefits expected from PPP are
mentioned below with the underlying benefit being
increased professionalism:

Cost-effectiveness through mobilizing public and

private capital as selection of the developer/
service provider depends on competition or some
benchmarking; the project is generally more cost
effective than otherwise.

Higher productivity by linking payments to

performance, productivity gains may be expected
within the programme / project.
Accelerated delivery since the contracts generally
have incentive and penalty clauses vis-a-vis
implementation of capital projects / programmes,
this leads to accelerated delivery of projects.

etc. require a great deal of commitment rather

than sheer professionalism. In such cases, it is
community/voluntary organisations (VOs) with
dedicated volunteers who alone can provide the
requisite relief.
Recovery of user charges innovative decisions
can be taken with greater flexibility on account of
decentralisation. Wherever there are possibilities
of recovering user charges, these can be imposed
in harmony with local conditions of governance
structures.

Disadvantages

Clear customer focus the shift in focus from

service input to output creates the scope for
innovation in service delivery and enhances
customer satisfaction.
Enhanced social service social services to the
mentally ill, disabled children and delinquents,

144

Lack of trust and transparency a lot of effort

is needed to make the entire engagement
transparent so that trust can be built on both sides
and the consumer is benefited. A lot of time and
effort goes into this, as clearly defined frameworks
donot exist and, each time, efforts are made to
evolve a PPP model. Once a PPP is formed, the
entire process should be transparent to all the
participating parties.

Standardising allied health education

People dependency PPP frameworks should be

between the public entity and the private players
based on defined measurable, tangible and
intangible metrics that are jointly agreed to by an
independent third party.

Table 3: Shift in trend of components of the

education system
From

To

Teacher-directed

Learner-centred

Content

Applied skills

Direct instruction

Risk mitigation plans there needs to be greater

public participation in a PPP model to reduce or
mitigate the risk of non-performing assets. Poor
performance is largely due to the monopolistic
characteristics of such activities.

Knowledge
Basic skills

Facts and principles

Theory

Weak regulatory systems these would prevent

competitive bidding or competitive negotiation
in the selection of the service provider and a
transparent monitoring and evaluation process to
ensure that monopolistic trends do not percolate
the PPP.

Curricula

Time slotted

One technique fits all

Competitive
Classroom

Text based

c) Curricula and skills-based training

methodology

Summative tests

i.

Curricula are based on problem solving, guiding

students learning through solving complex, realworld problems, and by the effective use of simulators,
thereby also ensuring patient safety. Field visits to
premier institutes indicate that these colleges have
standardised curricula for allied health streams, some
of which are at par with international standards, and
conduct continuous curricula upgradation in a timely
fashion. However, the literature review points out that
the curricula of similar courses in most of the colleges
differ in content and structure across India. A detailed
list of books used in various courses and specialties
compiled by NIAHS secretariat is given in Appendix-6.

Interactive exchange
Skill

Applied skills

Question and problems

Practice

Projects

On demand

Personalised

Collaborative

Global community
Web based

Formative evaluations

Shift to a skills-and competency-based

education system

While skill is defined as the ability to perform a task

well and can be acquired through training or practice,
competency is usually a collection of skills and
attitudes required to perform a function to expected
standards.(14) In competency-based training, learning
objectives are formulated based on competencies
and enable students to attain these competencies in
order to perform their tasks successfully. Therefore,
students cannot be promoted to a higher level till they
successfully demonstrate the required competency.(15)
Four essential components of competency-based
training have been described.(16)

Table 3 shows some of the major shifts in trend of

various components of the education system over
time.(13)

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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

The competencies that are to be achieved

are carefully identified, verified and then widely
disseminated are given below:

The criteria are firmed up, including the conditions

under which these competencies will be assessed,
and are listed and made known to the assessors
and students.

practise cardiopulmonary resuscitation on a human

mannequin.

Actual performance during assessment determines

the attainment of the specified competency.

Internationally, a competency-based approach

has increasingly become vital for undergraduate and
postgraduate training. The key to uniformity lies in
the standardisation of content which, in turn, is based
on standardisation of faculty development, frequent
assessment of student performance and assessment
of standard operating protocols. Patient encounters
are used for developing competencies and also for
evaluating performance. If there are any deficits, these
are addressed through audio-visual aids, teaching
sessions, observations and practice under supervision.

George H. Buck, after a historical review of the use

of simulators in 1991, said,
Given the developments in this technology within
the last 50 years, it is possible that the use of simulators
will increase in the future, should the need arise to
teach new concepts and procedures at set times to large
groups of individuals.

The course curriculum includes the development

of competencies and training methodology.
Each student will develop the competencies at
his/her own pace.

Characteristics of competency-based training

programmes

Supporting theory is integrated with skill practice.

Detailed training materials are designed.

Participants knowledge and skills are assessed

as they enter the programme, and those with
satisfactory knowledge and skills or those who
have already attained competencies may by pass
training.

ii. Leveraging technology for skills building

Healthcare education and training is the backbone of

an efficient healthcare system and Indias education
infrastructure is yet to gain from the ongoing
international technological revolution. Our literature
review and in-depth interviews indicate that teaching
and learning of clinical skills occur at the patients
bedside or other clinical areas such as laboratories,
augmented by didactic teaching in classrooms and
lecture theatres. Though keeping up with the pace
of technological advancement, there has been a
paradigm shift to outcome-based education with
adoption of effective assessment patterns and demand
for demonstration of competence in some of the
institutions.

Learning is self-paced.

Flexible training approaches are used, including

large group methods, small group activities and
individual study.

A variety of support materials including print,

audiovisual and simulations (models) is used.
Satisfactory completion of training is based on
achievement of all specified competencies.

Management of health facilities remains a weak

component in both public and private sector hospitals.
Increasing patient literacy and newer technology has
made patients more demanding. While corporate
hospitals have introduced training in information
technology (IT) skills, communications and mobile
technology applications, the public sector is yet to gain
from advances in these areas.
Models and simulation laboratories play an
important role in competency-based training courses.
In this method, students in major disciplines first

146

Our study indicates that some of the allied

health schools have instituted clinical skill centres,
laboratories and high-fidelity simulation laboratories
to enhance practice. Simulation is the replication
of part or all of a clinical encounter through the use
of mannequins, computer-assisted resources and
simulated patients. The use of simulators addresses

Standardising allied health education

any department. Guidelines usually exist for their

supervision along with professional development
programmes. Thus, a successful internship programme
has clearly defined policies and procedures with
proper orientation programmes. Regular supervision
and feedback mechanisms should be in place along
with professional development activities.In India,
internship is not compulsory for the same course in a
number of institutions.

many issues such as suboptimal use of resources and

equipment by adequately training the manpower on
newer technologies, limitations for imparting practical
training in real-life scenarios, ineffective skills
assessment methodsamong others (Table 4).
Table 4: Clinical learning opportunities imparted
through the use of advanced techniques(17)
Teaching
modality

Learning opportunity examples

Patients

Teach and assess in selected clinical

scenarios

Mannequins

Simulators

Task under
trainers

This situation exists due to lack of regulation. The

duration of internship and payment of an honorarium
during internship is also not uniform. Hence, the
employability and salary levels of the students are not
assured.

Practise soft skills

Practise physical examination

Receive feedback on performance

BOX 4: Apprenticeship models

Perform acquired techniques

The Ministry of Human Resources Development

(MHRD) has set up the Central Apprenticeship
Council for students to learn onthejob. Courses
related to the health sector are as follows:

Practise basic procedural skills

Apply basic science understanding

to clinical problem solving
Practise teamwork and leadership

Graduate and technician apprenticeship: medical

laboratory technology, biomedical engineering,
public health engineering, medical laboratory/
technology assistants, health worker, nursing,
child care and nutrition, health sanitary inspector,
hospital documentation, hospital housekeeping,
ophthalmic technician, physiotherapy and
occupational therapy, X-ray technician, multirehabilitation worker, biomedical equipment and
technician, dental hygienist, dental technician,
multi-purpose health worker, pharmacist, ECG
and audiometry technician, nutrition and dietetics,
auxiliary nurse midwife (ANM) and primary health
worker.

Perform cardiac and pulmonary

care skills

Apply basic science understanding

to clinical problem solving
Practise phlebotomy, lumbar
puncture, etc.

iii. Internship as a skills-building exercise

An internship is done after completion of the academic
cycle giving, for the first time, the aspiring health
personnel a practical and hands-on learning experience
outside the classroom. During the internship, students
work with patients under a mentor. The most
significant reason for an internship period is to help
the students decide their area of expertise. However,
internships may or may not be compulsory, depending
on the institution conducting the course.

In this model, the theoretical aspect of learning

is weak, and only the simplest skills are learnt,
resulting in low-quality products. These are
conducted under the aegis of the Central
Apprenticeship Council.

iv. Assessment to validate skills in graduating

professionals

Under the guidance of a mentor, interns learn

to analyse and report patient conditions and refine
their skills. As interns require a lot of support from
team members and the hospital administration,
they are usually oriented before being placed in

Students undergo internal and external assessments,

in addition to a theory examination at the end of each
year or semester. The theory papers come from the
universities to which the institutions are affiliated.
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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

The semester system is not widely prevalent, though

MCOAHS is in the process of converting to the semester
system.

in communication, clinical examination and medical

procedures/prescriptions.

For instance, in physiotherapy, orthotics and

occupational therapy, competency-based tests
involve exercise prescription and joint mobilisation/
manipulation techniques. In radiography, radiographic
positioning, radiographic image evaluation and
interpretation of results are tested. The basic
essential elements consist of functional analysis of
the occupational roles and assessment of trainees
progress.

Internationally competency-based parameters

form part of the performance procedures of regulatory
organisations such as the General Medical Council
(GMC) of the United Kingdom. In India, this is not
embedded in the allied health education system. An
objective structured clinical examination (OSCE)
is used these days in a number of allied health
courses, e.g. orthotics, optometry, physiotherapy and
radiography to test the performance and competence

BOX 5: International Atomic Energy Agency (IAEA) training approach in radiopharmacy(18)

This training is designed to encourage local, national and regional empowerment. In most cases, local
professional bodies create a framework for assessment and take responsibility for the follow up. National or
regional nuclear medicine professional bodies set standards and accordingly assess the achievements of the
participants. The same bodies also provide guidance for nuclear physicians as supervisors on standardised
assessment requirements after three months. Three months on-the-job training and a practice diary under
supervision of a tutor are essential. Daily log book entries and self-assessments are an integral part of the IAEA
training in radiopharmacy practice. Each trainee is expected to prove a minimum level of competency after
completion of the training. In some cases, professional bodies have also taken note of trainees performances
immediately following the training with a series of open and carefully designed multiple choice questions.
The key elements of a follow up include:

Practical log book entry for at least three months; feedback from trainee and tutor; and method of final
assessment and certification In the practical logbook, not all elements have to be completed. However, an honest
assessment of application is essential. Regular dialogue between the trainee and supervisor is essential to keep
the process on track.

A periodic audit process of training should include reviews with trainees and progress reports following
training. The trainees should be encouraged to provide feedback, therefore helping todevelop a sustainable
culture of regular reviews, updates and change. Through regional projects, the IAEA can provide an external
review process to further strengthen the system

d) Importance of affiliation of allied health

institutes with tertiary-care hospitals/medical
colleges

The advantage of a hospital is that the faculty is

available and can be shared in the subjects of anatomy,
physiology, biochemistry, pathology, microbiology,
pharmacology, forensic medicine and community
medicineareas where there is generally a great
shortage. It is possible to share laboratory equipment,
especially sophisticated equipment, simulation
laboratories, models, classrooms and audiovisual aids.

Reputed courses are usually run in institutions

attached to tertiary-care hospitals. A skills-based
method of teaching as described above can only be
incorporated when students are able to practise their
newly acquired clinical skills in a real-life setting such
as a hospital or a high-tech simulation centre that will
provide commensurate learning opportunities.
148

Allied health institutions attached/affiliated to a

medical college or teaching hospital have many
advantages over those that stand alone, as enumerated
below:

Standardising allied health education

Since a large number of allied health services

normally exist in a medical college hospital, the
personnel there automatically become faculty in
their particular allied health specialty.

which require faculty to teach them. The

possibilities for research in such institutions are
also great.

Moreover, it is difficult to sustain a stand-alone allied

health institution since the costs of running such an
institution are very high and the fees collected from
students are insufficient for the purpose. Hence, by
affiliating with medical college hospitals, allied health
institutions can stretch their budgets to levels of
sufficiency.

A medical college hospital has a heavy patient

load. This is considered a conducive learning
environment owing to the sheer exposure,
demonstration and hands-on experience, which
is not possible in places where the patient load is
lighter.
An affiliation with a medical college promotes
updation of knowledge and skills through regular
seminars and the culture of continuing medical
education. Peer-group learning is possible among
the allied health group, their seniors, and from
nursing and medical students. The potential to
acquire the skills to work in the entire gamut of
scenarios, from those which are very basic to
those which are sophisticated, is only possible in
medical colleges.

e) Faculty shortage and development

Faculty development programmes have a critical role

to play in promoting academic excellence and are
highly regarded in medical, technical and professional
education systems.

Such programmes are generally designed to

improve an individuals knowledge and skills in
teaching, educational research and educational
administration.

A larger number of students can be admitted per

course in a medical college-affiliated institution.
Since medical colleges work round-the-clock,
there is constant availability of patients and
mentors, and thus a variety of options are available
for the same course, for example, evening classes,
weekend classes and intensive contact sessions.

BOX 6

Attachment with professional associations

or networks: some institutions have formed
partnerships with professional associations or
networks for credibility, expertise or faculty, e.g.
with organisations such as the Christian Medical
Association of India (CMAI) and Rehabilitation
Council of India (RCI). Some institutions have
formed partnerships with hospitals for practical
training, since they do not have their own hospitals.

Career paths for the faculty can also be realised

in medical colleges, since there are possibilities
for starting new courses, including degree,
postgraduate diploma and doctorate courses,

Table 5: Estimation of faculty (National Commission for Macroeconomics and Health)(11)

Subject

For UG education

Additional for PG
education

Total

No. of new faculty

required annually

Anatomy

2346

315

2661

89

Pathology

3476

315

3791

126

1565

52

Physiology

Biochemistry
Microbiology

Pharmacology

Forensic Medicine

2346
1216
1273
1931
1230

315
315
315
315
315
149

2661
1531
1588
2246

89
51
53
75

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

For UG education

Additional for PG
education

Total

No. of new faculty

required annually

Community
Medicine

2618

315

2933

98

Paediatrics

2961
1545

2961

99

Subject

General Medicine
General Surgery

TB & Chest diseases

Skin and
venereology

Psychiatry

2961
687

687

687

Orthopaedics

1545

Obstetrics&
Gynaecology

2003

Anaesthesia

2575

ENT

Ophthalmology

Radiodiagnosis
Radiotherapy

Physical medicine
and rehabilitation

Total

2961

1545

687

687

687

99
52

23

23

23

1545

2003

744

315

1059

35

959

959

32

687

687

1688

315

36852

687

315

Table 5 indicates the number of subject-wise faculty

members required for undergraduate and post
graduate teaching in medical colleges.

23

687

23

2003

67

2890

3465

52

40317

preventive and social medicine.

67

96

1344

Trainers or teachers perceive faculty development

programmes as a means to enable personal and
professional growth, such as an opportunity to
network with colleagues, and a platform for initial
positive experiences to promote ongoing involvement.
Institutes can either follow faculty development
programmes or recurrent training and orientation
sessions to improve the quality of teaching methods.
In India, there are few instances where conscious
efforts have been made to improve teaching skills
in the medical sciences. Some of them are listed in
Table 6.

There is an overall shortage of teachers, which

has an adverse impact on the quality of instruction.
The situation is so acute that even state governments
are compelled to undertake irregular practices, such
as mass transfer of teachers of different specialities
from one college to another on a temporary basis at
the time of inspection of the MCI. Field work by NIAHS
Secretariat has indicated an acute shortage of faculty
in anatomy, physiology, biochemistry, microbiology,
pathology, pharmacology, forensic medicine, and

150

Standardising allied health education

Table 6: Example of faculty development in India(19)

National teacher training
centres (NTTCs) and
medical education units
(MEUs)

First NTTC at JIPMER, Pondicherry, in March 1976

This was supported by WHO.

Three more centres established by the Ministry of Health and Family Welfare
(MoHFW) at Post Graduate Institute of Medical Education and Research (PGIMER),
Chandigarh; Banaras Hindu University (BHU), Varanasi; Maulana Azad Medical
College (MAMC), Delhi.
Six- to ten-day courses were conducted for medical college faculty.

K.L. Wig Centre for Medical

Education and Technology
(CMET)
Consortium of Medical
Colleges (CoMC)

These resulted in a large number of innovations and setting up of MEUs in medical

colleges.
K.L. Wig CMET set up at AIIMS, New Delhi in 198990
Support from governments of UK and New Zealand
Teachers sent to the UK

Organised a national conference in November 2007 with Foundation for

Advancement of International Medical Education and Research (FAIMER)

As part of a WHO-SEARO initiative, AIIMS, New Delhi, IMSBHU, JIPMER

Puducherry and CMC Vellore collaborated with the Medical Education department
at the University of Illinois, Chicago.
These institutions formed a consortium with 16 medical colleges.

They prepared a curriculum document with national consensus specifying a list

of essential skills, with must know and good to know categories, and outlining
integrated modules on topics of national health importance.
Consortium of Medical
Institutions for Reform
of Medical Education
(CMIRME)

The consortium activities ended as it stopped receiving support from WHOSEARO.

Formation of medical/health science universities to support medical colleges

and other health-related institutions for quality education, initiating faculty
development courses, promoting research

Six of these, Rajiv Gandhi University of Health Sciences (RGUHS), Karnataka; Dr

MGR University, Tamil Nadu; Manipal University, Karnataka and Maharashtra
University of Health Sciences (MUHS), Nashik, established curriculum
development units.

They conduct faculty development and training-of-trainers (TOT) programmes.

Consortium of Health
Foundation for Advancement of International Medical Education and Research
Science Universities (CHSU) (FAIMER) (2001)
Foundation for
Advancement of
International Medical
Education and Research
(FAIMER) (2001)

FAIMER at Philadelphia is a non-profit organisation of the Educational

Commission for Foreign Medical Graduates (ECFMG), USA.

It supported faculty development through two-year part-time fellowship

programmes for the development of managerial and leadership skills.
FAIMER has formed regional institutes worldwide.

Three regional centres are located in India at Seth GS Medical College, Mumbai,
CMC Ludhiana and PSG, Coimbatore.

There appears to be a lack of commitment at the

central and state government levels towards faculty

development as seen by the meagre and irregular

grants given to the NTTC until 2002 and stopped

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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

altogether since then.(19) The existing system of

recognition of institutions appears to be based solely
on criteria such as infrastructure, number of teachers,
number of students, among others, without specific
measures for quality of educational methods, periodic
review of teachers performance or accountability.

orthotics and prosthetics and other rehabilitationrelated disciplines, and regulating the courses through
professional associations have led to reforms in
the educational process through the formation of
structured syllabi for the respective courses. However,
much still needs to be done for other allied health
sciences courses, which function in the hospital and
diagnostic sectors.

Our research also indicates that under the UGC,

although importance is increasingly being given to
faculty development, the health sector is yet to reap
its benefits.(20) For instance, no grants were earmarked
for the teachers to attend workshops and seminars
in many institutes being reviewed for the situation
analysis study. Similarly, in central, eastern and northeastern India, the insignificant number of faculty
training institutions indicates regional variability in
faculty development efforts.

The education and training of professionals in

well-known institutes are conducted by professionals
in their own disciplines, as well as others whose
expertise may also be necessary for providing complete
care to beneficiaries. Transitioning to institutional- and
university-based arrangements has helped to harness
teaching capacity in developing as well as developed
nations.

i. Transition of courses and development of

teaching capacity

ii. Training models and guidelines for instructors

in various settings

Education in the allied health streams is largely

confined to hospitals and is encouraged in many
policy recommendations such as the Bhore Committee
Report and National Health Policy.(21, 22) Transitioning
of courses from the limited hospital setting to
institutes and universities is a recent development
in the disciplines of allied health sciences and often
regarded as a response to increased demand for these
services and professionals.

There are several mechanisms for faculty development,

such as teacher-training courses, workshops,
conferences and seminars. Peer education, selflearning, learning from the internet and mentorship
have been used for improving knowledge and practices
among teachers.

Checklists were developed by Steinert and Mann

in 2006, based on the cognitive development required
for imparting technical competencies, and these
methods were found to be much more effective than
the traditional see one, do one, teach one approach.

The literature review indicates that in India,

successful initiatives to address the educational gap
in specialties such as audiology, speech pathology,

Figure 6: Levels of training suggested by WHO

The WHO committee in 1965 suggested three levels of training

Educational specialists: Medical
and other health professionals who
have obtained training in education,
or professional educators familiar
with the health profession

Educational leaders: Medical and

other health professionals who
would acquire sufficient knowledge
of educational science to integrate
into programmes of study in
institutions

Source: Faculty development in medical education in India

In most cases, our literature search and interviews

indicate that there is no separate group of teachers
dedicated to teaching allied health sciences. Even in

152

Educational practitioners: Medical

and other health professionals
whose training would be limited
to primarily improving their
competence as classroom teachers
or clinical teachers.

reputed institutions across the country, the subject

is taught by medical specialists and not faculty
specializing in the allied health sciences.

Standardising allied health education

Among those who study allied health sciences, the

general career pattern has been to choose lucrative
clinical career paths over academic routes. As per
conservative estimates, there is acute shortage of
2030 per cent of teachers in medical colleges in
the country.(19) Research indicates that relying on
physicians to teach allied health sciences, given the
shortage of teaching physicians, has diluted teaching
quality in both branches of medicine.

In the absence of well-defined career paths and

physician-centred healthcare delivery, which results in
a lack of recognition of the AHPs contribution, attrition
rates are high and retention of talent is emerging as a
serious concern. The sector does not nurture academic
talent to turn them into future faculty. A comprehensive
plan is therefore needed to train the existing graduate
and postgraduate students in various apex institutes
to enable them to take up teaching positions.

3. Policy issues for consideration

The concept of developing faculty dedicated to training

AHPs is yet to be embedded in the educational system.
Field visits to various allied health colleges imparting
such courses shows that trainers train on the basis of
experience gained on the job. This is largely because of
lack of certified faculty development courses for AHPs
in India.

Several key aspects required for a robust educational

programme are lacking. These include infrastructure
standards,
human
resource
requirements,
qualifications and career path design for professionals,
licensing, continuous skill and competency upgradation
through effective and supervised hands-on training,
links with potential public and private employers,
and modifications to existing policy guidelines on
recruitment and staffing in public health facilities.

Meanwhile, several options exist for training of faculty

in other streams, as listed below:

Continuing professional educational programmes;

Workshops related to teaching strategies, test

construction, evaluation or other issues;

International best practices indicate that an

effective faculty development programme seamlessly
brings together aspects such as mentorship, research
and continuous professional self-development
standards while imparting training. In India,
however, the quality and quantity of faculty is a major
impediment to the capacity building of faculty in allied
health sciences.

Seminars and participation in conferences;

Community participation;

Departmental faculty development programmes;

Short-term courses;

Obtaining additional qualifications in other areas

related to their field such as administration,
leadership, management and professional
relationships;

Budgetary allocations towards each of the issues

listed below, along with flexibility to hire the number
of allied health staff required by each level of the
public health system, would go a long way in spreading

Provision of sponsorship assistance for research;

Provision of ongoing support services;

Mentoring programmes such as those followed in

the USA which include: advice and counsel, review
of course materials, observation of instructions,
assistance in processing evaluation data, bringing
innovative ideas or modifying programmes based
on evidence and data, conducting research-based
evaluation of programmes, their implementation,
and checking.

The literature review and research by NIAHS Secretariat

indicate that the current allied health faculty in India is
largely unprepared to assume the role of professional
academicians. The need for instituting a professional
development programme for prospective faculty in the
allied health sciences will enhance their effectiveness.
The first step in this regard would be to identify those
activities for which there is the greatest need for
faculty development.

iii. Training of trainers

Provision of latest teaching centres and research

offices; and

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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

existing best practices in the allied health services.

Creating common educational platforms for

the various health workers:

Expanding teaching capability and developing

faculty development programmes:

Retaining students and

addressing equity issues:

teachers

and

Promoting the development of policies:

National and institutional policies need to be in place

for PPP and faculty augmentation and development
through promoting the use of non-traditional teachers
from different backgrounds. This will increase the
availability of faculty. Incentives should be instituted
for those persons willing to join the faculty. Other
policy decisions include hiring part-time teachers
from the clinical sector, recruiting teachers from the
diaspora, conducting compulsory teacher training
with in-service learning and continuing education, and
introducing the semester system.

Integration of pre-service and in-service

education and training:

Pre-service curricula should incorporate lifelong

learning, relevant health issues and competencies to
prepare graduates adequately for in-service work.
Lifecycle and modular approaches to learning also
need to be incorporated. Lateral entry courses need
to be initiated at various entry points so that health
workers can join the workforce at different entry
points and thereby have access to career growth.

quality

A study should be undertaken to look into the issues

related to high turnover of teachers and drop-out
among students. These issues need to be adequately
addressed. Gender differences too need to be studied
and addressed.

Qualified teachers need to be in place with adequate

qualifications and experience. There is a need to map
the levels of faculty present, from where additional
faculty can be sourced and where the faculty
development can take place. Based on this information,
a systematic plan needs to be in place for faculty and
its development, not only in technical issues but also
in teaching. Faculty should be adequately reimbursed
and a career path chalked out.

and

A systematic quality assurance programme should

be established, including development of protocols,
standards and benchmarks specific for allied health.

A common educational platform for various health

workers should be created so that resources can be
optimally used and teamwork is promoted.

Continuous
improvement
assurance programme:

Allied health sciences constitute a wide variety

of professionals that complement the clinical team of
doctors and nurses. While standardising curricula and
practice guidelines, the vast differences between each
of these numerous cadres have to be kept in mind, and
guidelines customised for each group using subject
experts in the area.

Developing quality institutions based on the

IIM and IIT models:

It is necessary to provide high-quality education

so that the allied health sciences become popular.
The education provided can be modelled on the
lines of premier institutes such as the IIMs and
IITs. Collaboration needs to be established with
premier national and international institutions and
the corporate sector and their teaching methods,
curriculum and practices incorporated. Twinning
with good institutions will bring in quality and create
opportunities for regular updation of knowledge,
teacher exchange and placement.

It is also important to plan for scaling up

the workforce under each cadre based on the
epidemiological need in the respective regions. Factors
to consider for this purpose are geographical and
other access issues related to the population, duration
taken to upgrade the existing staff to the requisite
levels of competency, and the private sector hospitals
and outpatient centres that would also require these
services.
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Standardising allied health education

4. Recommendations
The recommendations for change in various elements
of the educational framework of the allied health
system have been formulated by NIAHS Secretariat,
and approved by the health ministry at the conclusion
of the National Initiative for Allied Health Sciences
project.

other objectives, and channel its personnel and

other resources towards optimum realisation of the
objectives. Thus, we recommend the following vision,
mission and values for NIAHS.
a) Vision statement of NIAHS
To be the centre of excellence for teaching, training and
research in allied health education and ensuring high
standards of education to facilitate human resource
development in allied health sciences to support
healthcare delivery in the country.

It may be noted that the recommendations are

made for initial implementation of future courses. Any
change that is not implemented may be integrated in
due course.

b) Mission of NIAHS
The mission statements of NIAHS aim at translating
the vision into action through:

Recommendation 1

NIAHS should be an autonomous institute fully

funded by the Centre through a combination of
grants-in-aid and fees, and should serve as the
apex centre of excellence within the nation for
allied health services. We also recommend that the
institute be fashioned along the lines of national
institutes of excellence such as the Indian Institutes
of Management (IIMs) / Indian Institutes of
Technology (IITs) to ensure effective governance
and management.

i. Creating a stimulating academic environment

with excellent learning facilities

ii. Setting up standards for education, which include

curricula, development of faculty, and appropriate
technology with an inbuilt dynamic process
iii. Accreditation and regulation of programmes and
institutions

The RIAHS should also follow an identical structure

at the regional level. It should be an autonomous
institute fully funded by the Centre and hosted in the
state premises, providing regional leadership to all
the surrounding states.

iv. Research and development

v. Acting as the think tank, catalyst andinnovator for

allied health sciences

vi. To become part of policy formulation and bean

advisory institution for allied health sciences

NIAHS should function as an apex technical institute

for allied health sciences, funded by the MoHFW for
the promotion of allied health sciences in the country
through education, training, research, evaluation,

vii. Collaborating with institutions in India and abroad

to enhance allied health education and promote
institution building for quality, improvement and
sustenance

consultancy and specialised services. A well thoughtout management structure may be put in place to
provide an overarching umbrella for the rapidly
growing private sector hospitals, public sector facilities
and technological advances. These require a relook
at human resources, changes in the organisational
structures, infrastructure and equipment.

viii.
Creating
opportunities
employment.
c) Values at NIAHS
i.

Service to humanity

ii. Excellence
iii. Equity

Every college needs to formulate its vision,

mission and goals in terms of academic, social and

iv. Convergence
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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

e) Composition of the governing body of RIAHS

The recommended composition of the governing body
of RIAHS is as follows:

v. Confluence
vi. Integrity

vii. Transparency

i. The Chairman shall be a person of eminence,

integrity and outstanding calibrewith a post
graduate degree in the discipline of health, health
policy, public health, management, technology,
law or finance from a recognised university
or institution with 20 years of experience in
the respective field (not an ex-officio member
but a full-time chairman), preferably having
demonstrated leadership in healthcare for that
specific region.

viii. Interdisciplinary team spirit

ix. Passion

x. Community orientation

xi. Catering to the dynamic needs of the industry

d) Composition of the governing body of NIAHS

The governing body would be responsible for all
decisions relating to the internal management of the
institute, management of finances and appointment
of the principal/dean and the teaching staff. The
recommended composition of the governing body is as
follows:

ii. State Secretaries, Health and Medical Education

iii. State Directors of Health and Medical Education

iv. Principal/dean of primary attached medical

college

i. The Chairman shall be a person of eminence,

integrity and outstanding calibre with
apostgraduate degree in the discipline of health,
health policy, public health, management,
technology, law or finance from a recognised
university or institution with 20 years of
experience in the respective field (not an ex-officio
member but a full-time chairman)

v. Administrative representatives of all states of the

region

vi. Representative from NIAHS to ensure coordination

and communication between NIAHS and RIAHS
vii. Faculty of specialised departments of affiliated/
satellite colleges

ii. President, NBE

viii.
Representatives from the corporate sector/
private hospitals/private institutions

iii. Director, AIIMS

iv. Director, School of Paramedical Sciences, IGNOU

ix. Additional nominated members by the governing

board of RIAHS

v. Director, IAMR

x. Civil society
A suggested organogram for NIAHS and RIAHS is given
in Figure 7.

vi. Representatives from the MoHFW and Directorate

General of Health Services (DGHS)

vii. Representatives from the Government of the NCR

of Delhi
viii. Representatives from the private sector

ix. Representative from the National Board of Allied

Health Sciences (NBAHS)

x. Representative heads from nominated affiliated

institutions

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Standardising allied health education

Figure 7: Illustrative organogram of NIAHS and RIAHS

f) Administrative committees under NIAHS and

RIAHS
Appropriate organisational structures within the
colleges are crucial for effective management. The
simplest way to focus on a wide variety of activities will

be to group the activities and functions expected to be

performed on the college campus. Thus, the following
administrative committees are recommended to
ensure seamless operations at the national and
regional institutes (Figure 8).

Figure 8: Administrative committees

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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

i. Planning and
Committee

Operations

Management

Several long-term financial sustainability mechanisms

have been suggested below; however, it is highly
unlikely, given the academic nature of these institutions,
that they will beable to operate with positive margins.
Thus, after bearing the initial set-up costs, the Centre
should at least fund the differential operating costs to
help the institutions to break even.

Planning and visioning for accurate assessment of

demand and future projections of demands on a
continuing basis
Faculty availability status and planning
for augmenting capacity for future faculty
development and production.

a) Financial management for assuring long-term

sustainability of NIAHS and RIAHS
Financial management of NIAHS and RIAHS will
require meticulous planning and implementation
under the following heads:

ii. Education and Training Committee

Developing curriculumframeworks and teaching/

learning material and providing resource support
to educators

i.

Developing, promoting and imparting faculty

development programmes for conducting inservice training programmes

ii. Fund generation from different resources

iii. Forwarding of proposals forfund requirements

with approximate cost of different needs to NBAHS

Assessment of competency levels, development of

question banks, continuous and comprehensive
evaluation, and exit tests

iv. Approval of proposals from different training

institutes across the country. Compiling and
projecting the budget requirement of NIAHS and
RIAHSs to the MoHFW budget allocation by NBAHS
after approval of vote of accounts by Parliament
under the Capital Head and Revenue Head

Conducting
programmes
for
preparation
of software and use of information and
communication technology (ICT) for quality
assurance and for teaching/learning

Starting allied health courses, especially

postgraduate and newer courses such as cardiac
perfusion technology, dialysis technology, cardiac
care technology, etc.

v. Fund utilisation as per standard policies and

procedures, financial regulations of central/state
government
vi. Forwarding of progress of expenditure as per
schedule issued by NBAHS (expenditure by each
quarter every financial year)

iii. Practice
and
Affiliation
Management
Committee

Planning, monitoring, evaluation and research on

allied health education and service

vii. Preparation of balance sheet, profit and loss

statement and financial audit by the chartered
accountant. Funds can be generated from tuition
fees, grant from the government, research grants,
technical assistance to other institutes, sharing
of faculty and providing services, projects for
implementation, etc.
For NIAHS and RIAHS, it is recommended that the
central government provide funds for capital and
recurring expenditure on an ongoing basis. Most states
do not incorporate new institutions and personnel in
their budgets; hence, the centre should support these

Adherence to standards for certification of skills

and competency levels as approved by the board

Maintenance of live registers for regular updates

on the demandsupply situation to the board.

Recommendation 2

Considering that health is a state subject, to ensure

acceptability and successful integration of the new
national and regional centres for allied health, it is
proposed that both the NIAHS and RIAHS be fully
funded by the Centre on an ongoing basis.

Needs analysis of funds for NIAHS and RIAHS

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Standardising allied health education

ii. Management and operations:

Management and operation of healthcare facilities for
technical efficiency, operational economy and quality

institutes. Grants-in-aid for regular courses should be

calculated on the basis of regular intake.
NIAHS and RIAHS should work on improving their
resources through tuition fees, services offered, funded
projects and others. Funds will be spent or allocated as
per the following heads:

iii. Capacity building and training:

Capacity building for formal, informal and continuing
education of professional, paraprofessional and
ancillary staff engaged in the delivery of healthcare

Academic
Services

iv. Financing mechanism:

Creation of voluntary as well as mandated third-party
financing mechanisms

Research

Institutes should adopt a policy of rational fixation of

fees for basic and in-service courses so as to recover
5060 percent of the costs incurred. This could be
achieved by the following options:

v. IT infrastructure:
Establishment of national and regional IT backbones
and health data repositories for ready access to clinical
information

Running open courses (government and private

sector) such as in the case of Sikkim Manipal
University and IGNOU

vi. Materials management:

Development of a maintenance and supply chain
for ready availability of serviceable equipment and
appliances, and medical supplies and sundries at the
point of care.

Accepting international participants from South

Asian Association for Regional Cooperation
(SAARC)/South-East Asian countries
Sale of learning resources

Bidding for research projects

In the reverse outsourcing model, foreign

educational institutions can set up campuses in India
and deliver lectures to students in India remotely.
The public funding pattern could be norm-based under
three broad categories:

Recovering a fixed portion through fees from:

Resident students at nominal rates

Non-resident students who may be charged

a fee based on international/private /market
rate, which will provide cross-subsidisation.

i.

b) Publicprivate partnership
The observations from the study conducted by
KPMG and CII indicate six major thrust areas where
a PPP could be evolved. This synergistic model
would combine both the social objective of universal
healthcare access and the business objective of running
a profitable healthcare facility.

Mandatory norms for minimum substantive grants

to all universities;

ii. Provision of maintenance grants to all universities

based on transparent and objective criteria; and
iii. Performance-linked incentive grants based on
assessable outcomes.
Generation of funds: funds can be derived from
many sources; however, the Central authorities must
ensure availability of funds in the initial phases of
establishment. Fee sharing, affiliation and funds
generated through affiliation are some of the sources.

The six areas where private sector contribution

can prove very beneficial are as follows:

i. Infrastructure development:
Development and strengthening of healthcare
infrastructure that is evenly distributed geographically
and at all levels of care
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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

iii. Development of teamwork: In an affiliated

institution, students learn how to work in teams.

Recommendation 3
A 100-bedded hospital has been recommended
(as per the Cabinet note) in Najafgarh which shall
eventually serve as a practice site for the graduating
students of NIAHS, in addition to serving the needs
of this populous West Delhi community.

iv. A medical college hospital has a huge load

of patients with all types of problems. This
is conducive to learning through exposure,
demonstration and hands-on experience, which
is not possible in places where the patient load is
less.

NIAHS is to be located at Najafgarh with an attachment

to a 100-bedded hospital. This hospital will be
equivalent to an upgraded community health centre
(CHC) or a sub-district hospital. There will be no super
specialties in this hospital. Since the mandate of NIAHS
is to conduct postgraduate and special courses, it is
essential that a multispecialty hospital be linked to
provide training. It has been identified that the hospital
currently functional at Najafgarh is a 30-bedded
hospital, which will take time to be upgraded to a
100-bedded facility with high-end diagnostics and
treatment facilities such as an intensive care unit, neonatal intensive care unit, etc.

v. The opportunity of learning from working in very

basic set-ups to sophisticated set-ups is possible
only at a medical college.
vi. An affiliation with a medical college promotes
updation of knowledge and skills through regular
seminars and the culture of continuing medical
education (CME).

vii. Peer group learning is possible among the allied

health group, their seniors and from nursing and
medical students.
viii. A larger number of students can be admitted per
course in a medical college-affiliated set-up.

The recommended details pertaining to the

100-bedded hospital structure are given in
Appendix-7.

ix. A defined career path can be actualised in a

medical college set-up, as initiating a large number
of new courses and starting degree, postgraduate
diploma and degree courses, and doctorate
programme is possible, along with faculty to teach
in these institutions.

Advantages of affiliation to a medical college and

teaching hospital
There are many advantages in having an allied health
institution attached/affiliated to a medical college and
a teaching hospital rather than having a stand-alone
institution.
i.

x. In an affiliated set-up, it is possible to have a

variety of options for the same course, e.g. evening
classes, weekend classes and intensive contact
sessions, as medical college hospitals work round
the clock. This ensures the availability of patients,
hands-on experience and mentoring.

Sharing of resources:
Sharing faculty in the subjects of Anatomy,
Physiology, Biochemistry, Pathology, Microbiology,
Pharmacology, Forensic Medicine and Community
Medicine, in which there are usually huge
shortages

Sharing of laboratory equipment, especially

sophisticated equipment, simulation laboratories,
models, classrooms, audio-visual aids.

ii. Since a large number of allied health services are

normally present in a medical college hospital, the
personnel there automatically become faculty in
that allied health specialty.

160

xi. Financial aspects: sustaining a stand-alone

allied health institution is difficult, as the costs
of running the institution are very high. The fees
collected from students are insufficient. Allied
health institutions can be sustained through
medical college hospital budgets for medical and
nursing education.
The situational review showed that universities/
institutions which have a functional organisation and

Standardising allied health education

director of the education and training committee,

under which sub-committees may be formed for each
specialty course.

share infrastructure with medical colleges have the

best curricula and learning culture.
Recommendation 4

The functions of each of the sub-committees shall

include framing the syllabi for various courses,
reviewing and updating curricula periodically,
determining the details for continuous assessment,
recommending panels of examiners, and evaluating
and recommending methods of teaching. The
composition and functions of the sub-committees can
be summarised as follows.

It is recommended that expert committees for

individual subjects be constituted to revise
curricula. Expert committees should be constituted
to revisit each subject and make modifications to
the syllabus based on criteria such as:

Skills and competency focus

Bedside manner, patient communication and

other soft skills

Composition

Application of current technical knowledge

and technological advancements

i. Head of the department from NIAHS/ RIAHS

(Chairman)*

Employability in both the public and private

sectors

ii. Selected faculty from each discipline to be

nominated from NIAHS and each RIAHS

Ability to choose either a practice, academic or

management track in the field

iii. External experts in the subject from premier

institutes such as AIIMS to be nominated by the
Director, NIAHS

Adhering to national and international best

practices

iv. One technical representative from end-users such

as industry/corporate sector/allied area

Standard teaching techniques have established that

academic and professional excellence of the faculty
is a critical component of the learning conditions for
students to achieve educational and professional goals.
The faculty needs to be looked at as crucial mediating
agents through whom learning is transacted.

v. Expert from affiliated institutions where these

courses are conducted.
*If there is more than one institute running the same
courses, a rotation policy of three years can be used
for nominating the chairman and members. Not more
than 13 members are proposed for each committee
per sub-group.

NIAHS should conduct research that documents

practices reflectively and analytically on the quality
and effectiveness of the present curricula. The first
step towards this is to establish an expert committee
of academicians which will review the curricula as
well as propose national curricula for various courses
on the basis of set criteria. In addition, frequent and
periodic review of course curricula for each existing
and emerging course should be undertaken by NIAHS
and RIAHS to ensure relevance and a competitive edge
in the market for allied health graduates.

Term
The term of the nominated members can be of three
(3)
years.

Meeting
Meetings may be scheduled as and when necessary,
but should be held at least once a year. Group e-mail
communication is proposed between meetings to
discuss issues.

a) Establishment of an education and training

committee at NIAHS
It is recommended that NIAHS establish an education
and training committee to be overseen by the assistant

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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Functions
The committees shall:
i.

ii. To measure the impact of pedagogical practices on

student outcomes;
iii. To design and study learning environments that use
innovative technological tools and accommodate
individual differences among students;

Identify the core competency for each job function

and prepare syllabi and content for various
courses, keeping in view the course objectives
and national requirement, for consideration and
approval of the Director, NIAHS;

iv. To identify effective intervention strategies that

improve classroom teaching and learning; and

ii. Suggest methodologies for innovative teaching

and evaluation techniques;

v. To identify and explore alternate models of

learning in the field of allied health sciences to
meet the current challenges of education.
This can be undertaken by:

iii. Suggest a panel of names for the appointment of

examiners; and

iv. Coordinate research, teaching, extension and

other academic activities in the various RIAHS/
affiliated institutes/satellite centres.

Research on educational methods

The main goals of research on educational methods
should be:
i.

Self-assessment through pre- and post-test

questionnaires at the end of each module;
Exit interviews at the end of the final examination;
and

Online surveys of ex-students or professionals in

the allied health fields.

The organogram in Figure 9 depicts the functioning

cells under the Education and Training Committee
headed by an Assistant Director.

To describe and document patterns of classroom

educational methods;

Figure 9: Organogram of the Education and Training Committee

The situation analysis indicates that there is a need to

create a new curricula framework in consonance with
the changes that have taken place in different spheres
of knowledge and practices in the field of allied health

sciences worldwide. Moreover, there is an urgent need

to develop curricula that focus on the competencies of
professionals rather than mere book learning.
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Standardising allied health education

b) A competency-based approach to curriculum

re-designing
A quality education includes assessing the student
not only on knowledge but on the competencies the
student has acquired. Hence, focus should be placed on
competence-based learning in which, till the student
is not competent on one skill, he/she cannot progress
to the next level. There is, therefore, an urgent need
to develop competencies not only for knowledge and
technical skills but also in IT and soft skills like bedside
etiquette, conflict resolution, communication, etc.

Councils (SSCs) which are, in turn, defining standards

for accreditation. The prerequisites for setting up
these standards include a clearly defined standard of
performance for each set of personnel and avoiding
underestimation of the kind of jobs/functions that
even the lowest rung of personnel need to do.

NOS can best be defined by the employers

themselves, hence these need to be developed by
involving not only experts but also employers, including
those in the corporate sector. Occupational analysis
should be carried out to develop the NOS. After that,
a review of the existing definitions is necessary, then
identifying gaps and further defining the remaining
occupations. The next step would be to define core
skills which could be cross-sectoral, and then moving
on to define skills specific to that sector.
As a part of occupational analysis, mapping is an
essential step that helps to decide priorities. The first
step is to conduct a needs assessment to identify where
the need is critical or where the need has already been
addressed and requires improvement. The second
step is to identify the gap in the skill requirement.
Each NOS would have a unique reference number
(based on the sector, sub-sector and NOS number), an
NOS title (referring to the exact occupation), overview,
knowledge and understanding, and performance
criteria.

Competencies should be part of the performance

procedures for selection of personnel. The basic
essential elements consist of functional analysis of
the occupational roles, translation of these roles
(competencies) into outcomes, and assessment of
trainees progress in these outcomes on the basis of
demonstrated performance. Progress is defined solely
by the competencies achieved and not the underlying
processes or time served in formal educational
settings.
Competencies should be developed through the
joint involvement of subject and technical experts,
industry and professional associations, along with
the National Skills Development Corporation (NSDC),
asit is in the process of setting National Occupational
Standards (NOS). The NSDC is setting up Sector Skill
c) Admission policy

Figure 10: Recommended admission policy at national and regional levels

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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

RIAHS will communicate the result of the regional

examination and admission intake information by
specialty to NIAHS.

especially in the corporate sector, and are being used

for CMEs in the US. Webinar as a learning technology
will offer a platform to overcome the educational
divide in allied health education and will help students
get acquainted with the latest developments. Webinar
has an edge in terms of its greater reach to audiences
and ability to overcome geographical boundaries, and
hence can be of tremendous use in rural and suburban
set-ups.

NIAHS will conduct entrance examinations only

for postgraduate courses in allied health through
a common entrance test at the national level. This
will help NIAHS to update the live register as well as
continuously manage the demandsupply gap. The
nodal regional institute will be responsible for the
overall seat matrix for all institutions in theregion.
Priority for allocation of seats by specialty should be
reviewed on an ongoing basis to address and adjust
the dynamic demandsupply equation in both the
private and public sectors. In addition, changing
epidemiological profiles and disease dynamics in each
region should also be considered while planning a
specialty-based seat matrix.

It is recommended that degree programmes and

individual courses be offered in the evenings. NIAHS
can start weekend courses with the aim of helping
working professionals and students who do not have
the time to undertake regular training courses on
working days.
It is recommended that internships be compulsory
for all the courses, especially diploma and graduate
courses. The duration of the internship needs to be
standardised and the practice of paying stipends be
followed to encourage and motivate students.

Recommendation 5

It is proposed that the current teaching and

training methodologies be reviewed for relevance,
applicability, scalability, practicality and ability
to translate didactic knowledge into skills and
competencies for the students. It is therefore
essential to adopt modern methods of teaching and
training, including cutting-edge technologies such as
simulation-based training in a team-based learning
approach for effective skill building.

Conducting regular in-service training

A major pre-requisite for providing quality

healthcare services is to upgrade the skills and
knowledge of all health personnel. It is recommended
that NIAHS develop a national training strategy
detailing various pre- and in-service and refresher
training courses and their frequency for the allied
health force in the country.

It is recommended that traditional learning methods

be complemented with newer techniques to impart
education. Use of demonstrative methods such as the
mass media, simulation laboratories and webinars will
not only increase student interest but also reinforce
memory retention, as they provide connections
between facts and real-world applications of those
facts.
Concerted efforts need to be made so that
institutions provide excellent and uniform training.
Methods like e-learning offer tremendous freedom
and flexibility and are, thus, are ideally suited to a
wide range of health-related careers. Massage therapy,
nursing and hospital administration, for example, are
all popular programmes within the distance education
sphere. Webinars are becoming increasingly popular,

Recommendation 6:

It is proposed to introduce an integrated 3-year

BSc course in Allied Health Sciences.

164

It is proposed to introduce the integrated 3-year BSC

in Allied Health Sciences, which consists of a common
course for first-year students called the Bachelor in
Para Medical Training (BPMT). In the second and
third years, the students study the subjects they were
enrolled for. The Sri Ramachandra University and
Maharashtra University of Health Sciences model
may be used. In the first year, the common courses
are Anatomy, Physiology, Biochemistry, Microbiology,
Pathology, Forensic medicine, Pharmacology, Medical

Standardising allied health education

The goals of such a simulation centre would be:

& Surgical Nursing, Preventive and Social medicine,

and basics of IT. The teaching hours and practical
sessions will be standardised accordingly. These
students could be recruited as general duty assistants
(GDAs) through the creation and promotion of such a
cadre in the public system.

i.

To increase the safety, efficacy and effectiveness of

patient care through innovative, interdisciplinary
training;

ii. To allow for learning in a safe, non-threatening

and controlled environment;

As early as 1998, Hamdard University took the

lead in conducting specialised courses for AHPs
by starting postgraduate courses inphysiotherapy
and occupational therapy. At present, Max hospital,
Symbiosis and SRU are among the colleges offering
three-year BSc courses in allied health sciences.

iii. To teach basic and advanced practical skills in

patient management;
iv. To build confidence and enhance the performance
of clinicians;

v. To increase exposure to critical, yet low-frequency,

patient encounters in order to minimise the risk to
patients;

Another model of specialised training is to have

a common course for first-year students such as the
BPMT started by MUHS. The students go on specialise
in chosen areas in the second and third years of study.

vi. To increase effective communication among all

members of the healthcare team;

Nineteen Bachelor courses have come under this

ambit:
Laboratory technician, radiographic technician,
radiotherapy technician, cardiology technician,
neurology technician, blood transfusion technician,
optometry technician, plaster technician, anaesthesia
technician,
perfusionist,
operation
theatre
technician, medical transcriptionist, cyto-technician,
histopathology technician, transfusion medicine
technician, clinical psychologist, community medicine/
health inspector/emergency medical services and
forensic medicine.

vii. To develop simulation as a tool for the assessment

of clinical skills;
viii. To use focused, methodologically sound research
to measure the impact of simulation activities on
learning and, ultimately, clinical practice;
ix. To significantly enhance quality improvement
initiatives using simulation activities;

x. To provide hands-on experience for the

implementation
of
best
practices
and
consolidatethe
process
of
continuous
measurement and improvement; and

According to the data available with MUHS, the total

teaching hours in the first year are 690 hours of theory
and practicals, including 64 hours of educational visits
over 240 days.

xi. To provide opportunities for remote learning and

distance education through state-of-the-art IT
tools.
The goal of delivering high-quality training and
education to the healthcare workforce across rural
and urban areas in an efficient manner can be realised
by an integrated approach to using technology for
medical education and skills training for physicians,
nurses, allied health professionals and those in other
disciplines of healthcare. There are four focus areas
of advanced medical education and learning where
technology can play an important role and address
gaps in the training capacity.

Recommendation 7

It is proposed that NIAHS house and promote

the concept of simulation-based training by
establishing a world-class simulation centre called
the Centre for Advanced Medical Education and
Learning (CAMEL) and a fleet of mobile simulation
units called CAMEL CARAVAN to offer high-fidelity
skills training for healthcare professionals.

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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

The first focus area lies in delivering practical

training and skills assessment to the healthcare
workforce. Skills such as IV insertion, suturing wounds,
central venous catheter placement, cardiac stent
placement, endoscopy, advanced cardiac life support,
basic life support, taking the blood pressure and ECG
monitoring, to name a few, are the basis of modernday medical practice. Practising these skills require a
considerable amount of time and resources. Many of
these skills are actually team skills that require the
healthcare workforce to function efficiently as a team.
Traditionally, these skills are practised on patients,
which is an extremely unsafe and inefficient method
of acquiring such skills. Fortunately, technology has
been developed which allows for practising such skills
repeatedly in a safe environment. Technology is also
available for providing skills training on rare skills
and treatments that enable the healthcare workforce
to be prepared for any eventuality, including disaster
management.

it is now possible to deliver didactic content and

training, and conduct examinations remotely. The
National Knowledge Network (http://www.nkn.in/)
is an example of such efforts in leveraging ICT for
education. In a similar vein, we can deliver medical
education and training remotely. There are, however,
two additional opportunities that lie in further
strengthening the mission of remote education
and monitoring. The first lies in developing remote
practice environments such as the skills training
systems described above, so practical skills in addition
to didactic material can be taught remotely. This is
again possible with the technology of motion tracking,
motion-based computing and virtual reality. The
second lies in using technology environments to create
personalised training modules that are consistent with
the practices of a region and its requirements. This can
again be done through personalised content delivery
and by employing mobile units that deliver training
through mobile systems.

There are also provisions in technology for

quantitative evaluation of skills. These allow for the
development of benchmarks in examination and
competency-based training. This is critical in ensuring
high-quality healthcare to the masses. Such technology,
centred on the core idea of medical simulation, has
matured rapidly in the past few decades and has
been shown to result in a marked improvement
in clinical skills and quality of care. (2, 23-40) Medical
simulation refers to a suite of technologies available
for healthcare professionals to practise skills in a
variety of disciplines, both individually and as a team.
It is imperative to develop a coordinated approach to
including simulation-based training in the medical
education and training infrastructure in India.

The third focus area lies in delivering best

practices in design, implementation and training.
Best practices imbibed through guidelines, procedure
checklists and decision-making algorithms have
become the cornerstone of the quality drive in the
medical profession.(41) Training for best practices
and implementing and designing best practices are,
however, not trivial. Simple didactic training for best
practices is not enough and there is a need for a safe
environment to practise implementation of best
practices and adapting best practices to a particular
socio-technical system. There is also a need for a safe
environment to design best practices. System wide
best practices and procedures can be designed and
tested in a simulation environment and such efforts
have been shown to have a highly positive impact in
improving clinical practice, which is more significant
than simple didactic training.(42) This is a golden
opportunity for creating a culture of quality and safety
in a systemwide manner.

The second focus area lies in employing

technology for remote education and monitoring.
A key element of training the healthcare workforce
is to contextualise training to the socio-technical
condition of the environment. Traditionally, this has
been hard as such efforts require establishment of
local infrastructure and support systems, which is
expensive. With the development of the ICT backbone,

166

The fourth focus area lies in practical training to

ensure the optimal use of equipment and resources
for quality healthcare. An important part of training
is in using medical equipment, drug administration

Standardising allied health education

examiners. Teachers should be encouraged to attend

faculty development programmes by offering leave
of absence, travel grants or such other facilities to
attend workshops and conferences. There should
be continuous dialogue with the central and state
governments, health sciences universities, MCI and
NBE, and support should be provided so that they
play a proactive role, identify active medical units and
support them in developing faculty. Faculty in-service
and induction training programmes should also be
developed.

protocols and making optimal use of existing resources.

Traditional training only serves as an orientation
but does not allow for advanced usage. There are
many features of equipment such as ECG monitors
that are not used efficiently due to lack of training.
Simulation environments allow interfacing of medical
simulators with equipment and provide the capability
for designing training scenarios where equipment and
resource usage can be taught.
Additional details of CAMEL are provided in
Appendix-8.

b. Revival of the various initiatives operationalised

earlier for faculty development
The National Teachers Training Colleges (NTTCs),
Medical Education Units (MEUs), Consortium of
Medical Institutions for Reform in Medical Education
(CMIRME), the Foundation for Advancement of
International Medical Education and Research
(FAIMER) Initiative, and the culture of providing
fellowships and travel grants should be revived with
support from the MoHFW and international agencies,
along with the establishment of many more centres of
excellence for faculty training.

Recommendation 8
It is proposed that a robust and on-going faculty
training and development programme be instituted
as part of the culture and framework of NIAHS and
RIAHS.

Our experts were of the view that this investment by

the MoHFW would be one of the most crucial drivers
in changing the paradigm of allied and medical health
education in the country and contribute immensely to
augmenting the allied health workforce.
The establishment of NIAHS and RIAHS and
expansion of training institutions for allied health
specifically indicate the need for comprehensive
teacher guidelines and facilitation guides for the
faculty in the regional institutes, especially for those
disciplines where the institutes have not formalised
protocols for training of their faculty. There is a need
to attract students in universities and institutions to
take up teaching as a career. In fact, as part of cadre
reforms, our experts have suggested three distinct
tracks for AHPs academics, clinical practitioners and
managers.

There is a need to strengthen the curriculum

development units at Rajiv Gandhi University of Health
Sciences, Karnataka, Bangalore; Dr M.G.R. Medical
University, Chennai, Tamil Nadu; and Maharashtra
University of Health Sciences, Nashik. In the other
health universities, departments of medical education
and technology need to be established.

The faculty development programmes to develop

teaching capacity in medical/health education
look beyond clinical competence and scientific
research skills and look forward at professional skills
development for teaching among the faculty.

a. Support for faculty development

Periodic teacher training courses should be organised,
which should form an essential requirement for
career development, promotion and empanelment as
167

c. Teachers training curriculum

The teachers training curriculum should be designed
keeping in mind the changing scenario and multiple
roles of teachers,apart from teaching. As far as possible,
faculty development should be integrated with the
educational programmes themselves. Separate sets
of activities are also required. Incorporation of skills
and competencies of diverse learning styles in teacher
training programmes should include adult learning
principles, student autonomy and self-learning,
experiential and reflective learning, and computerassisted learning, including the use of computers, the
internet, distance learning, e-learning as well as skills-

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

coordinated development of the teacher education

system throughout the country, regulation and proper
maintenance of norms and standards in the teacher
education system, and for matters connected with
these.

learning laboratories models, simulation laboratories

and wet laboratories.

d. Teachers training course content

Instructional
improvement,
organisational
development, development of professional academic
skills and teaching of specific disciplines should be
part of the course content. Other important issues to
be incorporated are ethics, management of services,
computer and IT skills, use of skill laboratories
including simulation laboratories.

g.
Developing
an
allied
health
faculty
development resource centre
The resource centre should develop a database of
persons who can become faculty and evolve strategies
for attracting younger professionals and support
various institutions in this process. A website and
a blog for the AHS faculty should be developed for
healthy discussions, sharing and learning.

e. Developing and using new assessment

methods and tools
Several new methods and tools are now available, the
use of which requires special training. Some of these
are given below:

h. Formulating strategies and supporting

institutions in developing incentives for faculty
Recognition and encouragement are important factors
in motivation.

Objective Structured Clinical Examination(OSCE),

Objective Structured Clinical Examination
(OSPE), Objective Structured Long Examination
Record(OSLER)

Mini Case Evaluation Exercise(CEX)

Case-based discussion(CbD)

Direct observation of procedures(DOPs)

Portfolio

Multi-source feedback

Patient satisfaction questionnaire

The focus of student assessment has shifted to the

use of multiple methods for testing a wide gamut of
learning outcomes, such as higher cognitive abilities,
communication skills, IT skills and professionalism,
including ethical behaviour.

Many of the methods lay emphasis on

frequent assessment of learning outcomes through
predetermined, agreed assessment criteria, using
observation check-lists or rating scales for scoring. It is
therefore essential for teachers be aware of these new
developments and suitably adopt them in the allied
health education system.
f. Developing norms and standards for faculty
Norms and standards for faculty at all levels should
be developed with the involvement of the NCTE. The
main objective of the NCTE is to achieve planned and

Teachers who have introduced innovations or

contributed to improvement in medical education
should be duly recognised and rewarded. There
should be a mechanism for periodic review of the
performance of teachers. Teachers should become
accountable.
Develop the concept of faculty governance where
all members of the faculty play an important
role in administering the diverse academic and
non-academic activities of the institute. The
empowerment of the faculty will become the
propelling force behind the high quality of learning
experience at various institutions.

Foster close connections with industry in India

and abroad through:

Consulting and customised training with

organisations

Participation of alumni in institute activities

168

Placements with corporate hospitals around

the world
Sponsorship of industry in research activities
Professorial chairs in the institute and others

Conducting the management development

programmes for corporate hospitals.

Standardising allied health education

based on our situation analysis.

Paid summer internships should be made

available in well-known corporate hospitals in
India and abroad for junior faculty to gain firsthand corporate experience.

a) NIAHS should be an autonomous institute, fully

funded by the Centre on an ongoing basis through
a combination of grants-in-aid and fees, to ensure
long-term financial sustainability.

Faculty exchange programmes can be held with a

large number of institutions in India and abroad.

b) Formulate subject expert committees to review

the curricula of 10 proposed specialty areas, based
on specific criteria and propose national curricula
to be followed across the country in various
institutions of allied health. In addition, conduct
frequent and periodic review of course curricula
for each existing and emerging course to ensure
relevance and a competitive edge in the market for
allied health graduates.

i. In addition, the following principles/tactical

approaches should be considered in faculty
development:

Initiate training programmes for lateral entry to

promote enhancement of qualifications to become
faculty;

Develop a database of persons who can become

faculty;
Tie-up with institutions conducting faculty
development training programmes so that the
faculty is trained in various styles of teaching;

c) Adopt modern methods of teaching and training,

including cutting-edge technology for effective
skills building.

Initiate CMEs and participation in seminars and

conferences for updation of knowledge;

d) NIAHS willhouse and promote the concept of

simulation-based training to offer high-fidelity
skills training for healthcare professionals.

Tie-ups with institutions such as CMC and other

national institutes of excellence for faculty to be
posted to gain hands-on experience in teaching,
methodology of mentoring, assessments and
review meetings;

e) Institute robust and ongoing faculty training and

development programmes as part of the culture
and framework of NIAHS and RIAHS.

Develop checklists, self-assessment tools, student

feedback formats and standard operating
procedures (SOPs);

f) Courses willbe conducted by specialty at both

the national and regional institutes in a phased
manner, keeping in mind the demandsupply gap
by region and by epidemiological need.

Institute review meetings for improvement in the

quality of teaching;

The expansion of technology for practice increasesthe

content that healthcare programmes, such as
allied health courses, must cover. Advancement in
educational technologies provides opportunities for
new approaches in education delivery, including a
shift to student-centred, active learning based on
competencies and skills enhancement. The various
suggested methodologies and techniques to be used
by educators within several allied health programmes
will ensure active learning and encourage students to
deliver quality care. The MoHFW, thus, should consider
how to best incorporate these active strategies into the
allied health education system.

Develop a work culture of quality so that this

is passed down to students who will actually
benefit through getting placements in premier
institutions; and
Evolve strategies for attracting younger
professionals and support various institutions in
this process.

5. Conclusion

The following summary describes in brief the

recommendations for the various components of the
education system under the ambit of NIAHS and RIAHS
169

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

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172

Process of consultations
Terms of reference for the project

The Public Health Foundation of India (PHFI) was

awarded a project for undertaking a situational
analysis for the National Initiative on Allied Health
Services (NIAHS) Augmenting Paramedical Services
on 28 March 2011; vide appropriate notification from
the Ministry of Health and Family Welfare, Government
of India.

i.

Desk review of the paramedical training landscape,

including situational analysis, methodology of
teaching, inputs and regulatory framework for the
paramedical disciplines;

ii. Content development, including training of trainer

(ToT) protocols, facilitation guides for faculty, and
resource references and instructional kits for the
NIAHS;

This national initiative undertaken by the Ministry of

Health and Family Welfare, Government of India, is an
historical opportunity to improve the health system
landscape of India. The countrys health systems
cannot be strengthened without the availability of
human resources for health (HRH). Since allied health
professionals (AHPs) perform an essential service role
in any health care delivery system,(1) they are needed
for increased access to and better quality of healthcare
services.

iii. Overall recommendations, including a framework

to augment the availability of paramedical
personnel, methodology of teaching, inputs,
protocols for certification, regulatory framework
and national standards, as well as benchmarking
for accreditation;

iv. Recommendations for the National Institute of

Paramedical Sciences (NIPS) and the Regional
Institute of Paramedical Sciences (RIPS),
including vision and mission statements, model
for operations, implementation plan, relationship
matrix outlining the roles of stakeholders, HR
positioning, management arrangements, financial
protocols and budget, protocols for a pedagogical
renewal process, scope of alternate models of
learning, framework for long-term sustainability,
creation and updating of training content and
modules, conducting regular in-service training
and training on cutting-edge technologies.

In early April, a dedicated project secretariat was

established at the Health Systems Support Unit of PHFI.
By the end of May 2011, a large amount of knowledge
had been accumulated. Diverse sources were visited
and sifted to create a large bank of information on
the concepts relating to allied health providers, their
education, training, career planning and regulation.
Diverse interest groups were consulted and the
transactions documented.
This chapter aims to capture the highlights of our
findings and the learning that emerged from each of
the specific activities.

1
Centre for Health Workforce Studies. State Responses to Health Worker Shortages: Results of 2002 Survey of States. Albany, NY: School of Public
Health, State University of New York, November 2002.

173

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Key activities undertaken as part of

the analysis

Symbiosis Institute.

The activities took place in four phases:

Phase 1: Consultations and extensive desk review
of national and international institutions, curricula,
teaching methods, regulatory frameworks, business
models and educational methods were conducted.

The group agreed that allied health required a diverse

group of professionals to be incorporated under a
common umbrella. For each specialty, standardisation
of various components was necessary such as course
duration and curricula among colleges.

Highlights of the discussions

Barring a few subjects, lack of qualified personnel

was seen across the sector. Hence, it was deemed
necessary to conduct a needs assessment of HR based
on the national requirements of the population rather
than the positions available. The group decided on
key institutes to be included in this programme such
as Postgraduate Institute of Medical Education and
Research (PGIMER), Chandigarh; Christian Medical
College (CMC), Vellore; Manipal University; Armed
Forces Medical College (AFMC), Pune and Institute of
Paramedical Sciences, Lucknow, among others. They
would also help to indicate institutions and the contact
points of those whose opinions could contribute
positively to this initiative. Suggestions were made to
include courses for podiatry and Central Sterile Supply
Department (CSSD) technicians.

Phase 2: Aggregation and organisation of information

collected from phase 1 during a desk review workshop
held in Manipal, Karnataka.

Phase 3: Recommendation-writing workshop based

on the findings from phases 1 and 2, which were
appropriately shared with experts.

Phase 4: Completion of data collection and analysis

from 276 national institutions and modelling of
projected allied workforce requirements based on the
supply-side data obtained.
Besides these four distinct phases, the last and final
deliverable is a comprehensive report that captures
the details of the findings in each phase of the project
which was presented to the health ministry in January
2012
The major activities undertaken during the course of
time are mentioned hereby:

2. Brainstorming session on methods and

overall landscape of the project with PHFI
leadership

1. Knowledge collation workshop

(15 April 2011 at the Sir J.J. Hospital, Mumbai,

Maharashtra)

Participants (external) included Prof. R. Rangasayee,

G. Mukhiyadan, Dr B. D. Athani, Dr M. V. Jagade, Dr G.
DCosta, Dr Ameeta Joshi, Dr (Col) K. Srikar and Dr
Sammita Jadhav.

(19 April 2011 at the Institute forStudies in

Industrial Development (ISID) campus, New Delhi
under the chairmanship of Dr Srinath Reddy,
President PHFI )

Participants included all the senior leaders of the PHFI;

Directors of the Indian Institutes of Public Health, Delhi
and Hyderabad, Dr Sanjay Zodpey and Dr G V Murthy;
senior advisors Dr Aiyagiri Rao, Dr Jay Satia and Dr
Subhash Salunke, Head of Training Dr Abhay Saraf,
Head of Human Resources Ms Kalpana Swamy, Head of
Operations Mr Suresh Kumar and Head of Finance Mr
Amit Chaturvedi. The presentations were made by Dr
Tarun Seem, Head, Health Systems Support Unit and
Ms Kavita Narayan, Associate Head Health Systems.

Participants (internal) included Dr Tarun Seem,

General M. Srivastava, Dr Subhash Salunke and Ms
Natasha DLima. Leaders and faculty were also present
from renowned educational institutions in allied
health services such as the Ali Yawar Jung Institute,
Maharashtra University of Health Sciences, All India
Institute of Physical Medicine and Rehabilitation,
Armed Forces Medical College, J.J. Hospital and
174

Process of consultations

3. Landscape workshop on augmenting

paramedical training capacity

publicprivate partnership (PPP) model was suggested

due to shortages in the government sector.

(26 and 27 April 2011 at the National Institute of

Health and Family Welfare (NIHFW) campus, New
Delhi)

ii. Educational methods

It was suggested that uniformity in the nomenclature
of courses needs to be maintained, which should be
decided before collaboration of the NIAHS and RIAHS
is initiated with the University Grants Commission
(UGC) or any other professional body. Standardisation
of curriculum design and duration of courses was
also recommended, which would be feasible with the
advent of the Paramedical Council, NIAHS and RIAHS.

Participants included (external) Ms Aparna Sharma,

Prof. Gouripada Dutta, Dr Ananthanarayanan P.H., Dr
R. Chandrashekhar, Prof. Deoki Nandan, Dr D Thamma
Rao, Dr Sita Naik, Dr R. P. Pai, Maj. Gen. (Dr) S. K. Biswas,
Dr B. Rajashekhar, Col Anurag Salwan, Mr S. K. Kalra,
Col. K. Srikar, Dr Sammita Jadhav, Dr B. B. Thukral, Dr
A. K. Mukhopadhyaya, Dr Lalit, Mr J P Mishra, Dr S. B.
Arora, Dr (Mrs) Naseem Shah, Dr Ritu Duggal, Prof.
Dr Sangeeta Sharma, Dr Arvind Rajwanshi, Prof. Dr
George Tharion, Dr Bipin Batra, Mr Sameer Mehta,
Dr B. D. Athani, Dr Niranjan D. Khambete, Ms Lalita
Shankar, Dr Sanjay Sarin, Dr Ameeta Joshi, Mr. Basab
Banerjee, Dr Tapan K. Jena, Dr Raj Shekhar, Mr. Gulshan
Baweja, Dr J S Dhupia, Dr Sanjay Aggarwal, Dr Adarsh
Singh, Dr Anita Singh, Dr Supriyo Ghosh, Dr Shubnum
Singh, Dr Somil Nagpal, Dr T Sundararaman, Dr Gowri
N Sengupta, Dr K. S. Prema, Dr V. P. Sah and Mr Vivek
Adhil.

iii. Regulation
The group suggested that goals and principles of
regulation of professional cadres to be developed.
Networking should be attempted among the
functioning councils so as to improve the coordination
between them. Governance models of the Indian
Institutes of Management (IIMs) and Indian Institutes
of Technology (IITs) can be studied for this purpose.
The group further considered three models for the
regulatory structure, keeping in view the overall
scenario:

Highlights of the discussions:

The participants were divided into five groups for

considering five major terms of reference (TORs):
physical inputs, educational methods, regulation,
management models, and ToT protocols and facilitation
guides, which were under the purview of this project.
The major highlights of the discussions are as follows:

A single umbrella model

A single paramedical council

Dissociating physiotherapy from the proposed

paramedical council bill since physiotherapy as
a discipline under the Paramedical Council has
been the subject of debate for quite some time and
consensus has yet not been reached.

iv. Management model

The group suggested that the management model
of NIAHS and RIAHS should have the following
characteristics: sustainability, viability, flexibility and
light-weight to enable ease of implementation within
the existing system. It was stated that the existence
of RIAHS as a separate entity or a department within
well-established medical colleges is questionable and
a cause for concern.

i. Physical inputs
The group came to a consensus that producing the right
number of allied health personnel would not serve the
purpose; the impetus needs to be on quality in training
and skills acquisition must be the priority. In view
of the term paramedical personnel being deemed
inappropriate by the expert group, it was suggested
that the NIPS and RIPS be rechristened as the National
Institute of Allied Health Sciences (NIAHS) and
Regional Institute of Allied Health Sciences (RIAHS).
For procurement of adequate staff and equipment, a
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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

5. Workshop with NSDC and CII

v. ToT protocols and facilitation guides

The group emphasised that the scope of training
specifications for the allied health services is huge,
thus it might not be possible to think about ToT
protocols for all courses.

A collaborative discussion was held with the National

Skills Development Corporation (NSDC) and the
Confederation of Indian Industries (CII) on the need
for the establishment of a distinct sector skills council
in healthcare, emerging from the issues related to
paramedical capacity building.

The group, while discussing the methodology for

preparing the protocols and guidelines, suggested that
the existing curriculum be reviewed in the institutions
identified as regional institutes. The protocols would
then be based on the gaps identified in these protocols
or facilitation guides, if any. The group also collated a
list of institutions that are known for their contribution
to the field of paramedical and allied health services.

Participants included Dr Naresh Trehan, Dr Shubnum

Singh, Mr Basab Banerjee, Ms Anagha Khot, Mr
Naveen Trehan, Mr Anoop Rawat, Col Badal Verma, Dr
Nipun Choudhry, Dr Mahesh Reddy, Dr A K Sood, Mr
Gulshan Baweja, Mr Rajesh Gopal, Mr Nakul Verma,
Mr J Sunderajan, Ms Roshni Datta, Mr Jonathan Lance,
Mr Joby George, Mr Marut Sen Gupta, Mr Ashwariya
Kumar Doval, Ms Elizabeth Jose, Ms Vaishali Srivastava
and Ms Cynthia Lobo.

4. Exploratory work shop with paramedics

(18 May 2011 at CII HQ)

(2 May 2011 at CMET-AIIMS, New Delhi)

A knowledge-collation workshop was held with

leading allied health service providers/practitioners
of more than ten different specialties at the K.L Wig
Centre for Medical Education and Technology (CMET),
AIIMS, New Delhi under the chairmanship of Dr K.K.
Deepak and Dr Adkoli.

Highlights of the discussions

The group proposed to analyse the human resource

gaps in the areas of postgraduate/graduate, nursing
and allied health to estimate the qualitative and
quantitative demand and to plan for HR requirements
accordingly to keep up with the industry growth (15%).
The Sector Skill Council (SSC) was to use uniform
National Occupation Standards (NOS) guidelines to
obtain a common training certificate and to include the
National Vocational Qualification (NVQs) Framework
to enable the work force to enhance skills and obtain
higher qualifications. All healthcare stakeholders were
to be represented by a single SSC that would have a
placement cell to facilitate employment. The group felt
that they could start with pilot project courses having
the highest employability factor and include others
subsequently.

Participants included Mr Vijay Aggarwal, Mr Pawan

Kumar Popli, Mr Ramesh Sharma, Mr Baban Mohankar,
Mr Pintu Kumar, Mr Prabhat Ranjan, Mr Rajeev
Aggarwal, Mr A.S. Moorthy, Ms Poonam Mishra, Mr
Harpreet Singh, Mr Yogesh Kumar, Dr Alka Mohan
Chutani and Dr Sita Naik.
Highlights of the discussions

The group decided to have uniform entry criteria for

AHPs and to keep options open for higher education.
According to them, the credit system could be
used to standardise assessments. They felt that
cadre structures needed to be clearly defined and
promotions should be assessment-based. Titles should
be reserved for those with different degrees. The need
for a certificate course was debated, as was the need
for salary grades to reflect specialised training.

6. Detailed meeting with paramedics,

(21 May 2011 at G.B. Pant Hospital, New Delhi)

A workshop was held on the subject with AHPs

belonging to existing formalised associations/other
structures for governance.
176

Process of consultations

Participants included the staff of G. B. Pant Hospital:

Ashok Kumar, Rajkumar Goel, Anil Kumar, Niroosh
Sharma, Jyotsna Gupta, Shashi Bhushan, Sanjeev
Kumar, Prashant Kumar, Biswajit Das, Alka Sharma,
Raj Kumar, Rattan Chand Kaushal, Mulkh Raj, Radhey
Shyam, Deepa Arora, Swati Tyagi, Suman Kamra, G. B.
Sharma, R. P. Gupta, Suman Gupta, K. Subbalakshmi
Rao, Ajumi M. Noohu, Devendra Singh, Ramesh Kamra,
Sudhir Kumar, Alice Kunjman, Savita Sharma, Rema
Gopinathan, Thankamani Amma, Pramod Tripathi,
Anjali Bhatnagar, Taruna Mathur, Neeraj Mishra, Anju
Jain, Rajesh Kumar and U. S. Negi

for all personnel and would provide clarity to all

stakeholders. To design the bridge courses that would
bring the existing workforce at par with the standard
requirements, the core functions and performance
outcomes were to be decided before building upon the
expected occupations. Sustainability would be decided
on whether the regulatory body would be the SSC or the
paramedical council, while return on investment (by
placement) would ensure the continued functioning of
an institute.

The group raised issues related to the allied health

cadre, such as ambiguity in nomenclature of positions,
hierarchy, no autonomy in the execution of services,
and a poorly standardised education system. They
also highlighted the fact that there is no distinction
in the remuneration and job, irrespective of the
education level of the candidates. The group shared
their concerns on a regulatory mechanism and career
progression process also.

Individual specialty/cadre consultations were

conducted with optometrists, physical therapists,
speech therapists, operation theatre (OT) technicians,
radiographers,
radiotherapists,
occupational
therapists, laboratory technicians and audiologists.
Highlights of the viewpoints shared by each of these
groups of professionals are included in Chapter 3.

8. Meetings with the paramedics group

Highlights of the discussions

Participants included: a host of poeple encompassing

the various specialties from among major institutions
such as the G.B. Pant Hospital, Delhi; PGIMER,
Chandigarh; AIIMS, Delhi; LNJP Hospital, Delhi and
Safdarjung Hospital, Delhi, among others.

7. Detailed meeting with NSDC and CII,

(2328 May 2011 at PHFI, New Delhi)

(24 May 2011 at PHFI, New Delhi)

This was a follow-up discussion with the NSDC, CII and

industry leaders representing leading hospital chains,
device and equipment manufacturers, and technology
solution providers on the importance of defining skills
and competencies as the basis for curriculum design,
training and capacity building.

9. Workshop of regulatory bodies

(30 May 2011 at NIHFW, New Delhi)

A consultation was held with key regulatory agencies

such as the existing state paramedical councils,
Dental Council of India, Indian Nursing Council,
Rehabilitation Council of India and Pharmacy Council
of India, and accrediting agencies such as the NABL
and QCI, autonomous educational/training institutes
such as AIIMS, NIHFW, NBE, AICTE and IGNOU,
industry leaders such as Dr Lal Path Labs, and leading
development partners such as WHO and DFID, among
others.

Participants included Ranjani Vaidyanathan, Naveen

Trehan, Dr Anita Singh, Dr A. K. Sood, Rohit Chandra,
Nakul Verma, Parag Varshney, Vaishali Srivastava,
Ashok Chandavarkar, Lt Gen. Narayan Chatterjee and
Jonathan Lance.
Highlights of the discussions

The SSCs were to define the National Occupational

Standards(NOS) to aid self-improvement as they
would include a clearly defined performance standard

Participants included Dr R.K. Srivastava, Ms Aparna

Sharma, Dr Maheshanand Bhardwaj, Dr Pankaj Kumar
Ghosh, Dr R. N. Rai, Dr K. P. Aravindan, Dr Arvind
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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

Theragaonkar, Dr A. K. Sood, Ms Anagha Khot, Maj.

Gen. I. Cardozo, Billy Stewart, Archna Mudgal, Dr
Punam Bajaj, Dr Bhawna Gulati, Dr Bipin Batra, Dr
T. Dileep Kumar, Dr S. B. Arora,Brig. (Dr) Arvind Lal,
Prof. Deoki Nandan, Dr D. M.Thorat, Prof. Rajvardhan
Azad, Dr Kamlesh Kumar, Mr Shreekant Ranjan, Mr D.
K. Ojha, Mr R. Das, Mr Sunil Nandraj, and Prof. Sanjay
Shrivastava.

Daing, Chandrika Pasricha, Dr Asha Bakshi, Richa

Gandhi and Vaibhav Gujral.

The discussions held wereabout course design,

curriculum, perceived status gaps in the profession
and other issues such as cadre restructuring, linguistic
training, etc.

11. Field visits to major institutes

Highlights of the discussions

Institutes that are currently centres of excellence

in these fields such as PGIMER Chandigarh, GMCH
Chandigarh, CMC Vellore, Amrita Institute, Manipal
College of Allied Health Sciences, Sree Chitra Tirunal
Institute, J&J Ethicon Institute of Surgical Education
New Delhi, Safdarjung Hospital, G.B. Pant Hospital,
K.E.M. hospital, J.J. Hospital, IPHH, Ali Yavar Jung
institute, AIIPMR, among others, were undertaken
by the PHFI secretariat. Details on inputs such as
infrastructure, faculty, student ratios, teaching
methods and highlights of the curricula were examined
in detail, in addition to management issues such as
organisational structure, mission, vision and values, as
well as financial sustainability models, if present. The
details of these visits are summarised in Chapter 3 of
this report.

The group stated that currently, there are neither

the data nor organised systems to manage the allied
health workforce in India. There is no existing system
for renewal of licenses, both for nurses as well as
physicians (live register). When the national and
state institutions have similar roles, the duplication
causes conflicts of interest. The roles of the NIAHS
and RIAHS should be clearly demarcated to avoid such
hassles. NIAHS should have the primary responsibility
for recognizing institutions while the states should
recognise courses. In the long term, the NIAHS should
be the overarching university once it establishes the
requisite number of beds and capacity to provide
training. Each RIAHS could be linked with the NIAHS.
Once the NIAHS gets national recognition there could
also be linkages with the six AIIMS-like institutions
that are proposed, where possible.

12. National data mapping

Questionnaires were dispatched to all the medical

colleges across India under the notification of the
Ministry of Health and Family Welfare. Out of 339
questionnaires sent, responses were received from
276 colleges across India. Data analysis of the
questionnaires was undertaken by the Organisation for
Health Management and Rural Development (OHMRD)
assisting PHFI in this initiative. The objectives were as
follows:

10. Industry consultation

(7 June 2011, ISID campus, Vasant Kunj)

A national consultation was held on 7 June 2011 with

industry on the National Initiative for Allied Health
Services for Augmenting the Paramedical Training
Capacity in India to involve industrial leaders in setting
standards for training of paramedical personnel.

Participants included Himanshu Roy, Vineet Kumar,

Pavan Choudary, Sundar R.K., Dr Ashok Moharana, Dr
Anita Singh, Joby George, Sunith George, Dr Karthik
Anantharaman, Aditya Singh, Dr Tamorish Kole, Dr
Talat Halim, Capt. Indira Rani, Ranjani Vaidyanathan,
Rajesh Radhakrishnan, Dr Punita Raheja, Prashant
Mohan, Shivkumar Hurdale, Gulshan Baweja, Neha

178

To review the structure and functions of the

educational institutions offering any allied health
course;
To evaluate the allied health courses in terms
of their ability to produce degree, diploma and
certificate holders with the expected knowledge
and skills;

Process of consultations

To assess the quality of allied health courses in

terms of training pedagogy and content.

The major contours of the infrastructure discussion

for the national and regional institutes as well as
the hospital in Najafgarh emerged after detailed
brainstorming by Col Anuraag Salwaan, Col Srikar, Dr
Kanav Kahol and Col Sajal Sen.

Twenty experts divided in five teams covered all five

regions of the country to complete the data collection
on the basis of the questionnaire sent by PHFI. The
details pertaining to the process and the results are
indicated in Chapter 3 of this report

14. Final Recommendation writing workshop

(1516 September 2011, Bristol Hotel, Gurgaon)

13. Situational review report writing

workshop

i.

Overall ecosystem

A three-day situational review report writing

workshop was organised between 4 and 6 July 2011
by the Manipal College of Allied Health Sciences
(MCOAHS). The faculty from MCOAHS and Medical
College participated actively and undertook the
majority of the writing work.

The group comprised the following representatives:

Ms Bhan, Dr Sita Naik, Dr Yogeshwar, Mr Pawan
Choudhary, Dr Prem Nair, Ms Monica Choudhary, Dr
Dileep Mavlankar, Dr Kanav Kahol (post lunch), and Dr
Tarun Seem.

Representatives from Manipal included the Dean, Dr

V. Rajshekhar, Pro-Vice Chancellor Dr Vinod Bhat and
Medical Superintendent Dr Pulgaonkar, Dr Kaushik
Sau, Dr Shivanand Bhushan, Mr T. Sri Harsha, Dr R.
P. Pai, Dr Shashidhar Rao, Dr Rajesh Sinha, Mr Avik
Ray, Mr Noushad, Dr Ramesh Unnikrishnan, Dr Ayas
Muhammed K.P., Dr Vivek Raghavan M., Dr Sabu
K.M., Dr Abraham Samuel Babu, Dr Krishna Y., Dr Sibi
Oommen, Dr Sunila John, Ms Nilna Narayanan, Ms
SebestinaDsouza, Ms Srinidhi G.C., N. Manikandan,
G. Ranganath, John Solomon M., Veena N.K., Megha,
Saumy Johnson and Ms Dolha Saha.

Human resources for AHPs: The experts were of the

view that, given the paucity of availability of AHPs,
it is necessary to look at various models to augment
the supply of medical and paramedical professionals
such as PPP models, etc. The scope of deployment of
the health cadre varies due to geographical diversity.
It is, therefore, necessary to look at augmentation of
medical professionals at primary and secondary health
facilities with trained AHPs.

Highlights of the discussions

External experts and those from the MoHFW included

Ms Aparna Sharma, Mr Aditya Goyal, Mr Ajeet
Bharadwaj, Dr Prema K. S., Dr Sammita Jadhav, Dr
Anita Singh, Mr Vineet Kumar, Dr K. P. Aravindan, Dr
Pritish J. K., Dr Ameeta Joshi, Col K Srikar, Mr Ashok
Chandavarkar, Capt. Indira Rani ,Dr J.P. Mishra, Dr
Bipin Batra, B. Paul Ravindran and Col Anurag Salwan.

It was decided that the courses coming under the

ambit of allied health will be called allied health
sciences and practitioners will be called allied health
professionals (4-year degree holders), allied health
providers (diploma holders) and allied health workers
(certificate holders).

Methodology of training: Experts felt an urgent

need to focus on faculty development and linking
paramedical training to district general hospitals
and medical colleges. Recommendations reflected
in Chapters 3 and 4 have details pertaining to issues
regarding methodology.

A comprehensive situational analysis document was

developed which provided the details of the major
courses discussed, competency and skills-based
models, ideal infrastructure requirements to run a
world-class allied health sciences institution, as well
as the use of simulation centres in scaling up these
professionals.

Quality improvement: Research funding and

establishment of research centres of excellence
(regional) should be done by ISRO, which should
allocate funding yearly for promoting research
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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

may be placed under the management of human

resources and prospects of new courses to be started
have to be debated in the house of the regulatory wing,
the communication and research wing of the NIAHS.

activities in allied health disciplines. In order to

maintain quality, a central umbrella council needs to be
created, and existing councils have to be harmonised
with national standards.
Mainstreaming existing professionals: Most of the
courses should be of diploma level; some specialised
ones such as physiotherapy, occupational therapy can
be for 4 years. Existing council-regulated disciplines
such as nursing, pharmacy, to name a few, may not be
included within the purview of AHPs. Details of the
topic are reflected in Chapter 1.

iv. Inputs and educational methods

The group comprised the following representatives:

Col Srikar, Dr S.K. Sharma, DrK.P. Aravindan, Dr J.M.
Tharakan, Dr Paul Ravindran, Dr Uma Nambiar, Dr B.
V. Adkoli and Dr Nilesh Kokane.
Highlights of the discussions

Cadres may be created as in case of nursing and a

distinction between diploma /degree holders can
also be adopted from the nursing cadre. In the case
of teaching, it should be replicated as in any other
teaching cadre.

It was decided that the course duration should be

based on the content of the course. The duration of
a bachelors course should be 3 years + 1 year paid
internship. A Masters internship should be researchbased or teaching-based. Provisions for lateral entry
should be made. It was decided that the basic courses
taught in the first 6 months should be common
with appropriate additions made subject-wise, and
periodic updation of curricula to be conducted by
relevant experts. The HR requirements, management
models for sustainability of the NIAHS and RIAHS, and
alternative and assessment methods were discussed.
Additional details of the discussions may be found in
the recommendations section of Chapters 1 and 4.

ii. NIAHS and RIAHS

The group comprised the following representatives:

Dr Shyam Ashtekar, Dr Athani, Dr Rajwanshi, Dr
Prathapan Nair, Dr A. K. Mukhopadhyayaand Dr
Kumkum.
Highlights of the discussions

The group decided that the NIAHS and RIAHS should

evolve as autonomous centres of excellence mandated
by an Act of Parliament, funded by the Central
Government, including all the recurring expenses of
the NIAHS and RIAHS. The centres would undertake
teaching, training and research in allied health
education. The mission, vision, governing structure
and scope of activities are detailed in Chapter 4.

v. Regulatory framework

The group comprised the following representatives:

Dr S. Salunke, Dr Col Sajal Sen, Dr J. P. Mishra, Maj. Gen.
I. Cardozo and Dr Bipin Batra.
Highlights of the discussions

iii. Management of NIAHS and RIAHS

Management of NIAHS and RIAHS

The group comprised the following representatives:

Lt Gen. Narayan Chatterjee, Dr Krishna Y., Mrs Praniti
Batra, Mr Vijay Kumar, Mr M. P. Singh, Mr Anil Sharma
and Dr Anita Singh.

Role delineation
It was decided that the NIAHS would take on the
responsibility for imparting education, promoting
research, developing faculty and providing technical
support for administration, affiliation and AHS
education itself, and through the nine institutions.
For the purpose of regulating education and grant of
affiliation, a National Board of Allied Health Sciences
is to be conceived.

Highlights of the discussions

Initially, a ToT programme should be institutionalised

and subsequently, the faculty development (FD)
programme should be put in place. The FD programme
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Process of consultations

of Allied Health Sciences. As additional data were

called for by the JS during this meeting, which would
involve data collection and analysis from all medical
colleges across the country, PHFI requested for an
extension of the project up to December 2011 at no
additional cost for completing all activities identified
under the contract agreement with the MoHFW.

Management board composition and functions (NIAHS

and RIAHS)
There will be a common governing board known as the
National Board of Allied Health Sciences for all the 9
institutions with a rotating chair to avoid the hierarchy
control of the Government of India on the institutions.
The function of the board and NIAHS should be
separate; the NIAHS may function as the secretariat for
the governing board that will act as a regulatory and
recognition body for all.

16. Modelling exercise to project future needs

for producing allied health professionals by
specialty and region across the nation

Options for structuring the AHS regulator

It was proposed to have an umbrella structure model
of the AHP regulator, which would cover all the
unregulated allied health professions. The function of
the overarching councils will be setting and enforcing
standards of professional conduct, live registers,
growth and development of cadres, and dispute
resolution within and among constituent councils.

A model was developed to estimate allied workforce

requirements. The questions for modelling helped to
determine the following:

Data sources used in the study were (a) databases

provided by PHFI, and (b) literature estimates. Review
of the literature estimates was undertaken to analyse
the different measures that have been used historically
to determine the shortage of medical practitioners in
developing countries.

The subject is dealt with in greater detail in Chapter 3.

15. Presentation of preliminary

recommendations and draft report to the
Ministry of Health and Family Welfare and
offices of Directorate General of Health
Services

Data requirements will be as follows:

a. Excel-based models developed for certain types of

human resources by their individual organisations
b. Results from the survey conducted by PHFI on
existing training institutes

A meeting was convened by the JS (HR) Mr Debashish

Panda at 2 pm on 28 September 2011 in his chamber.
The aim was to review the progress of the consultancy
being provided by the PHFI under the scheme on
establishment ofthe NIAHS and RIAHS and supporting
HR development in government medical colleges
for running paramedical courses through a one-time
grant. The following people attended the meeting:

c. List of health facilities mapped to each allied

health workforce category
d. Any data on the ideal staffing level of public
health facilities

e. Data on installed/working public health facilities

where the allied workforce are likely to be present

f. Any data on an existing installed database of

private health facilities, either actual or projected

Dr Arvind Thergaonkar, DDG(P), DGHS

Ms Aparna Sharma, Director (PMS)

g. 2011 Census data

Dr S. Salunke, Advisor, PHFI

h. Burden of various diseases across the country

Dr Tarun Seem, Head, Health Systems Support

Unit, PHFI

i.

India/developing country-specific projections for

required number of health workers per patient
The study aimed to answer the following questions:
What allied health human resources are required?,

Dr D.M. Thorat, ADG(P), DGHS

The draft report was submitted in two volumes: Allied

Health Ecosystem in India and Establishing Institutes

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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

and Where are these human resources required

geographically for efficient delivery of care?

17. Final report compilation followed by

dissemination of recommendations to key
stakeholder groups

The final report was submitted in January 2012 and

presented to the Consulting Monitoring Committee.
The health ministry formally conveyed acceptance of
the report in September 2012 and directed PHFI to
undertake steps for production and dissemination of
the final report in Decemeber 2012.

182

List of experts
External expert contributors
1. Maj. Gen S. K. Biswas, Academy of Hospital Administration (AHA)

2. Dr V. P. Sah, Ali Yavar Jung National Institute for the Hearing Handicapped (AYJNIHH)
3. Dr S. S. Mantha, All India Council for Technical Education (AICTE)

4. Dr Hari Parkash , All India Institute of Medical Sciences Centre for Dental Education and Research, New Delhi
5. Dr Naseem Shah, All India Institute of Medical Sciences Centre for Dental Education and Research, New Delhi

6. Dr Rajesh Sinha, All India Institute of Medical SciencesDr R. P. Centre for Ophthalmic Sciences (AIIMS-RPC),
New Delhi

7. Dr Alok K. Ravi, All India Institute of Medical SciencesDr R. P. Centre for Ophthalmic Sciences (AIIMS-RPC),
New Delhi
8. Dr Lalit Mohan, All India Institute of Medical SciencesDr R. P. Centre for Ophthalmic Sciences (AIIMS-RPC),
New Delhi
9. Prof. (Dr) Supriyo Ghose, All India Institute of Medical SciencesDr R. P. Centre for Ophthalmic Sciences (AIIMSRPC), New Delhi

10. Dr B. V. Adkoli, All India Institute of Medical SciencesK L Wig Centre for Medical Education & Technology
(AIIMS-CMET), New Delhi
11. Mr Yogesh Kumar, All India Institute of Medical SciencesK L Wig Centre for Medical Education & Technology
(AIIMS-CMET), New Delhi
12. Dr A. K. Mukhopadhyaya, All India Institute of Medical Sciences (AIIMS), New Delhi
13. Mr A. S. Moorthy, All India Institute of Medical Sciences (AIIMS), New Delhi

14. Dr Alka Mohan Chutani, All India Institute of Medical Sciences (AIIMS), New Delhi
15. Mr Baban Mohankar, All India Institute of Medical Sciences (AIIMS), New Delhi
16. Mr Harpreet Singh, All India Institute of Medical Sciences (AIIMS), New Delhi

17. Mr Pawan Kumar Popli, All India Institute of Medical Sciences (AIIMS), New Delhi
18. Mr Pintu Kumar, All India Institute of Medical Sciences (AIIMS), New Delhi

19. Ms Poonam Mishra, All India Institute of Medical Sciences (AIIMS), New Delhi
20. Mr Prabhat Ranjan, All India Institute of Medical Sciences (AIIMS), New Delhi
21. Dr R. C. Deka, All India Institute of Medical Sciences (AIIMS), New Delhi

22. Mr Rajeev Aggarwal, All India Institute of Medical Sciences (AIIMS), New Delhi

23. Prof. Rajvardhan Azad, All India Institute of Medical Sciences (AIIMS), New Delhi
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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

24. Mr Ramesh Sharma, All India Institute of Medical Sciences (AIIMS), New Delhi
25. Dr Sanjay Agarwal, All India Institute of Medical Sciences (AIIMS), New Delhi
26. Mr Vijay Aggarwal, All India Institute of Medical Sciences (AIIMS), New Delhi
27. Prof Vinod Paul, All India Institute of Medical Sciences (AIIMS), New Delhi

28. Dr B. D. Athani, All India Institute of Physical Medicine and Rehabilitation (AIIPMR), Mumbai
29. Dr K. S. Prema, All India Institute of Speech & Hearing (AIISH), Mysore
30. Dr Ajit Nagpal, Amity University, Gurgaon

31. Dr Gaurav Bharadwaj, Amity University, Gurgaon

32. Dr Hariman Kaur, Amity University, Gurgaon

33. Dr Kamini Tanwar, Amity University, Gurgaon

34. Ms Monica Chaudhary, Amity University, Gurgaon

35. Ms Pranati Barua, Amity University, Gurgaon
36. Prof R. Bhan, Amity University, Gurgaon

37. Mr Vijay Kumar, Amity University, Gurgaon

38. Dr Vikas Majumdar, Amity University, Gurgaon

39. Dr Prathapan Nair, Amrita School of Medicine, Kerala

40. Dr Prem Nair, Amrita School of Medicine, Kerala

41. Mr B. N. S. Kumar, Andhra Pradesh Paramedical Council

42. Ms Sangita Reddy, Apollo Group of Hospitals

43. Brg. Sanjeev Chopra, Armed Forces Medical College (AFMC), Pune
44. Col. K. Srikar, Armed Forces Medical College (AFMC), Pune

45. Mr Ajeet Bhardwaj, Asia-Pacific Council of Optometry; World Council of Optometry

46. Mr Jonathan Lance, Aspiron Consulting Pvt. Ltd.
47. Mr S. S. Bajaj, Atomic Energy Regulatory Board
48. Mr Anish Bafna, Baxter (India) Private Limited

49. Dr Ashok Moharana, Baxter (India) Private Limited

50. Dr Adrash Pal Singh, Becton, Dickinson and Company (BD)

51. Ms Lalita Shankar, Becton, Dickinson and Company (BD)

52. Mr Manoj Gopalakrishna, Becton, Dickinson and Company (BD)

53. Dr Ritu Duggal, Becton, Dickinson and Company (BD)

54. Dr Anita Singh, Becton, Dickinson and Company (BD), India

55. Dr Shyam Ashtekar, Bharat Vaidyaka Sanstha

56. Mr Subodh K Khanduri, Central Government Health Scheme (CGHS)

184

List of experts

57. Dr Gowri N. Sengupta, Central Health Education Bureau

58. Dr Rita Nagpal, Central Health Education Bureau

59. Dr S. C. Pradhan, Central Health Education Bureau

60. Dr George Tharion, Christian Medical College Hospital, Vellore

61. Dr George Mathew, Christian Medical College, Vellore
62. Dr Paul Ravindran, Christian Medical College, Vellore
63. Dr Pritish J. K., Christian Medical College, Vellore

64. Ms Vaishali Srivastava, Confederation of Indian Industry (CII)

65. Mr Rohit Chandra, Confederation of Indian Industry (CII) - Global Peers Management Group
66. Mr Bharat Bhushan, Deen Dayal Upadhyay Hospital

67. Mr Ramesh Kamra, Delhi Medical Technicians Employees Association, Delhi.

68. Mr A. K. Tyagi, Delhi Optometrists Association

69. Dr Dibyendu Mazumder, Dental Council of India

70. Dr Billy Stewart, Department for International Development (DFID), India

71. Dr Vikas Gupta, Distance Education Council (DEC)

72. Brig. Dr Arvind Lal, Dr Lal Path Labs Privated Limited

73. Mr Prem Kumar Singh, Dr Shroffs Charity Eye Hospital

74. Dr Ishwar C. Premsagar, Dr Ram Manohar Lohia Hospital, Delhi

75. Mr K. S. Jain, Dr Ram Manohar Lohia Hospital, Delhi

76. Dr Mridula Powar, Dr Ram Manohar Lohia Hospital, Delhi

77. Mr Pankaj Dubey, Dr Ram Manohar Lohia Hospital, Delhi

78. Dr Rajbala Yadav, Dr Ram Manohar Lohia Hospital, Delhi

79. Dr Shyam Sunder, Dr Ram Manohar Lohia Hospital, Delhi

80. Dr Anjan Prakash, Dr Ram Manohar Lohia Hospital, New Delhi

81. Dr Krishna Kumar, Elite School of Optometry
82. Mr Prashant Kumar, ESI Hospital, Okhla

83. Mr Gulshan Baweja, Everonn Medical Education

84. Mr Sameer Mehta, Everonn Medical Education

85. Prof Deepti Gogate, Ex. School of Optometry, Bharati Vidya peeth, Pune University.
86. Mr Shivinder M. Singh, Fortis Healthcare Limited
87. Dr Uma Nambiar, Fortis Healthcare Limited

88. Mr Ashok Kakkar, GE Healthcare Private Limited

89. Mr Chaitanya Sarawate, GE Healthcare Private Limited

185

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

90. Mr Parag Varshney, GE Healthcare Private Limited

91. Ms Prina Donga, GE Healthcare Private Limited

92. Dr Punita Raheja, GE Healthcare Private Limited

93. Mr Sumit Sharan, GE Healthcare Private Limited
94. Mr Sundar R. K., GE Healthcare Private Limited

95. Mr Sunith George, GE Healthcare Private Limited

96. Dr S. Hiremath, Government Dental College, Bangalore

97. Mr R. S. Berwal, Government of Haryana

98. Prof. (Dr) Gouripada Dutta, Government of West Bengal

99. Mr Dhiren Joshi, Government Prosthetics and Orthotics college

100. Ms Alice Kunjman, Govind Ballabh Pant Hospital, New Delhi
101. Dr Amit Banerjee, Govind Ballabh Pant Hospital, New Delhi

102. Ms Anjali Bhatnagar, Govind Ballabh Pant Hospital, New Delhi

103. Ms Anju Jain, Govind Ballabh Pant Hospital, New Delhi

104. Ms Deepa Arora, Govind Ballabh Pant Hospital, New Delhi

105. Mr Devendra Singh, Govind Ballabh Pant Hospital, New Delhi

106. Mr Gyaneshwar Tiwari, Govind Ballabh Pant Hospital, New Delhi

107. Ms Jyotsna Gupta, Govind Ballabh Pant Hospital, New Delhi

108. Ms K. Subbalakshmi Rao, Govind Ballabh Pant Hospital, New Delhi

109. Mr M. S. Rane, Govind Ballabh Pant Hospital, New Delhi
110. Mr Mulkh Raj, Govind Ballabh Pant Hospital, New Delhi

111. Mr Neeraj Mishra, Govind Ballabh Pant Hospital, New Delhi

112. Dr Nilesh Kokane, Govind Ballabh Pant Hospital, New Delhi

113. Mr Niroosh Sharma, Govind Ballabh Pant Hospital, New Delhi

114. Mr Pramod Tripathi, Govind Ballabh Pant Hospital, New Delhi

115. Mr Raj Kumar, Govind Ballabh Pant Hospital, New Delhi

116. Mr Rajesh Kumar, Govind Ballabh Pant Hospital, New Delhi

117. Mr Ramesh Arya, Govind Ballabh Pant Hospital, New Delhi

118. Mr Rattan Chand Kaushal, Govind Ballabh Pant Hospital, New Delhi
119. Ms Rema Gopinathan, Govind Ballabh Pant Hospital, New Delhi
120. Ms Savita Sharma, Govind Ballabh Pant Hospital, New Delhi

121. Mr Shashi Bhushan, Govind Ballabh Pant Hospital, New Delhi

122. Mr Sudhir Kumar, Govind Ballabh Pant Hospital, New Delhi
186

List of experts

123. Ms Suman Gupta, Govind Ballabh Pant Hospital, New Delhi

124. Ms Suman Kamra, Govind Ballabh Pant Hospital, New Delhi

125. Ms Swati Tyagi, Govind Ballabh Pant Hospital, New Delhi

126. Ms Taruna Mathur, Govind Ballabh Pant Hospital, New Delhi

127. Mr Thankamani Amma, Govind Ballabh Pant Hospital, New Delhi

128. Mr U. S. Negi, Govind Ballabh Pant Hospital, New Delhi

129. Mr Manoj Kumar Nirala, Guru Teg Bahadur Hospital and University College of Medical Sciences
130. Dr Maheshanand Bhardwaj, Himachal Pradesh Paramedical Council
131. Mr Amar Jeet, Hindu Rao Hospital

132. Col Anurag Salwan, HLL Lifecare Limited

133. Mr Prashant Mohan, HL LLifecare Limited

134. Mr S. K. Kalra, HLL Lifecare Limited
135. Mr Naveen Trehan, IFAN Global

136. Dr N. K. Arora, INCLEN Trust International

137. Ms Vandana Bhardwaj, Independent Physiotherapist

138. Dr T. Dileep Kumar, Indian Nursing Council (INC)

139. Mr Gaurav Anand, Indian Optometrists Association (IOA)

140. Mr Rajesh Wadhwa, Indian Optometry Federation (IOF)

141. Mr Kshitij Chandra Vishal, Indian Spinal Injuries Centre (ISIC)

142. Mr Ranjeet Kumar, Indian Spinal Injuries Centre (ISIC)

143. Ms Monica Chaudhry, Indira Gandhi National Open University (IGNOU)

144. Dr S. B. Arora, Indira Gandhi National Open University (IGNOU)

145. Prof V. N. Rajasekharan Pillai, Indira Gandhi National Open University (IGNOU)
146. Mr Anil Sharma, Institute of Public Health and Hygiene (IPHH), New Delhi

147. Dr Anita Mukherjee, Institute of Public Health and Hygiene (IPHH), New Delhi
148. Mr M. P. Singh, Institute of Public Health and Hygiene (IPHH), New Delhi
149. Dr Pankaj Kumar Ghosh, Integrated Institute of Technology, Dwarka
150. Mr Ashok Chandavarkar, Intel Technology India Private Limited
151. Dr Ameeta Joshi, J J Hospital, Mumbai

152. Ms Majumi M. Noohu, Jamia Millia Islamia - Centre for Physiotherapy and Rehabilitation sciences
153. Mr Apurv Mehta, Janak Health Care Pvt Ltd

154. Dr Ananthanarayanan P.H., Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER),
Pondicherry
187

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

155. Dr K. S. Reddy, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry
156. Mr Himanshu Roy, Johnson and Johnson Medical India
157. Mr Manish Jain, Johnson and Johnson Medical India
158. Ms T. E. Mercy Bai, Kerala Paramedical Council

159. Mr Amit Dikshit, Lok Nayak Jai Prakash Narayan Hospital

160. Mr Biswajit Das, Lok Nayak Jai Prakash Narayan Hospital

161. Mr G. B. Sharma, Lok Nayak Jai Prakash Narayan Hospital

162. Mr R. P. Gupta, Lok Nayak Jai Prakash Narayan Hospital

163. Mr Sanjeev Kumar, Lok Nayak Jai Prakash Narayan Hospital

164. Dr R. K. Chaurasia, Madhya Pradesh Paramedical Council, Bhopal

165. Mr Abraham Samuel Babu, Manipal College for Allied Health Sciences (MCOAHS)
166. Mr Avik Ray, Manipal College for Allied Health Sciences (MCOAHS)

167. Mr Babu Noushad P., Manipal College for Allied Health Sciences (MCOAHS)
168. Ms Dolha Saha, Manipal College for Allied Health Sciences (MCOAHS)

169. Mr G. Ranganath, Manipal College for Allied Health Sciences (MCOAHS)

170. Mr John Solomon M., Manipal College for Allied Health Sciences (MCOAHS)
171. Mr Kaushik Sau, Manipal College for Allied Health Sciences (MCOAHS)
172. Dr Krishna Y., Manipal College for Allied Health Sciences (MCOAHS)
173. Ms Megha, Manipal College for Allied Health Sciences (MCOAHS)

174. Mr Muhammed Ayas K. P., Manipal College for Allied Health Sciences (MCOAHS)
175. Mr N. Manikandan, Manipal College for Allied Health Sciences (MCOAHS)

176. Ms Nilna Narayanan, Manipal College for Allied Health Sciences (MCOAHS)
177. Dr R. P. Pai, Manipal College for Allied Health Sciences (MCOAHS)

178. Mr Rajesh Sinha , Manipal College for Allied Health Sciences (MCOAHS)

179. Mr Ramesh Unnikrishnan, Manipal College for Allied Health Sciences (MCOAHS)
180. Dr Sabu K. M., Manipal College for Allied Health Sciences (MCOAHS)

181. Ms Saumy Johnson, Manipal College for Allied Health Sciences (MCOAHS)

182. Ms Sebestina Anita DSouza, Manipal College for Allied Health Sciences (MCOAHS)
183. Mr Shashidhar Rao, Manipal College for Allied Health Sciences (MCOAHS)

184. Dr Shivanand Bhushan, Manipal College for Allied Health Sciences (MCOAHS)
185. Ms Sibi Oommen, Manipal College for Allied Health Sciences (MCOAHS)

186. Mr Srinidhi G. Chandraguthi, Manipal College for Allied Health Sciences (MCOAHS)
187. Ms Sunila John, Manipal College for Allied Health Sciences (MCOAHS)
188

List of experts

188. Mr T. Sri Harsha, Manipal College for Allied Health Sciences (MCOAHS)
189. Ms Veena N. K., Manipal College for Allied Health Sciences (MCOAHS)

190. Mr Vivek Raghavan M., Manipal College for Allied Health Sciences (MCOAHS)
191. Dr B. Rajashekar, Manipal College for Allied Health Sciences (MCOAHS)
192. Dr Mahesh Kumar, Maulana Azad Institute of Dental Sciences

193. Mr Radhey Shyam, Maulana Azad Institute of Medical Sciences

194. Ms Alka Sharma, Maulana Azad Medical College (MAMC)
195. Mr Anil Kumar, Maulana Azad Medical College (MAMC)

196. Mr Ashok Kumar, Maulana Azad Medical College (MAMC)

197. Mr Rajkumar Goel, Maulana Azad Medical College (MAMC)

198. Mr Rohitashwa Singh, Maulana Azad Medical College (MAMC)

199. Capt. Indira Rani, Max Healthcare
200. Mr Joby George, Max Healthcare

201. Dr Shubnum Singh, Max Healthcare

202. Dr Talat Halim, Max Healthcare

203. Dr Tamorish Kole, Max Healthcare

204. Mr Analjit Singh, Max India Limited

205. Ms Neha Daing, Max India Limited

206. Ms Chandrika Pasricha, Mckinsey and Company

207. Prof K. K. Talwar, Medical Council of India (MCI)

208. Prof. (Dr) Sangeeta Sharma, Medical Council of India (MCI)

209. Prof. Sanjay Shrivastava, Medical Council of India (MCI)
210. Dr Shiv Sarin, Medical Council of India (MCI)
211. Dr Sita Naik, Medical Council of India (MCI)
212. Mr Rajesh Radhakrishnan, Medtronic
213. Mr Shivkumar Hurdale, Medtronic
214. Dr Asha Bakshi, MQure

215. Ms Richa Gandhi, MQure

216. Mr Vaibhav Gujral, MQure

217. Dr Bhawna Gulati, National Accreditation Board for Hospitals & Healthcare Providers (NABH)

218. Dr Punam Bajaj, National Accreditation Board for Testing and Calibration Laboratories (NABL)
219. Mr Anil Relia, National Accreditation Board for Testing and Calibration Laboratories (NABL)
220. Prof Goverdhan Mehta, National Assessment and Accreditation Council (NAAC)
189

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

221. Dr Bipin Batra, National Board of Examinations (NBE)

222. Dr J. N. Sahay, National Health Systems Resource Centre (NHSRC)

223. Dr T. Sundararaman, National Health Systems Resource Centre (NHSRC)

224. Dr A. K. Sood, National Institute of Health and Family Welfare (NIHFW)

225. Prof Deoki Nandan, National Institute of Health and Family Welfare (NIHFW)
226. Dr N. K. Sethi , National Institute of Health and Family Welfare (NIHFW)

227. Mr Vivek Adhil, National Institute of Health and Family Welfare (NIHFW)
228. Mr Basab Banerjee, National Skill Development Corporation (NSDC)

229. Ms Ranjani Vaidyanathan, National Skill Development Corporation (NSDC)

230. Dr C. Siddappagowrav, Osmania Medical College (OMC)
231. Dr A. R. Aruna, Paramedical Board, Karnataka

232. Ms Archna Mudgal, Pharmacy Council of India (PCI)

233. Prof B. Suresh, Pharmacy Council of India (PCI)

234. Dr Arvind Rajwanshi, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
235. Mr Naresh Virdi, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
236. Dr S. K. Sharma, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh

237. Prof. Vinay Sakhuja, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
238. Mr S. C. Bansal, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
239. Maj. Gen Ian Cardozo, Rehabilitation Council of India (RCI)

240. Dr R. N. Rai, Rural Health Training Centre (RHTC), Najafgarh

241. Dr B. B. Thukral, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi
242. Mr Sohan Pal, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi
243. Dr Ajit Sinha, Safdarjung Hospital, New Delhi

244. Dr Anup Raj Gogia, Safdarjung Hospital, New Delhi

245. Mr D. Kumar, Safdarjung Hospital, New Delhi

246. Dr H. S. Issar, Safdarjung Hospital, New Delhi

247. Dr J. S. Dhupia, Safdarjung Hospital, New Delhi

248. Dr N. Das, Safdarjung Hospital, New Delhi

249. Mr R. K. Sharma, Safdarjung Hospital, New Delhi

250. Dr Sunita Saluja, Safdarjung Hospital, New Delhi
251. Mr Aditya Goyal, Sankara College of Optometry

252. Dr Jaganmohan A. Tharakan, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)
253. Dr Niranjan D. Khambete, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)
190

List of experts

254. Mr J. P. Misra, State Health Resource Centre (SHRC), Chattisgarh

255. Mr Ajay Pitre, Sushrut Surgical Private Limited

256. Dr Rajiv Yeravdekar, Symbiosis Institute of Health Sciences (SIHS)

257. Dr Sammita Jadhav, Symbiosis Institute of Health Sciences (SIHS)

258. Dr K. P. Aravindan, T D Medical College; Kerala Paramedical Council

259. Dr N. A. Kazmi, University Grants Commission (UGC)

260. Prof. Ved Prakash, University Grants Commission (UGC)

261. Mr Padmashree Vipin Buckshey, Visual Aids Centre
262. Mr Pavan Choudary, Vygon India Private Limited
263. Mr Vineet Kumar, Vygon India Private Limited
264. Mr Nakul Verma, Wipro GE Health Care
265. Mr Aditya Singh, Wipro GE Healthcare

266. Dr Karthik Anantharaman, Wipro GE Healthcare

267. Dr Somil Nagpal, World Bank

268. Ms Anagha Khot, USAID (Formerly World Health Organization)

269. Dr Sunil Nandraj, Advisor, Ministry of Health and Family Welfare (MoHFW) (Formerly World Health
Organization)
270. Dr Madhur Gupta, World Health Organization (WHO) India Country Office

Expert contributions from the Government of India

Directorate General of Health Services (DGHS)
1. Dr R. K. Srivastava, Former Director General
2. Prof. (Dr) Jagdish Prasad, Director General

3. Dr R. Chandrashekhar, Chief Architect, Central Design bureau (CDB)

4. Dr D. M. Thorat, ADG (DMT)

5. Dr Arvind Thergaonkar, DDG (P)

6. Dr G K Sharma, DDG (M)

7. Dr Mangala Kohli, ADG (ME) and CPIO

Ministry of Health and Family Welfare (MoHFW)

1. Mr R Chandra Mouli, Former Secretary
2. Mr P K Pradhan, Secretary

3. Mr Keshav Desiraju, Special Secretary

4. Mr Debashish Panda, Principal Secrretary, Agriculture, UP Govt., Former JS (HR, MoHFW)

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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

5. Dr Vishwas Mehta, Joint Secretary

6. Ms Aparna Sharma, Director

7. Mr Sube Singh, Deputy Secretary

Expert contributions from PHFI staff

1. Prof K. Srinath Reddy, President

2. Dr V. Rao Aiyagari, Senior Advisor Research Development and Scientific Operations

3. Lt Gen. Narayan Chatterjee (Retd), Special Advisor Government and NGO Relations
4. Dr Thamma Rao Damisetti, Senior Advisor

5. Prof Jay K. Satia, Senior Vice President Management and Coordination; Chair of Academic Management
Committee
6. Prof. Ramanan Laxminarayan, Vice President - Research and Policy

7. Dr Sanjay Zodpey, Vice President North Region and Director Indian Institute of Public Health, Delhi

8. Dr Dileep Mavalankar, Vice President West Region and Director Indian Institute of Public Health, Gandhinagar
9. Dr Abhay Saraf, Director Training and Health Systems Support Unit
10. Dr Subhadra Menon, Director Health Communication

11. Dr Kanav Kahol, Team leader Affordable Health Technologies Division

12. Dr Hanimi Reddy, Senior Social Scientist, South Asia Network for Chronic Disease

13. Dr Himanshu Negandhi, Assistant Professor Indian Institute of Public Health, Delhi
14. Dr Kabir Sheikh, Assistant Professor Indian Institute of Public Health, Delhi

PHFI NIAHS secretariat

1. Dr Subhash Salunke, Senior Advisor, PHFI

2. Ms Kavita Narayan, Project Director
3. Ms Shivangini Kar, Project Lead 1
4. Ms Namita Gupta, Project Lead 2

5. Ms Natasha DLima, Project Associate

6. Dr Tarun Seem, Former Project Co-ordinator and HeadHealth Systems Support Unit
7. Ms Ruchi Mishra

8. Dr Amar Nawkar

9. Ms Nirmala Mishra

10. Dr Yogeshwar Gupta

11. Mr Divya Prakash

12. Dr Parmeshwar Kumar

192

List of experts

13. Mr Kaushal Kumar

14. Dr Kumkum Srivastava- external consultant

15. Dr Sajal Sen- external consultant

16. Dr Ashish Gupta- external consultant

17. Ms Vidya Krishnan- editing consultant

193

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

ABBREVIATIONS
AFMC

Armed Forces Medical College

AICTE

All India Council for Technical Education

AHP
AHS

AIIMS
AIISH
AIMS

AIOTA
ANM

AYJNIHH
AYUSH
BARC
BHU

BITS
BMJ

BPMT
BSc
CA

CAMEL
CbD

CCTV
CEO
CET
CEX

CHC

CHSU

CHV/G
CII

CMAI
CMC

CMET

CMIRME
CMOC
CoMC
CRHE

Allied Health Professional

Allied Health Science

All India Institute of Medical Sciences

All India Institute of Speech and Hearing

Amrita Institute of Medical Sciences

All India Occupational Therapist's Association

Auxiliary nurse midwives

Ali Yavar Jung National Institute for the Hearing Handicapped

Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy

Bhabha Atomic Research Centre
Banaras Hindu University

Birla Institute of Technology and Sciences

British Medical Journal

Bachelor in Paramedical Technology

Bachelor of Science

Charted Accountant

Centre for Advanced Medical Education and Learning

Case-based discussion

Closed Circuit Television

Chief Executive Officer

Common entrance test

Case evaluation exercise

Community health centre

Consortium of Health Science Universities

Community health volunteer/guide
Confederation of Indian Industry

Christian Medical Association of India

Christian Medical College

Centre for Medical Education and Technology

Consortium of Medical Institutions for Reform of Medical Education

Common minimum optometry curriculum
Consortium of Medical Colleges

Council for Healthcare Regulatory Excellence

194

Abbreviations

CSSD

Central Sterile Supply Department

DCI

Dental Council of India

CT

CUSAT
DEC

DGAFMS
DGHS
DME
DOP

ECFMG
ECG

ECHO

EDUSAT
EEC

EEG

EISE

EKG/ECG
EL

EMG
EMT

FAIMER
FOGSI
GE

GMC
GoI
GoI
GP

HCPC

HPCA

HPCAA
HPPI
HRH

IAEA

IAMR
IAO
IAP

ICMR

ICSSR
ICT

Cytotechnologist

Cochin University of Science and Technology

Distance Education Council

Director General, Armed Forces Medical Services

Directorate General of Health Services
Department of Medical Education
Direct observation of procedures

Educational Commission for Foreign Medical Graduates

Electrocardiography

Exploring careers in health occupations

Education Satellite

Electroencephalography
Electroencephalography

Ethicon Institute of Surgical Education

Electrocardiogram
e-learning

Electromyography

Emergency Medical Technician

Foundation for Advancement of International Medical Education and Research

Federation of Obstetric and Gynaecological Societies of India
General Electric

Government Medical College ,Chandigarh

Government of India
Government of India
General physician

Health and Care Professional Council

Health Professions Council of Australia

Health Practitioners Competence Assurance Act

Health Professions Partnership Initiative
Human resources for health

International Atomic Energy Agency

Institute of Applied Manpower Research

International Accreditation Organisation

Indian Association of Physiotherapist
Indian Council of Medical Research

Indian Council of Social Science Research

Information Communication Technology
195

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

IGNOU

Indira Gandhi National Open University

IIT

Indian Institute of Technology

IIM

IISC

IMSBHU
INC
INI

INR

IPHH
IPHS
ISCO

ISM&H
ISO

ISRO
IT

J&J-EISE
JIPMER
JJ

JSR

KEM

KPMG

M.Phil

MAMC
MBBS
MCI

MCOAHS
MD

MEU

MGR

MHRD
MICU
MLP
MLT

MMS

MoHFW
MoU
MRI
MSc

MUHS

Indian Institute of Management

Indian Institute of Science

Institute of Medical Sciences- Banaras Hindu University

Indian Nursing Council

Institutes of National Importance

Indian national rupee [singular]

Institute of Public Health and Hygiene

Indian Public Health Standards

International Standard Classification of Occupations

Indian Systems of Medicine and Homoeopathy

International Organisation for Standardisation

Indian space research organization
Information technology

Johnson and Johnson Ethicon Institute of Surgical Education

Jawaharlal Institute of Post Graduate Medical Education and Research

Jamshetjee Jejeebhoy

Jan Swasthya Rakshak

King Edwards Memorial Hospital, Mumbai

Klynveld Peat Marwick Goerdeler
Master of Philosophy

Maulana Azad Medical College

Bachelor of Medicine and Bachelor of Surgery

Medical Council of India

Manipal College of Allied Health Sciences

Doctor of medicine

Medical education unit

M.G. Ramachandra university

Ministry of Human Resources Development

Mobile intensive care unit
Mid-level provider

Medical laboratory technology

Mini mental state examination

Ministry of Health and Family Welfare

Memorandum of understanding
Magnetic resonance imaging
Master of science

Manipal University of Health Sciences

196

Abbreviations

NAAC

National Assessment and Accreditation Council

NAHEAC

National Allied Health Evaluation and Assessment Committee

NABET
NABH

NAHEC
NBAHS
NBE

NBHE

NCHRH
NCO
NCR

NCTE

NDMC
NEAC
NHP
NHS

NIAHS
NIPS
NOS

NRHM
NSDC
NSSO

NTTC

Obs&Gynae
OCABR
OECD
OEM

OSCE

OSLER
OSPE
PCI
PG

PGIMER
Ph D
PHC
PhD

PHFI
PMR
PPP

National Accreditation Board for Education and Training

National Accreditation Board for Hospitals & Healthcare Providers

National Allied Health Education Committee
National Board of Allied Health Sciences
National Board of Examination

National Board for Health Education

National Commission for Human Resources for Health

National Classification of Occupations
National capital region

National Council for Teacher Education

New Delhi Municipal Council

National Evaluation and Assessment Committee

National Health Policy

National Health Service

National Initiative on Allied Health Services

National Institute of Paramedical Sciences
National occupational standards
National Rural Health Mission

National Skill Development Corporation

National Sample Survey Organisation
National Teacher Training Centre
Obstetrics and gynaecology

Office of Consumer Affairs and Business Regulation

Organisation for Economic Co-operation and Development

Original Equipment Manufacturers

Objective Structured Clinical Examination

Objective Structured Long Examination Record

Objective Structured Clinical Examination
Pharmacy Council of India
Post-graduate

Post Graduate Institute of Medical Education and Research, Chandigarh

Doctor of Philosophy

primary health centre

Doctor of Philosophy

Public Health Foundation of India

Physical Medicine and Rehabilitation

Public-private partnerships

197

From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

PSG

Polysomnography

RCI

Rehabilitation Council of India

QA

QCI

RGUHS
RHPA

RIAHS
RIPS
RML

SAARC
SAMU

SARRAH

SCTIMST
SEARO
SGPGI
SMUR
SOP
SSC

TBA
ToT
UG

UGC
UK

USA
VD
VO

WCO

WHO

WHO-SEARO
WILP

Quality assurance

Quality Council of India

Rajiv Gandhi University of Health Sciences

Regulated Health Professions Act

Regional Institute of Allied Health Sciences

Regional Institute of Paramedical Sciences
Ram Manohar Lohia hospital, New Delhi

South Asian Association for Regional Cooperation

Service d'AideMdicaleUrgente'

Services for Australian Rural and Remote Allied Health

Sri Chitra Tirunal Institute for Medical Sciences and Technology

Regional Office for South-East Asia (of WHO)

Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow

Service Mobile d'Urgence et Reanimation
Standard operating protocols
Sector Skill Councils

Traditional birth attendant

Training of trainers
Under-graduate

University Grants Commission

United Kingdom

United States of America

Venereal disease

Voluntary organisation

World Council of Optometry

World Health Organization

World Health Organization South-East Asia Regional Office

Work integrated linked programmes

198

BIBLIOGRAPHY
1. A Global Competency-based Model of Scope of Practice
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org.hk/wco_upload/261201285975.pdf.
2. A M. The Regulation of Public and Private Health Care
Markets. 1982.
3. Abhay Bang MC, Jashodhra Dasgupta, Anu Garg, Yogesh
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From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward

204

NATIONAL INITIATIVE FOR

ALLIED HEALTH SCIENCES

NATIONAL INITIATIVE FOR

ALLIED HEALTH SCIENCES
The Government of India, through the Ministry of Health and Family Welfare,
appointed the Public Health Foundation of India (PHFI) as a technical partner to
develop a strategic framework for building capacity for allied health.
The National Initiative for Allied Health Sciences (NIAHS) is a product of the concerted
efforts of several stakeholders. The report recommends a paradigm shift in approach to
health human resource management, in keeping with the national priority of providing
affordable and accessible healthcare for all.

FROM PARAMEDICS TO ALLIED

HEALTH PROESSIONALS

The fundamental aim of this project has been to equip policy-makers with tools to set
benchmarks in regulation, education and training of allied health professionals, and
bridge the vast demandsupply gap. The Government of India is committed to investing
in national and regional institutes across the country to nurture and retain talent in the
allied health space.
The NIAHS report is the first step towards moving from a doctor-centred health system
to a team-based approach involving allied health professionals a move that has
globally demonstrated improved outcomes in healthcare delivery.

NATIONAL INITIATIVE FOR

ALLIED HEALTH SCIENCES

A STUDY TO AUGMENT THE

CAPACITY AND QUALITY
OF ALLIED HEALTH
PROFESSIONALS IN INDIA

Paramedics
to Allied Health
Professionals:

From

Landscaping the Journey and Way Forward

Public Health Foundation of India

PHD House, Second Floor,
4/2, Sirifort
Institutional
Area, August Kranti Marg
New Delhi 110016, India
www.phfi.org

ISBN 978-81-926145-3-3

A report commissioned by the

9 788192 614533

MINISTRY OF HEALTH AND FAMILY WELFARE

Government of India