Need for Curricular Innovation in Higher Education

Our higher educational system has not gone through substantial reforms and changes vis-à-vis curriculum innovation over the past several years. We continue to offer same post-graduate programmes in Science, Arts, Commerce, Social Science and Education faculties since decades with little innovations, although their internal review and updating is carried out from time to time. Consequently our curriculum is lacking in dynamism and flexibility and we are failing to offer new programmes in tune with changing times and global trends. On the contrary, multidisciplinary campuses of private universities that are coming up across India are offering most innovative and modern courses to students and we are terribly lagging behind in keeping pace with them. Rigidity and paralysis of our course curriculum, improper selection, organization, implementation and evaluation of curriculum content and its little relevance to the needs of our society are some of the problems associated with our higher education system. For any meaningful advancement to be made in our education system a mid and long-term strategic orientation of our curriculum needs to be undertaken and some time-bound goals need to be fixed to achieve the desired results.

A core committee of experts from diverse fields needs to be framed that will assume the responsibility of identification, design, restructuring and renovation of the curriculum offered at college and university level in a manner to make our courses learner-centered, problem-based and research-driven. Curriculum renovation that is realistic and student-centered, that is quick in rejuvenating and revitalizing hope and passion for acquisition of broad-based knowledge that is worthwhile in a learner should be the focus of our higher education structure. Methodology that will aid self discovery and problem-solving ability which allows learners the opportunity for creativity should be entrenched in our curriculum. Quality and relevance are the two main features that curriculum development in our University system needs at present. At the same time changes and innovations of our higher education system must involve the emergence of elastic curricula models and educational policies which emphasize interdisciplinary courses, open-ended systems, inter-generational and inter-professional relationships and sustainability. 

Lack of initiative, innovation, skills, independent constructive mindset and creative ideals characterize today’s system of our higher education. We need to shift from a system that encourages memorization in learning processes and theoretical explanation to areas that need practical illustration. Our present system favours cognitive development above other domains of education. Therefore need of the hour is to keep pace with brisk technological advancements in teaching learning process. There is need to modify conventional teaching methodologies and introduce recent advances in technology into the teaching-learning process.  We must switch over from chalk and talk to more interactive modes of teaching and learning by making use of audio-visual aids, e-contents, databases, e-learning objects etc. We should not lag behind in adopting the latest technology in every sphere of our education system, be it in teaching, devising syllabi, evaluation methods, certification and automation. 

The role of a teacher in our education should change from knowledge disseminator to knowledge creator. At University level as well as college level, innovation and greater diversification of our subjects is the need of the hour. For ages same courses are being offered by our colleges and universities with little scope for newer specializations and upcoming programmes. Therefore we need to offer more specializations in all existing subjects and faculties and introduce new subjects wherever not available at present, so that a broader choice is made available to the students and they emerge as specialists in one specific area rather than ending up being generalists. 

There is need to start new courses like industrial production, biomedical technology, nanotechnology, fashion technology, microprocessor technology, embedded systems, nuclear science technology, hotel management, microbiology, polymer chemistry, textile chemistry, hydro-chemistry, petrochemistry, electro-chemistry, chemistry of natural products, astrophysics, geophysics, nuclear physics, optical physics, particle physics, economic botany, phytochemistry, phytomedicine, phytopathology, entomology, paleontology, rural and urban management, hospital management, investment management, education management, enterprise management, entrepreneurship development, business law, e-commerce, corporate tax planning, consumer protection, rural finance and credit, advertising, international business, agricultural marketing, genetics, microbiology, cell biology, molecular biology, biophysics and structural biology, immunology, biostatistics, radiation biology, virology, privatization and deregulation, environmental economics, political economy, public policy and regulation, resource economics, visual communications, travel and tourism, interior design etc to name a few.

National Knowledge Commission in its report for the period 2006-2009 has also stated that innovation is a key driver of growth based on knowledge inputs and to ensure quality, it has called for reform of existing universities to ensure frequent curricular revisions, introduction of course credit systems, enhancing reliance on internal assessment, encouraging research, and reforming governance of institutions. The need for a paradigm shift from theoretical certification to a practical application of knowledge necessary for skill development and self employment should be the cardinal objectives of our education. Emphasis should be on the changing needs of the society through reliance on the understanding and application of new pedagogies and emerging technologies.

- Dr Geer Mohammad Ishaq

WHY IS JKMSC NOT WORKING IN THE STATE?

A recent CAG report tabled in the legislative assembly has brought to light some serious lapses in the procurement processes for equipments and supplies in J&K Health Department, and has also depicted gross negligence and apathy on part of the officials in ensuring quality and safe medicine to patients that can be gauged from the fact that 50.95 lakh sub-standard tablets, capsules and injections had been given to patients in hospitals. CAG report has also revealed acute deficiency of drugs and disposables for testing in healthcare institutes. Such lack of proper mechanism is resulting in supply of substandard medicines to the patients that is highly deplorable.

Need of the hour is to streamline procurement of medicines on scientific and professional lines alongwith their foolproof quality testing leaving no room at all for any compromises on the quality of medicines being supplied to patients. There is need to establish state-of-art warehouses in each district besides central warehouses in Srinagar, Leh and Jammu divisions so as to ensure round-the-clock availability of medicines in all health facilities of the state. To ensure this dedicated transportation facilities, adequate funding, sufficiently trained manpower are also needed besides a systematic centralized procurement and decentralized distribution of medicines. JKMSC is functioning in the state in absence of proper procurement policy framework, lack of drug storage facilities in all districts and divisions of the state, lack of dedicated transportation facilities, non-availability of qualified and adequate manpower trained specifically in supply chain management, paucity of funds, lack of adequate drug testing facilities and deficiency of drug sampling procedures. All this has led to inefficiency of the JKMSC and has paved way for failure of the whole system. Therefore there is need to streamline the entire system on scientific lines and organize all their activities in a systematic manner in tune with international standards and guidelines. In absence of such a fool proof mechanism JKMSC will continue to fail in its objectives of making standard quality medicines available throughout the year without any stock-outs in all health facilities of the state.

While the spirit with which JKMSC was established is admirable, the way it is functioning is unwarranted and needs some serious thinking. No such corporation can be a success unless it is fully autonomous, fully transparent, free of corruption and functions on well established principles of pharmaceutical supply chain management. Government needs to engage suitably qualified and adequately trained personnel for the purpose of drug procurement, demand estimation, quantification, pre-qualification and post-qualification procedures. It needs to fulfill all necessary pre-requisites like state-of-art warehouses, dedicated transportation, qualified manpower, adequate funds, sophisticated quality testing facilities, regular inspections of retail outlets and frequent drug sampling in order to bring the JKMSC back on track and fulfill its objectives.

Existing medicines management and supply chain systems have many gaps and shortcomings with lack of resources and well documented policy framework. Urgent steps are needed to assess the functioning of the public distribution system for medicines for bridging up the gaps and rectification of shortcomings. Priority needs to be accorded towards developing well-qualified manpower, suitably trained in medicines management and pharmaceutical supply chain. Various national standards suggest that drug quality should be assessed as compliance with pharmacopoeial specifications concerning a drug’s identity, purity, potency and other characteristics like uniformity of the dosage form, bioavailability and stability. Establishment of a comprehensive Quality Assurance system involving both surveillance and testing of drug quality, including both technical and managerial activities, helps in ensuring quality of the products. Basic quality assurance procedures like visual inspection, labelling carried out by a qualified pharmacist can easily be adopted at facility level. JKMSC must not rely completely upon the insufficient govt. drug testing facilities available in the state. It must empanel accredited private drug testing laboratories on the lines of Tamil Nadu Medical Services Corporation and send coded samples to them for testing after carrying out due process of their validation. Meanwhile govt. needs to accord top priority to augmenting drug testing facilities in the state on modern lines by installing state-of-the-art sophisticated equipments and mobile testing vans laced with all the modern gadgetry required to test drugs on the spot in far flung areas.

Government needs to promulgate a robust drug procurement policy and implement the drug policy in letter and spirit that has already been approved by the state assembly four years back. It is highly negligent on part of the government that even after the lapse of four years drug policy is still awaiting implementation because of which poor patients are suffering for want of good quality medicines at government health facilities of the state. In this regard government needs to take following measures towards improving the drug procurement and distribution mechanism of the state:

§  There is an immediate and dire need to uplift the existing health care infrastructure of the J&K state, with involvement of more qualified human resource and better health facilities.  Urgent steps are needed to assess the functioning of the public distribution system for medicines for bridging up the gaps and rectification of shortcomings. Priority needs to be accorded towards engaging well-qualified manpower, suitably trained in medicines management and pharmaceutical supply chain procedures.

§  Improved availability of affordable essential drugs, vaccines and other health care products depends on effective medicines management and logistic systems to move essential commodities down the supply chain to the service delivery point and, ultimately, to the end user. An effective policy framework for medicines management is desired for providing the health care system with a road map for continuous improvement in pharmaceutical supply chain.

§  Inappropriate and inefficient medicine procurement system leads to sub-optimal use of resources with poor value for money. So far centralized procurement and decentralized distribution of medicines was not being practiced in the state. However recently J&K Medical Supplies Corporation (JKMSC) that was constituted way back in 2013 has started its procurement activities by issuing its first ever Notice Inviting Tenders. It needs to be further strengthened and made more dynamic with  adequate funding,  trained  manpower,  modern  infrastructure  laced  with  MIS,  state-of-art warehousing and cold chain transportation facilities. Recently news reports appeared in the local press that first ever state level Essential Drugs List (EDL) has been customized and the same consists of a total of 1200 medicines. Such a huge list kills the basic aim and objectives of formulating an Essential Drugs Lists since a concise list would have allowed concentration of all efforts vis-à-vis medicines management activities as well as limited resources on a small number of drugs leading to better results in terms of conservation of resources, large volume of purchases and consequently greater availability of essential medicines. Having 1200 drugs in EDL literally means including almost all drugs available in the market which would hardly translate into any tangible benefits for the patients. If the essential list finalized by JKMSC consists of 1200 drugs, it need correction as the essence of EDL lies in limiting the number of essential drugs based on individual facility/societal needs.

§  There is a need to develop state-of-art  warehousing  and  cold  chain  transportation  facilities  at  all district  headquarters  along  with  Management  Information  Systems  for  real-time verification of stocks at district levels. Moreover JKMSC in itself needs to follow national and international guidelines for developing its standards governing medicines management practices and use of drugs.

§  Various national standards suggest that drug quality should be assessed as compliance with pharmacopoeial specifications concerning a drug’s identity, purity, potency and other characteristics like uniformity of the dosage form, bioavailability and stability. Establishment of a comprehensive Quality Assurance system involving both surveillance and testing of drug quality, including both technical and managerial activities, will immensely help in ensuring quality of the medicines.

§  Medicines management  and supply chain  management is a highly technical and professional activity that can only be achieved by suitably qualified, adequately trained, sufficiently skilled manpower both at managerial and ground level. At present no executive or administrative staff is available in sufficient numbers exclusively for medicine management activities at any of the government health departments of J&K state like Departments of Health, Family Welfare, Medical Education, Provincial Medical Stores or Govt. Medical College, Srinagar that are adequately trained to serve the purpose.

§  Therefore appropriate measures need to be taken in the forms of decisions, actions particularly for proper selection, quantification, forecasting, procurement, distribution and use of medicines to make the supply chain more efficient. Moreover disbursement of funds should also be sufficient and timely to cater to the needs of individual hospitals across all levels of care. All the activities related to medicines management and supply chain need to be carried out in accordance with standard guidelines and good practices involving only qualified and professional manpower. Evaluation of supply chain should be carried out regularly to monitor the performance. Health facility specific policies and procedures with SOPs should be developed and adhered to for better compliance with existing standards.

In conclusion appropriate measures need to be taken in the forms of decisions, actions particularly for proper selection, quantification, forecasting, procurement, distribution and use of medicines to make the supply chain more efficient. Moreover disbursement of funds should also be sufficient and timely to cater to the needs of individual hospitals across all levels of care. Scattered and sparse budgetary allocations for medicines available with individual hospitals need to be pooled at the central level for optimal utilization of available resources resulting into more efficient procurement since centralized procurement and decentralized distribution has been found to improve access to medicines in all settings. All the activities related to medicines management and supply chain need to be carried out in accordance with standard guidelines and good practices involving only qualified and professional manpower. Evaluation of supply chain should be carried out regularly to monitor the performance. Facility specific policies and procedures with SOPs should be developed and adhered to for better compliance with existing standards.

(Author teaches at the Dept. of Pharmaceutical Sciences and can be reached at ishaqgeer@gmail.com)

Pros and cons of third amendment to UGC Regulations, 2010

On May 10^th, 2016 UGC published a Gazette Notification that promulgates third amendment to UGC Regulations of 2010 governing minimum qualifications for appointment of teachers and other academic staff in universities and colleges and measures for the maintenance of standards in higher education. Though third amendment mainly concerns changes in qualification for direct recruitment to the posts of Assistant Professors and exemption from the requirement of eligibility condition of NET/SLET/SET for recruitment subject to certain conditions for those candidates who completed their Ph.D. degrees prior to July 11, 2009, it also amended Academic Performance Indicators (API) for Career Advancement Scheme (CAS) promotions for Assistant Professors, Associate Professors and Professors and for direct recruitment of Associate Professors and Professors in universities and colleges.

Regulations governing recruitment of Assistant Professors

Several regulations passed by the UGC in the past have been contradictory and enigmatic with no logic or justification whatsoever. For example, to ensure and maintain the quality of Ph.Ds, UGC developed a set of regulations in 2009, and executed the same with retrospective effect. Consequently newly appointed Assistant Professors, having obtained their Ph.D. degrees before 2009 , who according to UGC rules were entitled to get several non-compoundable increments, were denied the same. They were asked to justify that their Ph.D was in accordance with UGC Regulations of 2009. One fails to understand how a Ph. D awarded in 2003 can comply with the regulations framed in 2009. While excellence and innovation need not be linked to perks, these kind of regulations definitely have a negative impact on the performance of those affected.

Similarly when UGC regulations 2009 were notified, it was mandated that only those holding Ph.D. degrees in accordance with standards set in 2009 are eligible for any fresh teaching posts. As per news reports, this rendered several thousand Ph.D. holders across India potentially ineligible for teaching jobs for the simple reason that when these people were pursuing their Ph.D. degrees, the rules setting new standards were not in place. Suddenly their Ph.Ds ran the risk of becoming invalid. Later UGC had to enforce the new rules prospectively to overcome this anomaly that had left large number of teaching faculty positions unfilled for quite a long time across India. These regulations had necessitated that even those applying for adhoc posts must hold Ph.Ds. It is common knowledge that adhoc posts are created by universities to attract teachers when they are unable to find suitable faculty meeting qualifications required for the regular posts. Now with Ph.D being stipulated for even adhoc posts, universities found it difficult to appoint any teachers for these positions, even on stop-gap basis.

UGC Regulations 2010 that mandated NET/SLET/SET for fresh recruitment as Assistant Professors in colleges and universities and necessitated Ph.D. degree completion in accordance with UGC Regulations of 2009 halted fresh appointments causing dearth of teaching faculty in educational institutions across India. Third amendment of May, 2016 sought to rectify this anomaly by laying down certain conditions for those candidates who completed their Ph.D. degrees prior to July 11, 2009 i.e., when UGC Regulations of 2009 were notified.  Third amendment of 2016 envisages that the candidates, who have been awarded a Ph. D. degree in accordance with UGC Regulations, 2009 or the subsequent Regulations if notified by the UGC, shall be exempted from the requirement of the minimum eligibility condition of NET/SLET/SET for appointment of Assistant Professor or equivalent positions in Universities/Colleges/Institutions. Further, the award of degrees to candidates registered for the M.Phil/Ph.D. programme prior to July 11, 2009, shall be governed by the provisions of then existing ordinances/by-laws/regulations of the institution awarding the degree and the Ph.D. candidates shall be exempted from the requirement of the minimum eligibility condition of NET/SLET/SET for recruitment and appointment as Assistant Professor or equivalent positions in Universities/Colleges/Institutions subject to the fulfillment of certain conditions like (a) Ph.D. degree of the candidate awarded in regular mode only (b) Evaluation of the Ph.D. thesis by at least two external examiners (c) Candidate had published two research papers out of which at least one in a refereed journal from out of his/her Ph.D. work (d) Candidate had presented two papers in seminars/conferences from out of his/her Ph.D. work (e) Open Ph.D. viva-voce of the candidate had been conducted. (a) to (e) as above are to be certified by the Vice- Chancellor/ Pro-Vice-Chancellor/ Dean (Academic Affairs).

Fault lines in API based performance assessment of teachers

From the very beginning there have been stark discrepancies in API based performance assessment system devised by the UGC in the year 2010. While it envisaged to accord API scores for publishing papers in journals, presenting papers in conferences, publishing books or book chapters and completing research projects, there was no allocation in category-III of PBAS for undertaking peer review of papers and books by teachers, for attending a conference or seminar without presenting a paper, for being a co-author in a paper that is presented by someone else, for chairing or co-chairing a scientific session during scientific meetings, for attending expert committee meetings or evaluating research projects submitted to funding agencies and for being appointed as a member of editorial and review boards of various journals. These vital academic activities had been blatantly ignored while fixing API scores. Though third amendment regulations of 2016 have made new API allocations for activities like winning a national or international award or fellowship, yet the all important activities mentioned above continue to remain unaccounted which is a gross injustice with teachers who spend considerable amount of their precious time in these significant academic activities. UGC had constituted an expert committee in September, 2015 under the chairmanship of Prof. Arun Nigavekar, former Chairman, UGC with a view to improve API score based performance assessment and make it more rational both at the entry point and during career advancement of teachers. It is very unfortunate that some of the ambiguities and discrepancies in API score allocation still persist after the recommendations of this committee have been notified in the official Gazette of India.

Under clause 3.9 of the UGC Regulations, 2010 it was specified that, “the period of time taken by candidates to acquire M.Phil. and/or Ph.D. degree shall not be considered as teaching/research experience to be claimed for appointment to the teaching positions”. This very clause adversely affected the prospects of promotion of a huge number of Assistant Professors across India whose plea was that “the period of time taken by the candidates to acquire M.Phil. and/or Ph.D. degree” should imply the period when an in-service teacher working on substantive basis in a university was on study leave for pursuing his research degree and not the period when he was actively teaching in his parent department while simultaneously pursuing his M.Phil. and/or Ph.D. It took UGC six years to clear the ambiguity and confusion in this clause. While the original regulations were ratified by UGC in its 468^th meeting held on February 23, 2010, it was after six years and 44 meetings of the Commission when UGC in its 512^th Meeting held on February 4, 2016 issued a clarification that “the period of active service spent on pursuing Research Degree i.e. for acquiring Ph.D. degree simultaneously without taking any kind of leave may be counted as teaching experience for the purpose of direct recruitment/promotion to the post of Associate Professor and above”. During the interim period of six years a huge number of teachers across India suffered academically, mentally, financially for no fault of theirs and had to pay through their nose for the incompetence of policy makers at the helm of affairs.

UGC brought in second amendment to its Regulations of 2010 in June, 2013 only to add more ambiguity, confusion and chaos to the already existing vague regulations. This time UGC introduced capping of API scores claimed by the applicants for direct recruitment as well as CAS (career advancement scheme) promotions under various sub-categories of Category III of PBAS (performance based assessment system). These sub-categories include research papers, books, research projects, research guidance, conference and seminar attendance. Thankfully third amendment has scrapped this harsh provision of second amendment altogether that had done more harm than good to both teaching and research, much to the relief and respite of suffering university teachers whose promotions were held up for several years on this account. A good riddance indeed! Third amendment has retained only one ceiling under category III(E)ii for invited lectures and oral presentations. The API score under this sub-category has been restricted to 20% of the minimum score fixed for Category III for any assessment period. The quantification of teachers’ performance using such stringent criteria has actually pushed teachers into a ‘rat race’ for gathering points for the sake of recruitment and promotion, and has forced them to mechanically turn into score building machines rather than concentrating on their basic responsibilities towards teaching and students.

Increase in weekly teaching workload

Previously UGC Regulations of 2010 had specified a workload of 16 hours per week involving direct teaching-learning process for Assistant Professors and 14 hours for Associate Professors and Professors. These Regulations had also specified that a minimum of 6 hours per week may be allocated to research activities of a teacher.  However third amendment of 2016 has specified a workload of 18 hours for Assistant Professors, 16 hours for Associate Professors and 14 hours for Professors in addition to 6 hours per week for tutorials, remedial classes, seminars, administrative responsibilities, innovation and updation of course contents for all the three categories of university teachers. This abrupt rise in workload seems to be neither reasonable nor justified. Third amendment of 2016 does not allocate 6 hours per week to research activities as envisaged in 2010 Regulations. However it is mentioned that those teachers who supervise the research of five or more Ph.D. students at a time shall be allowed a reduction of two hours per week in direct teaching hours.

It would have been preferable to allocate a specific time duration per week towards research activities irrespective of the number of Ph.D. scholars that a teacher is supervising at a time. 18/16/14 hours per week as envisaged in third amendment includes lectures/practicals/project supervision, wherein two hours of practicals/project supervision have to be treated as equivalent to only one hour of lecture. It is beyond one’s comprehension why two hours of actual contact/teaching-learning process during practicals or project supervision has to be reduced to only one hour. This kind of reduction is usually done for the calculation of number of credits in the choice-based credit system of teaching but not for calculating actual contact hours of teaching. Further it is not clear why the weekly teaching workload has been increased by two hours for Assistant and Associate Professors whereas the hours spent on examination duties such as invigilation, question paper setting, evaluation of answer scripts and tabulation of results are over and above the prescribed direct teaching hours and are an integral part of overall teaching workload of 40 hours per week as per the third amendment to UGC Regulations of 2010.

On May 26^th, 2016 Press Information Bureau, Govt. of India released a press note stating that the Union Ministry of Human Resource Development (MHRD) has reviewed the third amendment of UGC Regulations, 2010 and issued a direction to the UGC under Section 20(I) of the UGC Act, 1956 to keep the overall workload of Assistant Professor and Associate Professors/Professors unchanged and in accordance with earlier regulations i.e., not less than 40 hours a week for 180 teaching days. It also directed that the direct teaching –learning hours to be devoted by Assistant Professors (16 hours) and Associate Professors/Professors (14 hours) shall also remain unchanged. Thus MHRD has asked the UGC to roll back its amendment in relation to teaching workload within a span of just twenty days. That reflects poorly upon the amount of homework/critical appraisal done by UGC before bringing out new regulations. 

Third amendment regulations of 2016 seek to divide the actual number of hours spent by a teacher during an academic year under category-II in professional development, co-curricular and extension activities by a factor of 10. Thus in order to score the maximum permissible 45 API points under category-II, a teacher has to spend a total of 450 (45 x 10) hours in each academic year of 30-40 weeks duration on these activities that sums up to one and a half hour each day over and above his daily teaching, research and administrative workload as detailed under category-I of PBAS. Practically speaking isn’t it too taxing for a teacher to devote so much time daily to these activities? Something seems to be terribly wrong with the mathematics of API calculation. It is pertinent to mention that as per UGC Regulations of 2010, there have to be a minimum of 30 weeks of actual teaching in a 6-day week, another 12 weeks having been devoted to admissions, examinations, sports, cultural and co-curricular activities, another 8 weeks for vacations and 2 weeks attributed to public holidays. Since we avail a total of 10-12 weeks for summer and winter vacations during the year, we can use 40 weeks (totaling 280 hours) for activities listed in category-II that require a total of 450 hours during a year for maximum permissible API score of 45, given the fact that total number of hours devoted to these activities in a year has to be divided by 10.

Silent regulations

UGC regulations continue to remain silent about the research guidance provided to the students for their M.Pharm./MBA/MCA/LLM/M.Ed. dissertations. This is yet another injustice to such supervisors who have to supervise several PG scholars every year for their year-long research projects that culminate in compilation of a dissertation and at the end of the day no weightage is given to these supervisors. However one good change made in third amendment regulations of 2016 relates to increase in API score for each Ph.D. thesis submitted from 7 to 10 and for each thesis awarded from 10 to 15. This was a much needed change. But the API score awarded to a book chapter continues to be too meager. For a book chapter published in an international edition, API score is only 10 and for national edition score is only 5 and if there are two or more authors for the chapter, this score has to be shared equally among all of them. So what does each author get, peanuts?  Worst part is that earlier regulations in this regard had clearly mentioned that the score needs to be equally shared among all authors, but surprisingly third amendment has chosen to remain silent on that, leaving enough scope for yet another ambiguity and confusion. Even for the books per se, third amendment allocates an “API score of 30 per book for single author” in case of an international edition and “a score of 20 per book for single author” in case of a national edition. What happens if there are multiple authors in either case remains unclear and has to be eventually left to the whims of scissor-happy officials at the helm of individual universities. Instead of using the term “single author”, term “each author” should have been used.

Anomaly in distribution of API score among first, second and the remaining authors of a journal paper has also been rectified in the third amendment regulations of 2016. Now the first and principal/corresponding author/supervisor/mentor would share equally 70% of the total points and the remaining 30% would be shared equally by all other authors. However the paradoxical and needless practice of getting papers already published in reputed journals re-evaluated by the experts at the time of promotions from state 3 to 4 and stage 4 to 5 has still not been abolished which is a big omission since the papers that have already undergone rigorous process of peer review by reputed and well established journals hardly need to be revaluated again by the experts and this only leads to wastage of time and consequent delay in timely promotion of teachers, moreso when API score has already been allocated to published papers on the basis of indexing/peer review by referees/impact factors and other such parameters.

This time UGC has decided to notify its own list of refereed journals and publishers with a view to fix the API scores in a more reliable manner and leave no scope for score allocation to papers published in paid substandard journals that have particularly surfaced in huge numbers after API based assessment system came to the fore or to books published by sleazy publishers. But how comprehensive and inclusive the list shall be and how much time UGC will take to notify the list remains to be one of the biggest dilemmas of third amendment since any inordinate delay in its notification could potentially impede the process of final settlement of pending as well as fresh promotion cases of teachers. Hope none of the quality journals or standard publishers are left out in the process. Collecting feedback about teaching quality from students who have put in more than 75% attendance in each course as envisaged in the third amendment is a welcome step, however any likelihood of confounding bias in such evaluation needs to be scientifically and systematically removed before incorporating that feedback in the performance assessment of teachers during their promotions. Furthermore earlier thrust on research at the cost of teaching has also been rectified and equal weightage has been accorded to teaching and research activities in the third amendment. Other modalities of UGC Regulations, 2010 and their fall-outs on the quality standards of higher education have already been discussed in detail in an earlier article by this author in this very newspaper.

Conclusion

API based performance assessment system seeks to promote a score-hunting attitude among teachers. It promotes mechanization rather than creativity. Nobody is against performance-based appraisal but this should not come at the cost of teaching, which has to be the primary focus. Teachers working in colleges and universities  all over India are feeling stressed and subdued on account of flaws in UGC regulations particularly API based assessment system since these flaws are posing a serious threat to their academic progress and are demoralizing them besides leading to unhealthy competition in educational institutions. Nobody is against incorporation of quantitative or qualitative measures for assessing the performance of teachers but they need to be flexible, rational and just rather than stringent, impracticable, irrational and unjust. What kind of standards are these that are not only demoralizing the teaching community but inciting unhealthy competition, infighting, dissuasion and dissidence among teaching faculty. In this manner desired objectives of UGC regulations can never be achieved and these regulations will continue to prove counter-productive. MHRD, UGC and the universities need to take all possible measures, initiatives and urgent steps to rectify the errors in UGC regulations, remove all ambiguities, discrepancies, anomalies and confusions in them so that they do not become an unnecessary hurdle in the promotion of teachers. UGC Regulations, 2010 on the whole need to overhauled altogether.

(Author teaches at the Dept of Pharmaceutical Sciences, University of Kashmir and can be reached at ishaqgeer@gmail.com Views expressed are his own)

Drug utilization evaluation of anti-microbials in ambulatory care and community households - a multicentric study

Introduction:

The widespread inappropriate use of antibiotics is considered as one of the important causes of the development of antibiotic resistance [1-4]. It is estimated that 20-50% of all antibiotics use is inappropriate, resulting in an increased risk of side effects, higher costs and higher rates of AMR in community pathogens [5]. Around 25 percent of ADRs are caused by antimicrobial medicines. Antimicrobials constitute about 20 to 40 percent of a hospital’s medicine budget and can lead to significant, unnecessary health care costs if not carefully managed. A crucial strategy to control antibiotic resistance is to reduce the excessive and inappropriate use of antibiotics in practice. One such strategy involves the detailed surveillance of antibiotic use in both hospitals as well as community to guide and control antibiotic overuse and misuse.

However, the antibiotic usage patterns and the problem of AMR has received relatively little recognition in developing countries like India and the ability to undertake extensive surveillance is lacking in resource-constrained settings [5].There is acute paucity of literature on antibiotic utilization patterns in developing countries like India where antibiotics can be obtained easily from private retail pharmacies without prescriptions and pharmacists also advise and dispense antibiotics to patients [6]. This tri-centric study is an attempt to analyze the situation on ground vis-a-vis antibiotic prescribing and utilization patterns in out-patient departments of government hospitals, private clinics and community households with an aim of identifying the gaps, barriers, prospects and challenges towards enhancing their rational use and minimizing emergence of antibiotic resistance.

Novelty:

There is dearth of literature published on DUE of anti-microbials from India as a whole. In the state of J&K, barring a couple of hospital based DUE studies by Jan et al [1] and Tandon et al [2], no community or hospital-based DUE studies have been conducted at all. However newspaper reports suggest large scale use of medicines including anti-microbials by the locals. Self-medication and over-the-counter dispensing of prescription drugs by mostly unqualified retail pharmacists seem to be rampant. There is acute paucity of literature about DUE studies from J&K. Therefore there is need to conduct a study which can reveal the picture of how anti-microbials are being prescribed, dispensed and used at primary, secondary and tertiary care hospitals. Christian Medical College (CMC), Vellore and Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh have already been designated as nodal centres in the ICMR’s antimicrobial surveillance programme launched in early 2014 to work on antibiotic resistance and its mechanization for developing a policy to minimize microbial resistance due to Gram +ve and Gram -ve bacteria. Through the present study they will be able to scale up and further evaluate drug utilization patterns in their affiliate hospitals and catchment areas and substantiate the antimicrobial resistance data.

Applicability:

Aim of this study is to determine the prescribing practices and utilization patterns of antimicrobials in private retail pharmacy outlets and out-patient departments at all the three levels of healthcare viz., primary, secondary and tertiary care and assess rationality of treatment for Upper Respiratory Tract Infections (URTI). This tri-centric study on antimicrobial utilization patterns will evolve a holistic picture about the overall utilization patterns of antimicrobials and identify gaps in literature, stumbling blocks in rational prescribing and barriers in appropriate use of antibiotics. This study will assess and document statutory frameworks required for equitable access and rational use of antibiotics at state level and tertiary care level hospitals. It will identify the problem areas vis-a-vis utilization of anti-microbials and thereby help in devising suitable strategies for necessary interventions required to enhance their rational use.

Methodology:

The study shall be conducted in catchment areas and affiliated hospitals of three study centers namely University of Kashmir, Srinagar, Christian Medical College (CMC), Vellore and Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. Healthcare facilities at all the three level of care viz., primary, secondary and tertiary care shall be selected on PPS (Probability proportional to size) based approach alongside private pharmacy retail outlets.

Phase-I of the study shall include drug utilization evaluation in ambulatory care of government hospitals and in private retail pharmacy outlets. Data collection will make use of a pre-validated, self-administered structured questionnaire. The study design will be a cross sectional baseline study based on the methods contained in WHO manual "How to investigate the use of medicines by consumers”[7] and WHO methodology on Drug Utilization Research as outlined in WHO guide “Introduction to drug utilization research”[8].

Objectives of the study are as follows:

1. To determine the extent and nature of antibiotic use, including FDCs, in prescriptions at retail dispensing pharmacist for community and OPD setting of primary, secondary and tertiary care in J&K, Chandigarh and Vellore (TN).
2. Evaluation of prescriptions for rationality of the antibiotic use in URTIs with pharmacist collecting additional patient data.
3. To see the availability and extent of adherence to standard treatment guidelines (STG) for URTIs.
4. To determine the proportion of cost of a prescription attributed to antimicrobials.
5. Determine availability of antibiotic policy in the tertiary care and district hospitals and assess the level of adherence to the same.
6. To correlate the patterns of DDDs of antibiotics with antibiograms wherever available.
7. To formulate effective intervention strategies to address antimicrobial use related problems.

Selection of districts, health facilities and community households:

Sampling of districts and health facilities from within the states shall be done in a systematic manner in accordance with PPS (probability proportional to size) approach so as to ensure that the findings are representative of the entire state. Selection of districts shall be done using economic and geographical criteria to capture maximum diversity. Steps in selection of districts involve ranking of districts on the bases of per capita Gross District Domestic Product (GDDP). Districts with equal intervals shall be selected taking first, last and the state capital. All levels of health facilities within India’s 3 tier public health system will be sampled, i.e., medical colleges (MC) at tertiary care level, district (DH) and sub-district hospitals (SDH) at secondary care level, community health centres (CHCs) and primary health centres (PHCs) at primary level. From each district one DH, 2 CHCs or SDHs (whichever are available) and 3 PHCs shall be randomly chosen for the study on the basis of capture diversity and geographical distribution intact. One Medical College or tertiary care hospital and one private hospital shall also be included from each study centre. Additionally ten community household and ten private clinicians practicing at a clinic willing to participate in the study would also be included randomly from each district.

Training of Field Workers

Data collectors/field workers/pharmacists would be trained over 1-2 days for collection of relevant data and addressing issues of confidentiality. Specifically, necessary skills would be imparted for the aspect of determination of rationality of antimicrobials prescribed/used for upper respiratory tract infections. Wherever possible algorithms will be made available for URTIs in order to help them determine the need and rationale of antimicrobials.

Data collection:

Trained data collectors (pharmacy practitioners or clinical pharmacologists) shall collect antibiotic use data by conducting exiting interviews with all patients receiving an antibiotic on leaving the medical facility. The patients will be interviewed at the attending pharmacy after they fill their prescription without the knowledge of prescribing physicians. This would avoid any bias on part of the prescribing physicians regarding their prescribing habits in relation to anti-microbials. However in hospitals where all prescriptions are filled within hospital premises and only negligible or none of the prescriptions go to retailers for dispensing, prescriptions will be audited within OPDs adjacent to consultation chambers of the prescribers. A pre-designed proforma shall be used to collect data regarding the diagnosis, name of the prescribed antibiotic/s, dose, dosage form, duration of treatment, number of units of antibiotic dispensed or purchased etc. The prescriptions will also be analyzed for various WHO drug use indicators. All the data collected shall be entered either into MS-Excel spreadsheets or any other suitable software that can also be used to process, code, clean and analyze the data.

Prescription audit:

In order to study prescription practices of anti-infectives in public health facilities, a prescription audit will also be undertaken at the healthcare facilities. Data from a random sample of prescription slips will be captured on the days of the facility visit as per WHO recommendation of 600 encounters (20 facilities and 30 patients/prescriptions per facility) for each survey. Prior consent of the respective medical heads of the facilities shall be sought as well as oral consent of the patients. Analysis of prescription slips would contribute to understanding the level and patterns of prescribing of anti-microbials. Consumption of antimicrobial drugs would be determined in terms of total number of DDDs using the WHO ATC/DDD system [13]. The Anatomical Therapeutic Chemical (ATC) classification and the Defined Daily Dose (DDD), ATC/DDD measurement units shall be assigned to the data.

Assessing rational use of Anti-microbials:

The rationality behind antibiotic use would be assessed by collecting information on availability of a hospital Essential Medicines list or formulary system; existence of a hospital drugs and therapeutics committee and infection control committee; availability, updation and dissemination of any standard treatment guidelines (STGs) related to the use of antibiotics in the hospital; whether doctors consult STGs available; availability of suitable diagnostic methods for diagnosing infectious diseases; magnitude of patient load in the hospital (high patient load can decrease consultation time resulting in erratic diagnosis and treatment); percentage of patients sent for microbial lab investigations; percentage of patients to whom antibiotics are prescribed empirically and reasons for empirical treatment. Reasons for non-adherence to STGs and recommendations on improving antibiotic use shall be sought from prescribing doctors. A suitable questionnaire would obtain relevant information from the prescribers.

Workshop for dissemination of results and devising intervention strategies

At the end of first year, workshop for dissemination of results to the practitioners involved in providing the information will be undertaken for creating awareness among stakeholders and devising suitable interventional strategies in consultation with all stakeholders towards ensuring rational use of antimicrobials that in turn shall be implemented during second phase of the study.

Feasibility:

Two of the study centres namely PGIMER, Chandigarh and CMC, Vellore are already part of a national study on estimation of Drug Resistance Index of antimicrobials. This study would scale up the national programme further and supplement data obtained on drug resistance surveillance programme. Furthermore, the health sector in Jammu and Kashmir is unique Indian state beset by many challenges. A combination of weak institutional capacity, limited access to modern equipment and infrastructure, and shortage of healthcare personnel has limited the effectiveness of health service delivery in the State. The healthcare system in J&K is primarily run by the state government. The private sector plays a smaller part in health service delivery. The non-governmental sector is largely absent.We don’t have qualified and trained pharmacy graduates working as pharmacists either in government or in private sector. In government hospitals Medical Assistants with one year multi-purpose health worker type diploma in their hands are employed as pharmacists whereas in private sector matriculates with some experience in sale of medicines at a retail counter have been registered as pharmacists and granted drug sale licenses. Consequently patients are deprived of good counseling services on the use of medicines. On top of that patients largely prefer to consult these very Medical Assistants or so-called pharmacists over registered medical practitioners for choosing medicines and curing their ailments. However the reasons for and consequences of such a drug utilization pattern have not been documented anywhere in the literature.

Outcome:

This study shall be able to generate baseline data on the nature, magnitude and extent of antibiotic prescribing, choice of the antibiotics, their dosage, frequency, duration, cost, disease conditions for which they have been prescribed, availability of Standard Treatment Guidelines, any deviations from the standard treatment guidelines etc across three study centres, one each in Srinagar (J&K), Chandigarh and Vellore (TN). This study will explore various policy options in accordance with the findings. Governments at the central and state level, hospital administrators, policy makers and ministries of health can use the research data for devising policies and strategies for enhancing rational use of antibiotics and for curbing the menace of antimicrobial resistance that is seriously limiting their effectiveness and use. In the second phase of the study interventions devised after due consultation with all stakeholders shall be implemented and their effectiveness evaluated for their subsequent translation into policy and practice.

References:

1. Jan A et al. Drug Utilization At SKIMS–A Tertiary Care Hospital.JK- Practitioner 2013;18(1-2):35-40.

2. Tandon R et al. Antihypertensive drug prescription patterns, rationality, and adherence to Joint National Committee-7 hypertension treatment guidelines among Indian postmenopausal women. J Midlife Health. 2014; 5(2): 78–83.

3. Chetley A, Hardon A, Hodgkin A, Haaland A, Fresle D. How to investigate the use of medicines by consumers.(WHO/PSM/PAR/2007.2) Geneva: World Health Organization, 2007.

4. WHO. Introduction to drug utilization research/WHO International Working Group for Drug Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology, WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacological Services 2003.

5. WHO (2002). Promoting rational use of medicines: core components. WHO Policy Perspectives on Medicines, No.5. Geneva, World Health Organization.

6. Potter M. Medication compliance - a factor in the drug wastage problem. Nurs times. 1981; 77 (suppl 5):17-20.

7. Nasser AN. Prescribing patterns in primary health care in Saudi Arabia. DICP. 1991; 25:90-93.

8. Serradell J, Bjornson DC &Hartzema AG. Drug Utilization Study Methodologies: National and International Perspectives. Drug Intelligence and Clinical Pharmacy. 1987; 21(12, December):994-1001.